Abstract
BACKGROUND: This study aimed to evaluate the outcomes of a two-stage surgical protocol-comprising open reduction and internal fixation (ORIF) with bone grafting followed by corrective osteotomy-for managing cubitus valgus deformity secondary to neglected lateral condylar fracture non-union in older children. METHODS: We retrospectively reviewed nine patients (5 males, 4 females; mean age, 11.1 years; range, 10-14 years) who underwent this two-stage procedure between January 2015 and January 2023. The mean interval from initial injury to first surgery was 7.7 years (range, 6-10 years). All patients presented with cubitus valgus deformity, ulnar neuropathy, and lateral elbow instability. The first stage involved ORIF via a lateral approach, thorough debridement of the non-union site, and filling of the bone defect with commercially available allogeneic or synthetic bone substitutes, stabilized with 4.0-mm cannulated screws and Kirschner wires. The limb was immobilized in a long-arm cast for three weeks, followed by active mobilization. The second stage-a medial closing-wedge supracondylar humeral osteotomy-was performed six months later and fixed with a reconstruction locking plate. Osteotomy hardware was removed six months postoperatively. RESULTS: At a mean follow-up of 24.2 months (range, 16-35 months), all fractures achieved radiographic union. The mean preoperative carrying angle of 37.4° (range, 31°-45°) improved to a mean of 10.8° (range, 9°-14°), which is within the normal range and closely matched the contralateral side. Elbow range of motion was restored to near pre-injury levels, with no joint laxity or avascular necrosis of the lateral condyle. All symptoms of ulnar neuropathy resolved completely. Outcomes were rated as satisfactory in all patients according to the Flynn criteria, with no treatment failures. CONCLUSION: In this small retrospective series, the two-stage surgical strategy appears effective in addressing both mechanical instability from non-union and the functional/cosmetic deficits of cubitus valgus in older children with neglected lateral condylar fractures. However, given the limited sample size and relatively short follow-up duration, these preliminary findings warrant validation through larger prospective studies with longer-term observation.