[Corrective osteotomies for posttraumatic elbow deformities].

OBJECTIVES

Correcion of elbow joint deformities that usually develop secondary to direct or indirect trauma of the arm or elbow with subsequent inadequate healing and consecutive axial/rotational malalignment and may be associated with cosmetic or functional deficits of the arm.

INDICATIONS: Relevant malalignment of the arm axis with corresponding cosmetic or functional deficits for the patient.

CONTRAINDICATIONS: Pre-existing degenerative and chronic inflammatory changes.

SURGICAL TECHNIQUE: Generally, two-dimensional supracondylar open or closed wedge osteotomies are used. In the presence of a three-dimensional deformity (with rotational component), an additional derotational correction is necessary. Extra-articular deformities following extension fractures should be treated preferably with an open wedge osteotomy, extra-articular deformities of flexion fractures with a closed wedge osteotomy. Valgus/varus deformities may also require a closed/open wedge osteotomy primarily through a dorsal or alternatively radial approach.

POSTOPERATIVE MANAGEMENT: The arm should be immobilized with a brachial cast splint for 2-3 weeks, with passive exercises of the elbow starting on postoperative day 7.

RESULTS

In general, the results for a three-dimensional osteotomy of the distal humerus are expected to be good to very good. Only in rare cases (2.5%) is a mostly transient irritation of the ulnar nerve observed.