Late treatment of displaced supracondylar fractures of the humerus using early wedge osteotomy

Malalignment of supracondylar fracture after inappropriate treatment with partial healing is sometimes difficult to manage. This usually occurs in patients who received initial treatment by a traditional bone setter or inadequately treated by an inexperienced orthopaedist. Open reduction in such circumstances may not be easy and effective. Waiting for solid union and scheduling for corrective surgery a few years later is justified but may not be practical for poor compliance patients who live in rural areas with poor socioeconomic status. Early correction of the deformity by using simple wedge osteotomy and fixation by 2 Kirscher wires combined with tension-band wire loop is proposed for this situation. This proposed method was used in nine patients with varus deformity after supracondylar fracture. The patient ages ranged from 3 to 10 years (average, 5.1). The operation was made 1 to 4 months postinjury. All patients were followed-up with an average of 13 months (range, 5-48). All patients had satisfactory cosmetic results after correction with an average carrying angle of 4.6 degrees (range, 0-8 degrees). Average maximum elbow flexion was 127 degrees (range, 115-140 degrees). The maximum extension average was 4 degrees (range, 0-10 degrees). No operative complications or flexion contracture occurred in this study group.