Correction Of Cubitus Varus Deformity Research Articles

Step-cut osteotomy for cubitus varus deformity with application of patient-specific instrument in children: a preliminary report.

The step-cut osteotomy has been recognized as a valuable approach for addressing cubitus varus deformity, albeit one that necessitates technical proficiency. This study aims to evaluate the efficacy of the modified step-cut osteotomy technique in conjunction with patient-specific instruments by clinical and radiological assessment. We conducted a retrospective review of patients who underwent modified step-cut osteotomy with the use of patient-specific instruments in conjunction with Kirschner wires fixation for the correction of cubitus varus deformity between April 2016 and April 2022. Follow-up was performed for a minimum of two years, during which pre-operative and post-operative clinical and radiological parameters were compared. Fifteen patients were enrolled in this study. The mean pre-operative humeral-elbow-wrist (HEW) of the affected side was -21.7° (ranging from -14° to -34°), while the normal side was 9.4° (ranging from 5° to 15°). The post-operation HEW of affected side was 9° (ranging from 4° to 16°). There was no significant difference between the normal side and affected side after operation (p = 0.74). Pre-operative range of motion in the affected side was 130°, while the post-operative range of motion was 132°. Fourteen patients (93.3%) were pleased with the overall appearance of their elbow. None lazy-S deformity was observed in these cases. There were no major complications. The modified step-cut osteotomy technique, utilizing patient-specific instrument in conjunction with Kirschner wires fixation was found to be a safe, reliable, and technically easy procedure for correcting cubitus varus deformity.

Comparative study of external fixator combined with Kirschner wire fixation and Kirschner wires fixation in treatment of cubitus varus deformity in children

To analyze the effectiveness comparison of external fixator combined with Kirschner wire fixation and Kirschner wire fixation in the treatment of cubitus varus deformity in children. A retrospective case-control study was conducted to collect 36 children of postoperative supracondylar humerus fracture complicating cubitus varus deformity between January 2018 and July 2022. Among them, 17 cases were treated with distal humeral wedge osteotomy external fixation combined with Kirschner wire fixation (observation group), and 19 cases were treated with distal humeral wedge osteotomy and Kirschner wire fixation (control group). The baseline data including age, gender, deformity side, time from fracture to operation, carrying angle of the healthy side and preoperative carrying angle of the affected side, elbow flexion and extension range of motion, and lateral condylar prominence index (LCPI) showed no significant difference between the two groups ( P>0.05). The operation time, hospitalization cost, healing time of osteotomy, postoperative complications, and the carrying angle, LCPI, and elbow flexion and extention range of motion were recorded and compared between the two groups. The elbow function was assessed by Oppenheim score at 3 months after operation and at last follow-up. The children in both groups were followed up 13-48 months, with an average of 26.7 months. There was 1 case of needle tract infection in the observation group and 2 cases in the control group, and no nerve injury occurred, the difference in the incidence of complication (5.88% vs 10.53%) between the two groups was not significant ( χ 2=0.502, P=0.593). There was no significant difference in the operation time and fracture healing time between the two groups ( P>0.05); the hospitalization cost of the observation group was significantly higher than that of the control group ( P<0.05). The Oppenheim score of the observation group was significantly better than that of the control group at 3 months after operation ( P<0.05), but there was no significant difference in the Oppenheim score between the two groups at last follow-up ( P>0.05). At last follow-up, the carrying angle of affected side significantly improved in both groups when compared with preoperative ones ( P<0.05); the differences of the pre- and post-operative carrying angle of affected side and elbow flexion and extension range of motion showed no significant differences between the two groups ( P>0.05), but the difference in pre- and post-operative LCPI of the observation group was significantly better than that of the control group ( P<0.05). External fixator combined with Kirschner wire fixation and Kirschner wire fixation both can achieve satisfactory correction of cubitus varus deformity in children, and the former can achieve better short-term functional recovery of elbow joint and reduce the incidence of humeral lateral condyle protrusion.

Computer aided multiplanar osteotomy using patient specific instrumentation to treat cubitus varus in children

Cubitus varus deformity is a common complication of supra-condylar fractures in children.Anatomic correction is the key to obtaining good functional results and avoiding later symptomatic degradation. Different techniques have been described, mainly lateral closing wedge osteotomy. A medial opening wedge osteotomy seems more intuitive, allowing an anatomic reduction, but it is technically challenging.Two-plane radiographs are too simplistic to appreciate the 3D deformity. With medical imaging and image processing advances, three-dimensional (3D) virtual models of a patient’s anatomy can be generated. Rapid 3D printing has allowed virtual simulations of surgical corrections to be transferred to real-world applications in the operating room, allowing more precise and accurate surgery with better 3D corrections.3D computer modeling with the development of customized drilling and cutting guides allows complex medial opening wedge osteotomy for correction of cubitus varus deformity in immature children with best-fit plate synthesis.Level of evidence: IV

A Modified Reverse Right-angled Triangle Osteotomy Using the Lateral Approach for the Treatment of Posttraumatic Cubitus Varus Deformity in Children.

Cubitus varus deformity is a complex 3-dimensional deformity. Various osteotomies have been introduced to correct this deformity, however, there is no consensus on the best procedure to correct the deformity while avoiding complications. In this retrospective study, we used a modified inverse right-angled triangle osteotomy to treat 22 children with posttraumatic cubitus varus deformity. The primary objective was to evaluate this technique by presenting its clinical and radiologic results. Twenty-two consecutive patients with a cubitus varus deformity underwent a modified reverse right-angled triangle osteotomy between October 2017 and May 2020 and were then followed for a minimum of 24 months. We evaluated its clinical and radiologic results. Functional outcomes were assessed using Oppenheim criteria. The average follow-up period was 34.6 months (range, 24.0 to 58.1 months). The mean range of motion was 4.32 degrees (range, 0 degrees to 15 degrees)/122.73 degrees (range, 115 degrees to 130 degrees) (hyperextension/flexion) before surgery and 2.05 degrees (range, 0 degrees to 10 degrees)/127.27 degrees (range, 120 degrees to 145 degrees) at the final follow-up. There were significant (P < 0.05) differences between the flexion and hyperextension angles before surgery and at the final follow-up. Based on Oppenheim criteria, results were excellent for 20, good for 2, and none of the patients had poor results. The mean humerus-elbow-wrist angle improved from 18.23 degrees (range, 10 degrees to 25 degrees) varus preoperatively to 8.45 degrees (range, 5 degrees to 15 degrees) valgus postoperatively (P < 0.05). The mean of the preoperative lateral condylar prominence index was 3.52 (range, 2.5 to 5.2) and the average postoperative lateral condylar prominence index was -3.28 (range, -1.3 to -6.0). All patients were pleased with the overall appearance of their elbows. The modified reverse right-angled triangle osteotomy can precisely and stably correct the deformity in the coronal and sagittal planes, we recommend this technique as a simple, safe, and reliable correction of cubitus varus deformity. Level IV; case series; therapeutic studies-investigating the results of treatment.

Functional Outcome Analysis of Cubitus Varus Deformity Treatment in Children undergoing Modified French Osteotomy with Technical Modification: A Retrospective Cohort Study

Introduction: Lateral closing wedge osteotomy is an accepted correction method for cubitus varus deformity. The techniques used to fix the osteotomy mostly lead to either angulation or loss of correction during the final tightening of the Stainless Steel (SS) wire at the osteotomy site. The records for patients undergoing two modifications in a conventional modified French Osteotomy were analysed. Four wires, two proximal and two distal to the osteotomy site for precision and guided compression over the other additional Kirschner wire (K-wire) at the osteotomy site, were the two modifications in these patients. Aim: To analyse the functional outcome of cubitus varus deformity in children treated with technical modifications of modified French osteotomy. Materials and Methods: This was a retrospective cohort study done at the Department of Orthopaedics, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. The study duration was three years (from April 2019 to April 2022). A total of 34 cubitus varus deformity patients were included in this study who were operated with lateral closing wedge-modified French osteotomy with technical modification by K-wires. The patients were followed-up for a minimum of six months. The results were analysed using Quick Disabilities of the Arm, Shoulder and Hand (DASH) and Flynn’s criteria. Statistical Package for the Social Sciences (SPSS) version 21.0 was used and p-value&lt;0.05 was considered statistically significant. Results: Twenty-three (67.65%) cases were male, and 11 (32.35%) were female. Twenty-eight (82.4%) patients were children aged 5 to 10 years, 20 (58.8%) cases involved a rightsided deformity, while the remaining 14 (41.2%) had left-side involvement. The mean age was 7.58±2.49 years (ranging from 3 to 12 years). The mean time since they had initial trauma was 2.42±1.28 years. The preoperative mean cubitus varus angle was 11.73±2.39°, the mean hyperextension was 13.27±2.69°, and the mean internal rotation was 36.48±5.01°. Postoperative six months’ corrective mean carrying angle (valgus) was 5.79±2.46°, corrective hyperextension was 2.18±1.06°, and corrective internal rotation was 5.39±2.74°. Out of 34 cases, all had excellent results as analysed by Quick DASH and Flynn’s criteria. Conclusion: The technical modifications by K-wires in conventional modified French osteotomy provided guided compression over the osteotomy site, ensured perfect implant placement without cutting out the screw, and improved 3D (Dimensional) correction of cubitus varus deformity. So, it’s safe, simple, and effective.

Corrective Osteotomy in cubitus varus deformity in children: A prospective study

Background and Aim: Cubitus varus deformity is the most common late complication aftersupracondylar fracture of the distal humerus in children, incidence varying from 4% to 58%. Thepresent study was done to evaluate the results of dome osteotomy. Material and Methods: Thisprospective study was conducted in a tertiary care hospital over 16 months. In all patients humerus-elbow wrist angle was measured on both sides and the correction needed was calculated. The lateralcondyle prominence index (LCPI) was calculated by anteroposterior view radiographs of thedeformed and the normal elbow in full extension by (AB-BC)/AC. Dome osteotomy with para tricepsapproach was used. Pre and post-operative carrying angle of elbow, range of motion and lateralprominence indices were compared. Results: The age of patients ranged from 3 to 15 years with amean age of 8.47±3.14 years. Preoperative carrying angle of normal side ranged from 80 to 140and that of effected side ranged from -23 to -13 and the difference was statistically significant(p&lt;0.05). LCPI ranged from -8.4 to 5.9%. The majority of cases had LCPI &gt;2.7%. As compared to,an improvement in carrying angle at defect side was observed to be 28.41±2.15 which wassignificant (p&lt;0.05). At baseline mean LCPI was 0.39±3.87% which changed to -0.86±3.47%, themean change of this was significant (p=0.01). baseline Conclusion: Dome osteotomy is a relativelytechnically demanding technique for correction of cubitus varus deformity but with a betterfunctional outcome without being associated with lateral condyle prominence.

Functional outcome of modified French osteotomy fixed with recon-locking compression plate in older children

IntroductionModified French osteotomy is commonly used method for the correction of cubitus varus deformity. Fixation of the osteotomy with figure of 8 wiring or 3.5 mm cortical screws were found to be insufficient in holding the distal fragment in children above 8 years. In this study we used a Reconstruction locking plate for the fixation of osteotomy in those children and evaluated the results. Materials and methodsModified French osteotomy and fixation with reconstruction locking compression plate was performed for eighteen cases of cubitus varus deformity within the time period of 5 years starting from March 2014 to February 2019. ResultsThe outcome of the study was assessed with Flynn’s criteria, where 12 cases had excellent and 6 cases had good outcome. There were no complications and no revision surgeries were performed. ConclusionReconstruction locking plate fixation of a modified French osteotomy in older children (above 8 years) provided excellent results in our study.

Cubitus varus deformity correction by uniplanar supracondylar humeral osteotomy with preset k-wires fixation: Our experience

Introduction: Cubitus varus deformity is the late complication after malunited supracondylar fracture of humerus in children. Various Osteotomies have been described in the literature and are associated with complications like nerve palsies, persistent varus deformity, infection, lateral condylar prominence, unsightful scar and loss of fixation.We report our experience for correction of cubitus varus deformity by uniplanar supracondylar humeral osteotomy and preset k-wires fixation with least complications. AIM: To study the results of of cubitus varus deformity correction by uniplanar supracondylar humeral osteotomy and preset k-wires fixation with least complications. Materials and Methods: A prospective study of 15 cases of cubitus varus deformity were included in the study. Pre-operative assessment of Carrying Angle and Elbow ROM was done. Uniplanar supracondylar humeral osteotomy and preset k-wires fixation was done in all cases. Results were evaluated using Mitchell and Adams criteria. Results: The average age at the time of injury was 5 years. The average age at corrective surgery was 6 years. The average operative time was 70 minutes. All cases were followed up till 1 year. All patients had increased carrying angle, increased elbow ROM and improved cosmetic outcome. The results were evaluated using Mitchell and Adams criteria. 1 patient had superficial pin tract infection, 1 pt had re-injury due to fall. The overall assessment showed excellent results in 80% and good results in 20% as per Mitchell and Adams criteria. Conclusion: From our study we conclude that cubitus varus deformity correction by uniplanar supracondylar humeral osteotomy with preset k-wires fixation is stable, simple, effective and safe method with least complications. Hence three dimensional tri planar correction of the deformity is not required for cubitus varus deformity correction.

Early correction of malunited supracondylar humerus fractures in young children

IntroductionSupracondylar fracture malunion usually results in cubitus varus deformity. The long-standing unsightly deformity causes psychological stress to the child and his/her parents in addition to biomechanical disturbances and functional disorders in the affected elbow. The optimal timing of corrective osteotomy is not well-established in the literature. The present study aimed to report the results of early correction of cubitus varus deformity using a simple technique and to focus on the timing of early correction after supracondylar fracture malunion. Patients and MethodsThirty consecutive patients treated for recent cubitus varus deformity after malunited supracondylar fractures, in the period between January 2012 and August 2017, were retrospectively reviewed. All patients had early surgical correction of the deformity within one year after the initial injury. In patients who presented with maluniting supracondylar fracture, the fracture was splinted until union was achieved, then active exercises were encouraged until elbow ROM was regained. The deformity was then corrected with a lateral closing wedge (LCW) osteotomy and fixed with two lateral and one medial wire. ResultsAll the osteotomies united. All the deformities were corrected. The humerus-elbow-wrist (HEW) angle significantly improved compared to the pre-operative values (p<0.001). All patients achieved satisfactory results at the final evaluation. Twenty-six patients (86.7%) achieved excellent results while four patients (13.3%) achieved good results. ConclusionEarly correction of cubitus varus deformity avoids the psychological stress of the long-standing unsightly deformity to the young child and his/her family. It also avoids the delayed biomechanical and functional disturbances to the affected elbow. The LCW osteotomy and the three-wires fixation technique are simple and effective to correct the deformity and maintain the correction.

Results of the modified reverse step-cut osteotomy in paediatric cubitus varus.

Cubitus varus deformity occurs in children as a late consequence of supracondylar fracture of the distal humerus. Different types of corrective osteotomies have been described, but a gold standard has not yet been established. The aim of this study is to report the clinical, radiological, and cosmetic outcome of the modified reverse step-cut osteotomy technique. This study was conducted on 15 cases, which were operated during the period between July 2015 and June 2016. We used the technique modified reverse step-cut osteotomy with the calculated medial translation of the distal fragment to correct varus and sagittal plane deformity and to achieve anatomical alignment of the forearm axis with the axis of the humerus. Follow-up was done for two years. Pre-operative and post-operative clinical and radiological parameters were compared, and patient satisfaction was assessed. The mean pre-operative humerus-elbow-wrist (HEW) angle was - 22.4°; it improved to + 9.4° post-operatively. The pre-operative mean range of motion was 131.6°, and the post-operative mean was 132°. The clinico-radiological outcome was assessed according to Oppenheim criteria. There was an excellent result in nine patients (60%), a good result in five patients (33.3%), and poor results in one patient (6.6%). Cosmetic outcome was assessed as per Barrett's criteria, excellent result in thirteen patients (86.6%) and poor results in two patients (13.3%). Post-operative lateral condylar prominence index (LCPI) was compared with the normal side, and there was no significant difference. We have achieved satisfactory results with acceptable cosmetic appearance and functional outcomes with minimal complications. We recommend this technique as a safe, reliable, reproducible, technically easy procedure for correction of cubitus varus deformity.

Application of 3D printing osteotomy plate in osteotomy for correction of cubitus varus in children

Objective To study the application value of 3D printing osteotomy plate technique in the correction of cubitus varus deformity in children. Methods From July 2014 to December 2015, 7 patients with cubitus varus deformity were treated with wedge-shaped osteotomy of lateral humeral supracondylar. Before surgery thin-section CT scan and elbow joint three-dimensional reconstruction were performed. According to the cubitus varus situation, the best osteotomy angle was designed and then a guide plate was established which was anatomically consistent with the osteotomy range. Three-dimensional data model of the guide plate were input into 3D printer for producing guide plate. During the operation, the established guide plate of osteotomy was matched with the part of humeral osteotomy. After osteotomy along the plate, the osteotomy gap was slowly closed and fixed by plate. Results The osteotomy angle was satisfactory in 7 cases after operation. Postoperative follow-up time ranged from 3 to 6 months with an average of 4 months. The elbow function was evaluated according to the Mayo elbow function score. The results were excellent in 5 cases, good in 1 case and fair in 1 case. Conclusion The osteotomy plate which is 3D printed can provide a personalized and accurate osteotomy for correction of cubitus varus deformity in children. Key words: Elbow joint; Osteotomy; Cubitus varus; 3D printing

A study of functional outcome of correction of cubitus varus deformity by stepcut translation osteotomy

ObjectiveTo analyse the cosmetic and functional outcome of correction of cubitus varus deformity in adolescents and adults by step cut translation osteotomy.To analyse the amount of varus deformity correction obtained.To analyse the amount of varus deformity correction obtained.To analyse the amount of correction of Lateral condyle prominence obtained.To analyse the post-operative arc of motion and the difference in the post-operative range of motion in comparison with the pre-operative range.To analyse the associated complications, andTo come to a conclusion as to the efficacy of the procedure.

Management of Cubitus Varus Deformity in Children by Closed Dome Osteotomy.

Supracondylar fractures are the most common elbow injuries in skeletally immature children between 5-10 years of age and cubitus varus deformity is the most common late complication. Cubitus varus or bow elbow or gunstock deformity is the result of malunion occurring as a complication of supracondylar fracture of the humerus. Various type of corrective osteotomies are used of which lateral closed wedge French osteotomy is commomly used which has its own complications like lateral condylar prominence, unsightful scar and limitation of movement. Closed dome osteotomy is a technique which overcomes these complications. This surgery is done with simple readily available instruments in the orthopaedic operation theatre with no special requirements for instrumentation. This study was done to study the results of closed dome osteotomy for correction of cubitus varus deformity, after malunited supracondylar fracture of humerus in children. This study included 25 children of either sex with malunited supracondylar fracture of distal humerus having cubitus varus deformity admitted in orthopaedics department. After appropriate pre operative assessment, closed dome osteotomy was done and post operatively X-ray of patients was taken and carrying angle and Lateral Condylar Prominence Index (LCPI) were calculated. Patients were re-assessed at complete union and results were calculated as per Mitchell and Adams criteria. In our study of 25 patients, 68% were males, 32% were females. Majority (84%) of patients were in the age group of 5-10 years. Carrying angle post operatively was 0-10° valgus in 64% of patients while 36% had 10-20° valgus. LCPI changed post operatively ranging from +5.0% to -10.7%, average -2.75%. Decrease in LCPI had better cosmetic appearance. Range of motion post operatively increased or remained same as previous full motion in 84% of the patients. Union occurred in all patients by eight weeks. Few complications were seen. Results according to Mitchell and Adams criteria were excellent in 88% and good in 12%; while no poor results were recorded. The results obtained in our study concluded that closed dome osteotomy is safe and effective treatment for the correction of cubitus varus deformity with few minor complications.

OSTEOTOMIE HUMERALE DE FERMETURE LATERALE DANS LE TRAITEMENT DU CUBITUS VARUS POST-TRAU

The objective of this work was to report the anatomical and functional results of the lateral closed wedge osteotomy of s¨humérus with a cross-pin fixation of 18 cases of cubitus varus deformity. Material and methods : We performed a retrospective study, on a period of 5 years, about 18 cases of cubitus varus deformity (16 boys and 2 girls, mean age of 10.4) treated by lateral closed wedge osteotomy, reviewed and evaluated at maximum follow-up. The mean of humero-ulnar angle was 29.7°. Elbow mobily in flexion was 121.3° before surgery. Complications and time to consolidation and hardware removal was noted. Satisfactory index and Flynn criterias was used to assess the fonctionnal and radiological outcome. Results : The mean follow-up was 58.8 months. Satisfactory index revealed 7 patients very satistied, 9 satisfied, 2 disapointed. According to Flynn criterias, we found 6 excellents results, 7 goood results, 3 fair results and 2 poor results. The correction of varus was of 29° on average. Minors complications (infections and rediction of elbow range of motion) was noted. Conclusion : The lateral closed wedge osteotomy is an excellent method for correction of cubitus varus deformity. Keywords : Cubitus varus, osteotomy, elbow, children

Kubitus Varus Deformitesinde Dome Osteotomi Sonuçlarımız

Amaç: Kubitus varus deformitesi dirsek çevresi travmaların en sık gözlenen uzun dönem komplikasyonudur. Deformitenin düzeltilip düzeltilmemesi konusunda kesin fikir birliği ve endikasyon kriterleri yoktur. Deformitenin anatomik restorasyonu için birçok cerrahi teknik tariflenmiştir. Bu çalışmada dome (kubbe) osteotomisi tekniği ile yapılan kubitus varus deformite düzeltme ameliyatının klinik ve radyografik sonuçlarının değerlendirilmesi hedeflendi. Gereç ve Yöntemler: Çalışmada kubitus varus tanısı ile dome (kubbe) osteotomi tekniği kullanılarak tedavi edilen 10 (6 erkek, 4 kadın) hastanın 10 dirseği retrospektif olarak değerlendirildi. Hastaların yaş ortalaması 15 (dağılım 7-26) yıl idi. Hastaların hepsinde dirsek travması hikayesi mevcut idi. Travma sonrası 4 hastaya ilk tedavi olarak açık redüksiyon, 2 hastaya konservatif tedavi uygulanmış, 4 hastanın ise tedavisi ihmal edilmiş idi. Üç hastada iç rotasyon deformitesi eşlik etmekte idi. Hastaların, ameliyat öncesi ve ameliyat sonrası humerus-dirsek-el bileği açısı, lateral prominens indeks, Mayo dirsek skorları incelendi. Ameliyat sonrasında Barret memnuniyet skoru değerlendirildi. Bulgular: Ameliyat öncesi ortalama 14,7±6,06° varusta olan humerus-dirsek-el bileği açısı, ortalama 25±6,33 derecelik düzeltme ile ameliyat sonrası dönemde ortalama 10,1±5,77° valgus olarak hesaplandı (p=0,005). Ameliyat sonrası dönemde hiçbir hastada iç rotasyon deformitesi gözlenmedi. Mayo dirsek skoru ameliyat sonrasında belirgin olarak iyileşti. Hastaların hiçbirinde kalıcı komplikasyon gözlenmedi. Barret memnuniyet skoruna göre hastalar veya ebeveynleri ameliyattan oldukça memnun idiler. Hastaların hiçbirinde ''Lazy S'' deformitesi gözlenmedi. Sonuç: Sonuç olarak kubitus varus deformitesinin tedavisinde kubbe osteotomisi etkili, güvenli ve kozmetik bir tedavi şeklidir.

Clinical Outcome of Dome Osteotomy in Cubitus Varus

Introduction: Cubitus varus (Gunstock deformity), is the most common long term complication of childhood supracondylar fracture of the humerus. For correction of cubitus varus deformity many types of osteotomies and fixations methods have been described. The most commonly used is the Lateral closing wedge osteotomy, which provides good results but results in two fragments of unequal width for bony union and the lateral condyle becomes prominent leading to Lateral condyle prominence, an another cosmetic deformity. To overcome this problem, Dome osteotomy was done. Material and Methods: This prospective study included 15 cases of cubitus varus deformity of elbow over a period of 18 months. Mean age of the cases was 9.07±3.07 years. Dome osteotomy with paratriceps approach was used. Pre and post -operative carrying angle of elbow, range of motion and lateral prominence indices were compared. Results: The mean follow-up period was 13.33±1.84 months. Mean time between injury and surgery was 16.53±4.10 months. There was significant improvement in carrying angle and lateral condylar prominence indices. Two of the cases developed transient ulnar nerve neuropraxia and one patient had superficial skin infection. Conclusion: Dome osteotomy is relatively technically demanding technique for correction of cubitus varus deformity but with better functional outcome without associated with lateral condyle prominence.

Postoperative accuracy analysis of three-dimensional corrective osteotomy for cubitus varus deformity with a custom-made surgical guide based on computer simulation

For correction of cubitus varus deformity resulting from supracondylar fracture of the humerus, we developed an operative method with use of a custom-made surgical guide, designed on the basis of 3-dimensional (3D) computer simulation with computed tomography data. The purpose of this study was to investigate the postoperative accuracy of this system in clinical cases. Subjects included 17 consecutive patients (13 males and 4 females) with cubitus varus deformity after supracondylar fracture. Patients underwent 3D corrective osteotomy with use of a custom-made surgical guide. Postoperative computed tomography scan was performed after bone union diagnosis on plain radiographs, and postoperative 3D bone models were compared with preoperative simulation by surface registration technique. In addition, we evaluated radiographic parameters (humerus-elbow-wrist angle and tilting angle) and range of elbow motion at the most recent follow-up. Mean errors in 3D corrective osteotomy were 0.6° ± 0.7° in varus-valgus rotation, 0.8° ± 1.3° in flexion-extension rotation, 2.9° ± 2.8° in internal-external rotation, 1.7 ± 1.8 mm in anterior-posterior translation, 1.3 ± 1.8 mm in lateral-medial translation, and 7.1 ± 6.3 mm in proximal-distal translation. The mean humerus-elbow-wrist angle on plain radiographs of the affected side was 15° in varus before surgery and improved to 6° in valgus after surgery. The mean tilting angle of the affected side was 31° before surgery and improved to 40° after surgery. The 3D correction of cubitus varus deformity was performed accurately within the allowable error limits.

Translation Step-cut Osteotomy for the Treatment of Posttraumatic Cubitus Varus

Cubitus varus deformity is the most common complication after the treatment of displaced supracondylar humerus fractures. A retrospective analysis was performed evaluating patients who had undergone a translation step-cut osteotomy for correction of cubitus varus deformity between 1993 and 2008. Postoperative radiographs to union were reviewed for all patients. Subjective information and range of motion measures were documented from the medical records. Patients and their families were also contacted through telephone and administered a questionnaire as well as the QuickDash functional outcome measure to assess their function and satisfaction. Thirty-seven participants were identified and reviewed. Average age at the time of surgery was 8 years and 10 months, with an average follow-up of 2 years and 4 months. Outcomes were assessed in terms of technical, functional, and satisfaction domains. Technical Domain: Average humeroulnar angle (radiographic carrying angle) correction was 26 degrees. Bauman's angle improved 21 degrees on average in patients who were skeletally immature. Functional Domain: Elbow range of motion was maintained in all planes with few exceptions. The clinical carrying angle improved 26 degrees on average, and was symmetric with the unaffected side in 22 of 25 cases in which it was documented. The QuickDash was applied to 15 participants. Eight participants had perfect scores for the symptoms/disability section, and 7 had scores in the top 20% for function. Satisfaction Domain: A study-specific questionnaire was applied to 16 participants. All patients and parents questioned would recommend the procedure to other parents/patients. The translation step-cut osteotomy reliably corrects the coronal plane angular deformity associated with cubitus varus, resulting in excellent outcomes in technical, functional, and satisfaction domains. The osteotomy is relatively simple to perform, and is inherently more stable than other proposed methods. It also minimizes the prominence of the lateral condyle associated with simple lateral closing wedge osteotomy.

Long-term results of remodeling of lateral condylar prominence after lateral closed-wedge osteotomy for cubitus varus

Despite the ability of lateral closed-wedge osteotomy for cubitus varus deformity to restore carrying angle and preserve elbow motion, there have been reports of poor cosmetic appearance of the elbow because of lateral condylar prominence. We evaluated long-term results of remodeling of lateral condylar prominence after osteotomy in 11 patients (7 of the prepuberty group, 4 of the postpuberty group). The follow-up period ranged from 4.7 to 14.2 years (average, 10). The mean preoperative and postoperative lateral condylar prominence index (LCPI) of the affected elbow were -1.2% and 36%, respectively. At final follow-up, the mean LCPI of the corrected elbow was 11.1%. In the prepubertal group, the mean LCPI decreased from 41.2% after surgery to 5.2% at final follow-up, whereas it decreased from 26.8% to 21.3% in the postpubertal group. The difference in reduction between the mean postoperative LCPI and the mean LCPI at final follow-up in the prepubertal group (36%) was greater than in the postpubertal group (5.4%) (P = .006). Lateral closed-wedge osteotomy is a relatively simple and effective procedure for correction of cubitus varus deformity before puberty, allowing cosmetically pleasing remodeling of lateral condylar prominence.

Supracondylar medial open wedge osteotomy with external fixation for cubitus varus deformity.

Many surgical procedures are used for the correction of cubitus varus deformity in children. Even if the primary indication is cosmetic, but many poor results have been described. The technique of a supracondylar medial opening wedge osteotomy with external fixation is presented and preliminary results in four cases are reported. An antero-medial approach is chosen with exposition and anterior transposition of the ulnar nerve. Under image intensifier control, insertion of four Schanz screws is performed from medial to lateral. In between, an incomplete medial osteotomy is performed obliquely (in the antero-posterior as well as in the medio-lateral plane), leaving a small part of the radial humeral cortex intact. The osteotomy is opened until varus and, if present, hyperextension deformation are corrected. Then, the fixator system is applied. All osteotomies healed primarily. Mean valgus correction of 21.75 degrees was achieved; in only one patient additional flexion modification of 17 degrees was necessary. At a follow-up of at least 2 years clinically three out of four presented symmetric elbow position, one slight residual varus deformity was noted in spite of 20 degrees of valgization due to important valgus position of the contralateral side. No lateral bulging of the corrected elbow was observed. The described technique is an alternative to other procedures, with special regard to the cosmetic outcome as well as to the control of correction for valgus and flexion.