[Supracondylar dome osteotomy with plate fixation via a posterior triceps-splitting approach]

Supracondylar correction outside the joint block is performed to achieve a symmetrical cubital axis in the frontal plane and a balanced range of motion in the sagittal plane without interfering with joint congruence.

Supracondylar correction is performed mainly in the frontal plane. A simultaneous correction in the sagittal plane is effortlessly possible as well. The condylar prominence can be balanced through additional medial translation.

Dome osteotomy is not suitable for patients aged under 10 years. It is not the first-choice method for correction of rotational deformity. Moreover, dome osteotomy alone is insufficient for correction of deformities with joint incongruence.

The distal humerus is exposed through a posterior triceps-splitting approach. A series of drillings in the curve of a dome were made using a 2-mm K‑wire. Gear-formed osteotomy was further completed with a 4-mm osteotome, so that the distal fragment could be gradually rotated. After the required correction had been achieved, the osteotomy was temporarily fixed with a 2-mm K-wire. Final fixation was achieved with a 3.5-mm locking compression tibia plate.

Free range of motion and full weightbearing are possible immediately after surgery. However, weightbearing exceeding the weight of the arm and propping up the arm are prohibited in the first 6 weeks. Radiologic examinations are performed after 6 weeks and 3 months. Sports are prohibited during the first 3 months. Further clinical follow-ups are continued annually until bone maturity is attained.

The correction that was aimed for was achieved in all concluded cases. None of the complications mentioned in the literature occurred in our cases. Moreover, elbow function and stability were significantly improved. Although dome osteotomy is technically demanding, standardized surgical execution contributes to excellent reproducible results.