Arthroscopic Correction of a Supracondylar Malunion in a Child Steven M. Koehler, M.D., Sara Sakamoto, M.D., Brenon L. Abernathie, M.D., Michael R. Hausman, M.D.  Arthroscopy Techniques  Volume 4, Issue 3, Pages e215-e221 (June 2015) DOI: 10.1016/j.eats.2015.01.006 Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 1 Preoperative radiographs of extension malunion of distal humerus. The anterior humeral line does not intersect the capitellum. Arthroscopy Techniques 2015 4, e215-e221DOI: (10.1016/j.eats.2015.01.006) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 2 Our preferred patient positioning for elbow arthroscopy: supine with a McConnell arm positioner. (A) Position for access to posterior compartment. (B) Position for anterior elbow access. Arthroscopy Techniques 2015 4, e215-e221DOI: (10.1016/j.eats.2015.01.006) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 3 Commonly used portals. (A) The lateral portals include the proximal anterolateral portal, 2 cm proximal and 1 cm anterior to the lateral epicondyle; the anterior radiocapitellar portal, directly anterior to the radiocapitellar joint (and closest to the radial nerve); and the posterior radiocapitellar, or soft-spot, portal. (B) Medially, the proximal anteromedial portal, 2 cm proximal and anterior to the medial epicondyle, is most widely used. An additional anteromedial portal can be placed 1 cm distal to the proximal anteromedial portal, but its insertion is more difficult because of the more fibrous common flexor origin tendon in the more distal position. (C) Posteriorly, the trans-triceps portal is supplemented with proximal and distal posterolateral portals for retractors and working instruments. Additional portals can be safely placed along the posterior radioulnar interval. Arthroscopy Techniques 2015 4, e215-e221DOI: (10.1016/j.eats.2015.01.006) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 4 Intraoperative radiographs showing arthroscopic osteotomy with 3.5-mm burr. (A) Positioning of burr and arthroscopic instruments. (B) Initiation of osteotomy in anterior humeral cortex. (C) Progression of osteotomy. (D) Completion of osteotomy with correction of extension malunion. Arthroscopy Techniques 2015 4, e215-e221DOI: (10.1016/j.eats.2015.01.006) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 5 (A, B) Intraoperative radiographs after fixation of osteotomy with K-wires. The extension malunion has been corrected, and the anterior humeral line now intersects the capitellum. (C, D) Radiographs at 1-year follow-up. The osteotomy site has healed, and the malunion correction has been maintained. Arthroscopy Techniques 2015 4, e215-e221DOI: (10.1016/j.eats.2015.01.006) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions