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Korrektur posttraumatischer Valgus- und Varusdeformitäten

Correction of posttraumatic valgus and varus deformities

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Die Deformität des Cubitus varus oder Cubitus valgus sind die häufigsten Spätfolgen von Frakturen des distalen Humerus im Kindesalter, insbesondere von suprakondylären und lateralen Kondylenfrakturen. Verschiedene Osteotomieverfahren wie die laterale Closed-wedge-Osteotomie, die Step-cut-Osteotomie, die Dom-Osteotomie und die Multiplanar-Osteotomie werden zur Korrektur eingesetzt. Die Closed-wedge-Osteotomie findet am häufigsten Anwendung, kann aber zu einer lateralen Epikondylenprotrusion führen (diese entsteht durch eine radiale Verschiebung des distalen Humerusfragments gegenüber dem proximalen Humerusschaft, was zu einer Protrusion des lateralen Humeruskondylus führen kann). Die Step-cut-Osteotomie und die Dom-Osteotomie bieten Lösungen für dieses Problem, sind jedoch chirurgisch anspruchsvoller und mit einem höheren Komplikationsrisiko verbunden. Die Dom-Osteotomie eignet sich sowohl für Varus- und Valgusdeformitäten ohne signifikante Malrotation. Obgleich der Einfluss der Rotation auf das funktionelle Ergebnis umstritten ist, sind multiplanare Osteotomien bei starker Malrotation indiziert. Eine eventuelle Verlagerung des N. ulnaris muss bei der Planung der operativen Korrektur Berücksichtigung finden. Die Suche nach einfachen, effektiven Techniken mit geringer Komplikationsrate und hoher Patientenzufriedenheit ist für die zukünftige Entwicklung auf diesem Gebiet wichtig.

Abstract

Elbow deformities, including cubitus varus and cubitus valgus, are the most common late sequelae of distal humerus fractures in childhood, especially supracondylar and lateral condylar fractures. Various osteotomy procedures are used to correct these deformities, such as the lateral closing-wedge osteotomy, step-cut osteotomy, dome osteotomy and multiplanar osteotomy. Closing-wedge osteotomy is most commonly used but can result in lateral epicondylar protrusion (caused by radial displacement of the distal humeral fragment in relation to the proximal humeral shaft, which can result in protrusion of the lateral humeral condyle). Step-cut osteotomy and dome osteotomy offer solutions to this problem but are more complex and carry a higher risk of complications. The dome osteotomy is suitable for varus and valgus deformities without significant malrotation. Although the influence of rotation on the functional outcome is controversial, multiplanar osteotomy is indicated in cases of severe malrotation. When planning the surgical correction, the possible need for ulnar nerve transposition must be considered. The search for simple and effective techniques with low complication rates and high patient satisfaction is important for future development in this field.

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  1. Sektion Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland

    Pavel Kadantsev, Lorenz Fritsch, Sebastian Lappen &  Sebastian Siebenlist MHBA

  2. Sektion Hand‑, Unterarm- und Ellenbogentraumatologie, Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    Konrad Mader

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Kadantsev, P., Fritsch, L., Lappen, S. et al. Korrektur posttraumatischer Valgus- und Varusdeformitäten. Arthroskopie 37, 77–86 (2024). https://doi.org/10.1007/s00142-024-00660-3

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