Corrective Osteotomy for Hyperextended Elbow Malunion
Corrective osteotomy is a surgical procedure performed to correct malunion or misalignment of bones following a fracture. In the case of the elbow, malunited fractures often lead to deformities that restrict motion and function. One common deformity is hyperextension of the elbow, which can result from a supracondylar fracture. A supracondylar fracture is a type of fracture in the distal humerus that typically occurs in children. When these fractures heal improperly, they can lead to limited flexion and difficulty with normal elbow movements.
The Role of Preoperative Simulation
A critical component of the treatment plan for correcting hyperextended elbow malunions is preoperative planning, which is achieved through the use of 3D computer simulations. These simulations allow the surgeon to understand the deformity in detail, including the angle of extension and any other contributing factors like varus (inward) or valgus (outward) deformities. This detailed analysis enables precise planning for the osteotomy, which is performed using patient-specific instruments (PSIs) created based on the 3D model.
Surgical Approach
The osteotomy is typically performed using a closing-wedge technique, where a wedge-shaped piece of bone is removed to correct the deformity. Patient-specific instruments ensure that the bone is cut in exactly the right place and angle to restore the elbow’s function. The use of PSIs can improve the accuracy of the procedure, reducing the risk of complications and ensuring that the desired outcome is achieved. In some cases, additional techniques like tension band wiring are used for fixation, depending on the patient’s age and the severity of the deformity.
Postoperative Recovery and Results
After the osteotomy, the elbow is immobilized for a few weeks to allow for healing. Gradual rehabilitation exercises are introduced to improve the range of motion, which often significantly improves the patient’s elbow flexion. The results of the corrective osteotomy can be dramatic, with patients experiencing a marked increase in their elbow range of motion. In the case studies reviewed, patients showed improvements in their elbow flexion by an average of 50°, with one patient achieving full flexion.
Conclusion
Corrective osteotomy for hyperextended elbow malunion is an effective option for patients over the age of 10 who suffer from limited elbow flexion due to a malunited supracondylar fracture. Preoperative computer simulations and patient-specific instruments have proven to be valuable tools in ensuring that the procedure is performed accurately. By restoring the anterior curve of the distal humerus, the surgery not only improves flexion but also enhances the overall range of motion of the elbow, leading to improved functional outcomes for the patient. Although the procedure is technically challenging, the potential for significant improvement in elbow mobility makes it a reasonable option for patients seeking relief from a restrictive deformity.
