PubMed · 16891948
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Oguz Cebesoy. 2006. Comment: does fibular plating improve alignment.... https://doi.org/10.1097/00005131-200608000-00013
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Wrist deformities can occur after fracture because of malunion of the fracture or injury to the growth plate leading to imbalance of growth. Prevention of malunion is paramount by early recognition with proper reduction and casting or fixation with casting. If a mal-union occurs, an osteotomy may be necessary if anticipated growth will not correct the deformity. Injury of the growth plate may lead to wrist deformity in two ways: angular growth or growth arrest. Angular growth deformities are corrected most commonly by osteotomy. Growth arrest of the radius or the ulna leads to an ulnar-positive or an ulnar-negative variance at the wrist. If the ulnar variance is symptomatic, treatment is centered on achieving a level joint. Options for joint leveling procedures include epiphysiodesis or physeal stapling of the longer bone, lengthening osteotomy of the shorter bone, or shortening osteotomy of the longer bone.
Nonunion of the lateral humeral condyle,cubitus varus, cubitus valgus, and fishtail deformity represent particularly challenging problems to the upper extremity surgeon. Although closed or open reduction and pinning of supracondylar fractures of the distal humerus can restore anatomic alignment and avoid anatomic deformities in most cases, closed reduction is still a common form of treatment. In those hopefully few cases in which reduction is less than optimal, or when a good reduction is performed but subsequently lost between follow-up visits, the aforementioned deformities of the distal humerus can develop. Even when anatomic reduction is obtained and held, avascular necrosis of the trochlea may develop, leading to the so-called fishtail deformity. Although not recognized for several years, and when initially recognized, not necessarily taken seriously, fishtail deformity may be one of the more devastating deformities in that it is not correctable by traditional methods of osteotomy. Flexion contracture when present may be treated by standard release; however, when a bony block exists as a result of the shape of the fishtail, nonsurgical options exist and the patient often is left with a permanent loss of motion.
Iatrogenic cervical deformity can develop after anterior or posterior procedures. Careful attention to detail can minimize the likelihood of creating a sagittal or coronal plane deformity. Strategies for the prevention and correction of postoperative cervical deformity are presented.