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.

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