The purpose of this paper was to evaluate the early results of a new technique for correction of angular deformity in adolescents. A retrospective review of all patients and radiographs undergoing an open wedge technique of corrective osteotomy employing a special plate designed to keep the osteotomy open at a precise amount was carried out. From 2000–2005, eleven patients have been treated by the author using this technique. Indications for surgery included adolescent Blount’s disease or Tibia Vara in eight cases, growth arrest after fracture of the proximal tibia in one case, distal tibia in one case and developmental genu valgum in one case. The mechanical axis was restored to normal in ten of the eleven cases. One patient with adolescent Blount’s disease remained in slight varus despite the maximum available correction of 22.5 degrees. All patients healed radiographically in eight to ten weeks. Two patients have had their plates and screws removed after union of the osteotomy because of the high profile construct. Excellent results can be achieved for correction of angular deformity in adolescents with use of a special plate designed for an open wedge technique. Attention to preserving the opposite cortex at the time of the osteotomy is critical to the success of the procedure. A maximum of approximately 20 degrees of correction is possible with this technique. Early union of the osteotomy and restoration of function give this technique specific advantages over other methods.
To compare the clinical and radiographic outcomes of Type III supracondylar fractures of the humerus in children managed either by open reduction and internal fixation versus those treated by closed reduction and percutaneous pinning. The indications for open reduction included an inability to obtain a satisfactory reduction by closed means; open fractures and fractures with vascular compromise after closed reduction. Retrospective chart and radiograph review over a ten year period (1995–2005), with two hundred and thirty-six children with Type III fractures treated at a Level One pediatric hospital within a universal health-care system. One hundred and seventy by closed reduction and percutaneous pinning and sixty-six by open reduction. The left arm was involved in one hundred and forty-eight cases and twenty-five patients had vascular compromise at presentation but no cases required vascular repair. There were ten open fractures in the open reduction group. The anterior approach was employed in twenty-nine patients, anteromedial in twenty-two and anterolateral, medial and lateral in equal preference. Entrapped structures included brachialis muscle in thirty-four patients, periosteum in eighteen, radial nerve in two, medial nerve in two, and the brachial artery in one. According to Flynn’s criteria, the open reduction group had an excellent or good outcome in 90% of cases while the closed reduction group had an 80% excellent or good outcome. In this study of displaced Type III supracondylar fractures, there was a higher rate of open reduction than was initially anticipated. There was a higher rate of excellent and good outcomes in the ORIF group but this may be due to a relatively short follow-up in the closed reduction group. Post reduction stiffness would likely dissipate and allow a higher rate of excellent and good outcomes in the closed reduction group. An anterior approach or variation of an anterior approach is best suited to visualise the anatomy and structures hindering the reduction. Despite this, there was no clinical or radiographic difference between the approaches employed. In conclusion, open reduction and internal fixation if displaced Type III supracondylar fractures is a safe and effective procedure. An anterior approach is recommended to identify and relieve the soft tissue obstacles to a suitable reduction. Significance: This study furthers the literature that proposes to lower the threshold for open versus closed reduction of displaced supercondylar fractures in children.
