Treatment Of Cubitus Varus Deformity Research Articles

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-simulated osteotomy based on health-side combined with guide plate technique in treatment of cubitus varus deformity in adolescents

To explore the feasibility and early effectiveness of computer-simulated osteotomy based on the health-side combined with guide plate technique in the treatment of cubitus varus deformity in adolescents. The clinical data of 23 patients with cubitus varus deformity who met the selection criteria between June 2019 and February 2023 were retrospectively analyzed. There were 17 males and 6 females, ranging in age from 4 to 16 years with an average of 8.5 years. The time from injury to operation was 1-4 years. The angle of distal humerus rotation was defined by humeral head posterior inclination angle using low radiation dose CT to scan the patient's upper extremity data at one time, and the preoperative rotation of the distal humerus on the affected side was (33.82±4.39)°. The CT plain scan data were imported into 9yuan3D digital orthopaedic system (V3.34 software) to reconstruct three-dimensional images of both upper extremities. The simulated operation was performed with the healthy upper extremity as the reference, the best osteotomy scheme was planned, overlapped and compared, and the osteotomy guide plate was prepared. The patients were followed up regularly after operation, and the formation of callus in the osteotomy area was observed by X-ray examination. Before and after operation, the carrying angle of both upper extremities (the angle of cubitus valgus was positive, and the angle of cubitus varus was negative) and anteversion angle were measured on X-ray and CT images. At the same time, the flexion and extension range of motion of elbow joint and the external rotation range of motion of upper extremity were measured, and Mayo score was used to evaluate the function of elbow joint. The operation time ranged from 34 to 46 minutes, with an average of 39 minutes. All patients were followed up 5-26 months, with a mean of 14.9 months. All the incisions healed by first intention after the operation; 2 patients had nail path irritation symptoms after Kirschner wire fixation, which improved after dressing change; no complication such as breakage and loosening of internal fixators occurred after regular X-ray review. Continuous callus formed at the osteotomy end at 4 weeks after operation, and the osteotomy end healed at 8-12 weeks after operation. At last follow-up, the carrying angle, anteversion angle, external rotation range of motion, and extension and flexion range of motion of the elbow joint of the affected side significantly improved when compared with preoperative ones ( P<0.05). Except for the extension range of motion of the healthy elbow joint ( P<0.05), there was no significant difference in other indicators between the two sides ( P>0.05). At last follow-up, the Mayo elbow score was 85-100, with an average of 99.3; 22 cases were excellent, 1 case was good, and the excellent and good rate was 100%. Computer-simulated osteotomy based on health-side combined with guide plate technique for treating cubitus varus deformity in adolescents can achieve precise osteotomy, which has the advantages of short operation time and easy operation, and the short-term effectiveness is satisfactory.

Neural wedge osteotomy method of correction for cubitus varus deformity in children.

In this study, we evaluated the clinical outcome of neutral wedge osteotomy assisted with the center of rotation of angulation (CORA) method of distal humerus anatomical axis for the treatment of cubitus varus deformity in children. From 2016 to 2019, 20 children with cubitus varus deformity after supracondylar fracture of the humerus were enrolled. Standard anteroposterior radiograph of the humerus was taken preoperatively. The CORA point and angulation angles were obtained by measuring the proximal and distal humerus anatomical axis. During the operation, neutral wedge osteotomy was performed to correct the varus deformity. The Baumann angle and the carrying angle were used to evaluate the correction effect of the distal humeral varus deformity. The average age of the patients was 7.8 years. Patients were followed up for an average of 29.3 months (range, 24–36 months). The average interval between surgery and injury was 12 months. The mean preoperative Baumann angle and carrying angle were 99° (90°–115°) and –14° (range, –10° to –30°), respectively. At the last follow-up, the mean Baumann angle and carrying angle was 76° (70°–80°) and 13.6° (10°–18°), respectively, with 16 cases showing excellent outcome and 4 cases showing good outcome. Our results indicated that the neutral wedge osteotomy assisted with CORA method of distal humerus anatomical axis showed good clinical outcomes in the treatment of cubitus varus deformity in children and is worthy of clinical application. The level of evidence is IV.

Outcome of three dimensional osteotomy for cubitus varus deformity

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Cubitus varus is the most common angular deformity resulting from supracondylar fracture of the humerus in children and adults. There are several options for correcting this deformity, but three dimensional osteotomy is now a popular method for the operative treatment of cubitus varus deformity. Objective of current study was to evaluate clinical and radiological outcome of three dimensional corrective osteotmy for cubitus varus deformity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;: This prospective interventional study was conducted in the department of orthopaedic surgery, BSMMU, Shahbag, Dhaka from January 2016 to September 2020. Within this period, total 40 cases of cubitus varus deformity, age ranging from 8-20 years that has the inclusion criteria was enrolled as a study sample with proper consent. All the data were analyzed statistically by using SPSS-22.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; The results of present study showed significantly improved carrying angle, range of motion, internal rotation angle at the time of final follow-up period of six months or more. The outcome of the subjects was graded as excellent in 16 (40%), good in 18 (45%), fair in 4 (10%) and poor in 2 (5%) patients. Excellent, good and fair results were considered as satisfactory outcome and only poor result was considered as unsatisfactory outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; After analyzing the results of present study it can be concluded that three dimensional osteotomy is a safe technique with satisfactory outcome in treatment of cubitus varus deformity.&lt;/p&gt;

The lateral curved osteotomy for cubitus varus deformity in children: A case report and literature review

IntroductionCubitus varus deformity after malunited supracondylar humerus fracture has various surgical techniques, implant configurations, and approaches. We describe a combination of French and Dome osteotomy and novel internal fixation technique to deliver an easy, safe, fast and reproducible result based on the current best evidence. Presentation of caseTwo cases of malunited supracondylar humerus are described. The first case involves a 3-year-old girl who presented with outstretched and supinated left arm after falling during bike riding 3 weeks earlier. We found no abnormality in radial and median nerve function, but the left arm radiographs showed a callus formation and the early stages of a malunited fracture of the supracondylar humerus. We waited two months for further radiographic evaluation and the radiographs showed the malunited supracondylar humerus with elbow flexion of only 105° and elbow hyperextension of 20°. The cubitus varus was recorded with clinical carrying angle of varus 10°. We used a combination of original French and Dome osteotomy, lateral approach, and our novel fixation technique with excellent results. The second case involved a 8-year-old boy with malunited right elbow and the surgery was done in the same manner, with the result of restoration to normal elbow range of motion. We also assessed the pain score and disabilities of the arm, shoulder and hand (DASH) score and recorded satisfactory results. ConclusionsThe combination of French and Dome osteotomy for treatment of cubitus varus deformity can provide an easy, safe, and reproducible result.

CUBITUS VARUS DEFORMITY IN ADULTS TREATED WITH LATERAL CLOSING WEDGE OSTEOTOMY AND FIXATION WITH PLATE

Cubitus varus deformity is a common complication of malunited supracondylar fractures of humerus. 5 cases were treated in our institute from Jun. 3 2016 to June 2018. They Cubitus were treated with lateral closing wedge osteotomy and fixation with plating. Mean operating time was 98 minutes. Lateral closing wedge osteotomy and fixation with plate is effective and safe technique in treatment of cubitus varus deformity in young adults. Keywords: Cubitus Varus, Deformity, Adults, Lateral, Closing Wedge, Osteotomy

Lateral closing wedge osteotomy and modified cross pinning with external tension band fixation in the treatment of cubitus varus deformity in childrenLateral closing wedge osteotomy and modified cross pinning with external tension band fixation in the treatment of cubitus varus deformity in children

To explore the therapeutic effects of distal humeral lateral closing wedge osteotomy followed by modified pinning combined with external tension band fixation in the treatment of cubitus varus deformity in children. Total 26 adult patients with cubitus varus deformity were treated by operation from March 2011 to June 2015, 15 patients were boys and the other 11 patients were girls, ranging in age from 4 to 13 years, with an average of 7.8 years. The cubitus varus angel ranged from 11 degrees to 24 degrees, with a mean(17.50±6.73) degrees, 3 patients complicated more than 10 degrees constriction of flexion. Lateral closing wedge osteotomy retaining the medial 3 to 4 mm intact cortex by lateral elbow approach was applied in these 26 patients. The wedge defect were closed and fixed by crossing pinning. The lateral column compression was achieved with external tension band(the crossing pins were bended laterally and the pin ends were hooked mutually). The pre-operative, post-oparetive and contralateral carrying angles were compared and Laupattarakasem criteria was used to evaluate the results at follow-up. All the patients got bony union 2 months after operation and there was no infection or nerve palsy. The average follow-up period was 18.8 months (ranged, 13 to 29 months). The carrying angle was restored to(11.50±3.17) degrees(ranged, 8 to 14 degrees). According to the Laupattarakasem evaluation criteria, 14 patients got an excellent result, 13 good and 1 fair. Normal carrying angle and elbow flexion could be restored by lateral closing wedge osteotomy, and stable fixation could be achieved with crossing pinning and external tension band, which is available for early mobilization.

Reverse V osteotomy and treatment of cubitus varus deformity - Results and experience.

Cubitus varus is a most common repercussion of malunited supracondylar fracture of humerus in paediatric age group. Initially, valgus osteotomies were in trend, but due to higher rate of complications, these procedures are not in trends today, as they were earlier. Here, we are sharing our experience and results of reverse V osteotomy done for cubitus varus. Reverse V osteotomy was done on 20 patients of cubitus varus (due to malunited supracondylar fracture of humerus). After correcting the deformity, cross K-wires and wiring (from lateral side) or Y-shaped plate was used for internal fixation. Y-shaped plate was used in older (in 20% cases) and K-wire was used for internal fixation in younger patients. All the patients underwent follow-up by clinical-radiological means and the analysis of functional outcome was done by the criteria of Oppenheim et al. Based on the Oppenheim's criteria, our results were 90% excellent and 10% good, among the 20 cases. We concluded in this study that reverse V osteotomy provides inherent stability and its stable behaviour further strengthened by internal fixation. It is a safe technique for correcting cubitus varus with aesthetic satisfaction.

New Fixation Method Using Two Crossing Screws and Locking Plate for Cubitus Varus Deformity in Young Adult Elbow: Case Report

Many types of osteotomy have been proposed for the treatment of cubitus varus deformity of the elbow, and various methods for fixation of the osteotomy site have also been described. However, no method has been perfect. We treated two cases of cubitus varus elbow deformity with step-cut osteotomy using a new fixation method with two crossing screws and an anatomically designed locking plate. Active assisted elbow range of motion (ROM) exercise was permitted at postoperative 3 days, after removal of the drainage. Preoperative and postoperative humerus-elbow-wrist angles and ranges of motion of the two patients were compared. At 3 months followup, each patient had recovered the preoperative elbow ROM, and achieved the complete bony union of the osteotomy site and proper correction of the cubitus varus deformity. In addition, the appropriate remodeling of the lateral bony protrusion was observed. Therefore, we introduce a new fixation method for achievement of stable fixation allowing immediate postoperative elbow motion after corrective osteotomy for cubitus varus deformity in young adults.

Application of computer-aided design osteotomy template for treatment of cubitus varus deformity in teenagers: A pilot study

Treatment of cubitus varus deformity from a malunited fracture is a challenge. Anatomically accurate correction is the key to obtaining good functional outcomes after corrective osteotomy. The aim of this study was to attempt to increase the accuracy of treatment by use of 3-dimensional (3D) computer-aided design. We describe a novel method for ensuring an accurate osteotomy method in the treatment of cubitus varus deformity in teenagers by means of 3D reconstruction and reverse engineering. Between January 2006 and May 2008, 12 male and 6 female patients with cubitus varus deformities underwent scanning with spiral computed tomography (CT) preoperatively. The mean age was 15.7 years, ranging from 13 to 19 years. Three-dimensional CT image data of the affected and contralateral normal bones of cubitus were transferred to a computer workstation. Three-dimensional models of cubitus were reconstructed by use of MIMICS software. The 3D models were then processed by Imageware software. An osteotomy template that best fitted the angle and range of osteotomy was "reversely" built from the 3D model. These templates were manufactured by a rapid prototyping machine. The osteotomy templates guide the osteotomy of cubitus. An accurate angle of osteotomy was confirmed by postoperative radiography. After 12 to 24 months' follow-up, the mean postoperative carrying angle in 18 patients with cubitus varus deformity was 7.3° (range, 5° to 11°), with a mean correction of 21.9° (range, 12° to 41°). The patient-specific template technique is easy to use, can simplify the surgical act, and generates highly accurate osteotomy in cubitus varus deformity in teenagers.

Treatment of cubitus varus deformity in adults with lateral closing wedge osteotomy

To explore the proper methodology to treat cubitus varus deformity in adults with lateral closing wedge osteotomy. The clinical data of 20 adult patients with post-traumatic cubitus varus deformity who underwent lateral closing wedge osteotomy and were followed up for 40 months on average were analyzed. twenty-seven of the 28 patients showed excellent heal, and one case of delay in healing occurred. Eighteen elbow joints were in a neutral position, 6 were slightly varus, and 4 were varus. Tardy ulnar nerve palsy occurred in 5 cases. Reduction of elbow flexion was 11 degrees, even more than 20 degrees in 5 cases. Four patients were able to flex their elbows by 120 degrees or less. The reduction of extension was 3.4 degrees on average. Two patients showed failure of internal fixation, Kirshner wires were used in both of which. Exact pre-operative planning of osteotomy, minimal injury to the soft tissues, proper dealing of the ulnar nerve, and stable internal fixation are the key factors that improve the function of elbow joint after the lateral closing wedge osteotomy and reduce the post-operative complications.

Three-dimensional corrective osteotomy for treatment of cubitus varus after supracondylar fracture of the humerus in children.

Cubitus varus deformity after supracondylar fracture of the humerus in children generally includes deformities of varus, hyperextension, and internal rotation. Presently almost all corrective osteotomies for treatment of cubitus varus deformity have been limited to correction of only the varus or of the varus and hyperextension deformity. Electromyographic study and stick picture motion analysis have revealed unphysiological joint motion and muscle activity around the joint in elbows with cubitus varus, hyperextension, and internal rotation deformity. On this basis we have successfully attempted simultaneous correction of all three deformities. The end results in 41 elbows have been satisfactory. In conclusion, we recommend simultaneous correction of the three elements of cubitus varus deformity to restore anatomic alignment of the elbow joint.

Cubitus Varus Deformity Following Supracondylar Fracture of the Humerus

Cubitus varus following supracondylar fracture of the humerus in children consists of varus, hyperextension, and internal rotation deformities of the distal bone fragment of the humerus. There has been no simple clinical method of measuring internal rotation deformity. The authors report here on a method of accurately measuring the internal rotation of the shoulder in a position with the elbow at 90 degrees flexion on the back and the shoulder held at the maximum extension. When a patient with developing cubitus varus attempts to rotate his shoulder internally, there is an apparent increase in the degree of internal rotation at the shoulder of the fractured side. The mean value of the angle formed between the horizontal plane of the back and the mid-line of the forearm was approximately 0 degrees in 217 normal children, whereas an increase of 35 degrees was seen in seven children with cubitus varus. When this angle was corrected successfully, the angle after surgical correction became approximately 0 degrees. In the treatment of cubitus varus deformity, it is necessary to simultaneously correct three-dimensional deformities.