Preoperative, Computer Simulation-Based, Three-Dimensional Corrective Osteotomy for Cubitus Varus Deformity with Use of a Custom-Designed Surgical Device

Abstract

Cubitus varus deformity after a supracondylar fracture classically includes varus, extension, and internal rotation components. However, to our knowledge, no reliable surgical method for three-dimensional corrective osteotomy has been established. We developed an intraoperative guide system involving a custom-made surgical template designed on the basis of a three-dimensional computer simulation incorporating computed tomography (CT) data. We aimed to investigate the feasibility of this novel technique for correcting cubitus varus deformity. Thirty consecutive patients (twenty-three males and seven females) with a cubitus varus deformity resulting from the malunion of a distal humeral supracondylar fracture were included in this study. Between October 2003 and May 2011, the patients underwent a three-dimensional corrective osteotomy with use of a custom-made surgical template. The patients were then followed for a minimum of twelve months. We evaluated radiographic parameters, including the humerus-elbow-wrist angle and tilting angle, as well as the ranges of motion of the elbow and shoulder at the time of the most recent follow-up. An overall clinical evaluation was performed. Bone union was achieved at a mean of four months after surgery. The mean humerus-elbow-wrist angle and tilting angle on the affected side improved significantly from 18.2° (varus) and 25.0°, respectively, before surgery, to 5.8° (valgus) and 38.0°, respectively, after surgery. Hyperextension of the elbow and internal rotation of the shoulder were normalized in all patients. Early plate breakage was observed in one patient. One patient had mild recurrence of varus deformity. Twenty-seven patients had an excellent result, three had a good result, and none had a poor result. Three-dimensional corrective osteotomy with the use of a custom-made surgical template that is designed and produced on the basis of computer simulation is a feasible and useful treatment option for cubitus varus deformity.