Errors and complications with post-traumatic frontal deformities of the elbow joint corrected with supracondylar osteotomy with the Ilizarov apparatus

Introduction Transosseous osteosynthesis has the advantages of controllability, mobility and minimal invasiveness and is commonly used by trauma and orthopaedic surgeons for elbow deformity correction. There is a paucity of publications reporting errors and complications with external fixation devices used to restore the biomechanical axis of the upper limb.

The objective was to identify errors and complications in patients with post-traumatic coronal deformities of the elbow joint treated with the Ilizarov apparatus and to determine a rational algorithm for the prevention.

Material and methods The study included 68 patients with elbow deformities in the frontal plane. The patients age ranged from 4 to 56 years. The surgeries were performed between 1990 and 2024. Patients were divided into 2 groups: control and treatment. The control group included 41 patients who underwent correction surgery up to 2018. The limb was realigned either acutely or gradually post op through Ilizarov distraction produced on the concave side of the deformity. In order to prevent errors and complications, since 2018, patients with the condition have been treated according to a protocol developed to contain the sequence of intraoperative and postoperative manipulations taking into account time factors. These patients were included in the treatment group (n = 27).

Results Complications were identified in the limb biomechanics (residual deformity, disturbed limb axis); in the joint (contractures); in the bone (comminuted osteotomy, presence of teeth); in the bone regeneration (ischemic regenerate); in the nerves (short-term and long-term neuropathies of the radial and ulnar nerves).

Discussion The number of complications in patients of the treatment group was seven times less compared to literature data, while the total number of complications after supracondylar osteotomy of the humerus and Ilizarov fixation was 1.6 times lower. Review of errors and complications in the treatment of patients with post-traumatic frontal deformities of the elbow joint using supracondylar osteotomy and the Ilizarov fixation facilitated development of a rational algorithm for the correction.

Conclusion The limb axis can be realigned and biomechanics of the elbow joint restored with corrective supracondylar osteotomy of the humerus and manipulations with the Ilizarov apparatus. The algorithm developed for treatment of patients with elbow deformities suggested a strict sequence of actions with time factors, reducing errors and complications in the form of failures in performing osteotomy, residual deformity, poor regeneration, contractures and neuropathies by 6.3 times.

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