Dome corrective osteotomy for cubitus varus deformity

Between 1994 and 1998, 15 patients had corrective dome-shaped osteotomy of the humerus for posttraumatic cubitus varus deformity. Thirteen patients had surgery before puberty and two patients had surgery after puberty. In the prepuberty group, all the osteotomies were done by a posterior approach with triceps muscle splitting, and cross pins were used to fix the osteotomy. In the postpuberty group, the osteotomies were done by a posterior approach with olecranon osteotomy, and reconstructive plates were used for fixation. The average followup was 2 years and 4 months. Preoperative carrying angle ranged from 19 degrees to 31 degrees varus (average, 26.2 degrees) and postoperative carrying angle ranged from 7 degrees to 15 degrees valgus (average, 10.7 degrees). No loss of correction was observed and all osteotomies united. The preoperative and postoperative differences of the lateral condylar prominence index ranged from -67% to +6% (average, -30.1%). After reviewing these cases, a dome-shaped osteotomy was found to have the following advantages for correction of cubitus varus deformity: the osteotomy site is more stable than a lateral closing wedge osteotomy for maintaining the correction obtained; the domed osteotomy avoids having the lateral condyle becoming prominent; and the posterior scar is more cosmetically acceptable than the lateral scar in the lateral closing wedge osteotomy.     

Medial approach for corrective osteotomy of cubitus varus: a cosmetic incision

Osteotomies described previously to correct cubitus varus had been associated with unsatisfactory results such as a prominent lateral scar and condyle and injury to the triceps. The authors evaluated the results of a medial approach for the corrective osteotomy of 14 consecutive children (mean age 8.4 years) with cubitus varus. The incision was made medially and the ulnar nerve was identified and protected. An image intensifier was used to identify the wedge. Lateral closing wedge osteotomy was performed and secured with cross K-wires, and the distal fragment was translated medially to reduce the lateral prominence. Both hyperextension and internal rotation deformity could be corrected with the osteotomy. The mean carrying angle and hyperextension of the elbow of 19.3 degrees varus and 22.2 degrees were corrected to 2.4 degrees valgus and 8.8 degrees respectively. Radiographically, the Baumann's angle and the flexion angle were improved from 90.1 degrees to 77.3 degrees and 24.2 degrees to 37.2 degrees respectively. No patient had a prominent lateral condyle, and the operative scars were well concealed along the medial aspect of the elbow. There was one case of transient ulnar nerve paresis with residual varus.     

Supracondylar corrective osteotomy in post-traumatic cubitus varus. 3 cases in 2 patients

Supracondylar fractures of the humerus in childhood frequently result in cubitus varus deformity. Pain, functional impairment and cosmetic problems can request surgical correction. This is a report on an adult and on a mature child with such deformities. The boy had sustained three injuries with following bilateral cubitus varus and lengthening of one lower leg. Planning, surgical technique and outcome of the osteotomies are described. We should recommend the resection of a full wedge with two oblique osteotomies and internal fixation with two plates on either side of the humerus.     

A new osteotomy for cubitus varus

From 1974 to 1986, a step-cut technique of distal humerus valgus osteotomy using one cortical screw for fixation was used to correct cubitus varus deformity in 11 patients. The results were graded as excellent, eight patients, good, two, and poor, one. The poor result was secondary to persistent varus. The average humeral-elbow-wrist angle in the ten patients with valgus correction roentgenographically measured 9.3 degrees. The average amount of correction was 28.4 degrees. All patients retained their preoperative level of elbow motion. There were no radial or ulnar nerve injuries, nonunions, infections, or hypertrophic scars. The osteotomy requires careful preoperative planning and special attention to surgical detail. Large amounts of deformity may be corrected safely with a low complication rate.     

Dome osteotomy for cubitus varus in children

In 11 children, varus deformity of the elbow after supracondylar or transcondylar fractures was corrected with a dome osteotomy. The indication was usually cosmetic. The patients were followed for 5 years. The correction was satisfactory in all the cases, and there was no serious complication.     

Post-traumatic cubitus varus. Long-term follow-up of corrective supracondylar humeral osteotomy in children

The results in twenty-four patients who had had a supracondylar osteotomy of the humerus to correct post-traumatic cubitus varus were reviewed after the patients had completed skeletal growth. The average age of the patients was 7.9 years at operation and thirty-one years at the time of follow-up. The average duration of follow-up was twenty-three years. According to our grading system, seven patients had a good; six, a fair; and eleven, a poor result. All but two of the nineteen patients in whom the humero-ulnar angle had been measured preoperatively lost correction that had been obtained at operation. No correlation was found between the quality of the result and either the age of the patient at operation or the amount of correction that had been obtained at operation. The correction that was obtained at operation was maintained in the two patients in whom the cubitus varus deformity had been caused by malunion of a supracondylar fracture. However, when the deformity followed either physeal injury or supracondylar fracture with damage to the physis secondary to the initial trauma, the correction was not maintained. At the most recent follow-up, three patients were symptomatic, and fourteen were dissatisfied with the cosmetic result because of the residual deformity of the elbow or the postoperative scar, or both. In spite of the partial recurrence of the deformity, which was sometimes severe, all but the three symptomatic patients had a very good functional result. Many of these patients worked at heavy manual labor.     

Dome osteotomy for cubitus varus in children

In 11 children, varus deformity of the elbow after supracondylar or transcondylar fractures was corrected with a dome osteotomy. The indication was usually cosmetic. The patients were followed for 5 years. The correction was satisfactory in all the cases, and there was no serious complication.     

Lateral closed wedge osteotomy for cubitus varus deformity

Background:

Lateral closed wedge (LCW) osteotomy is a commonly accepted method for the correction of the cubitus varus deformity. The fixation of osteotomy is required to prevent loss of correction achieved. The fixation of the osteotomy by the two screw and figure of eight wire is not stable enough to maintain the correction achieved during surgery. In this prospective study we supplemented the fixation by Kirschner''s (K-) wires for stable fixation and evaluated the results.

Materials and Methods:

Twenty-one cases of the cubitus varus deformity following supracondylar fractures of the humerus were operated by LCW osteotomy during February 2001 to June 2006. The mean age of the patients at the time of corrective surgery was 8.5 years (range 6.6-14 years). The osteotomy was fixed by two screws with figure of eight tension band wire between them and the fixation was supplemented by passing two to three K-wires from the lateral condyle engaging the proximal medial cortex through the osteotomy site.

Result:

The mean follow-up period was 2.5 years (range seven months to 3.4 years). The results were assessed as per Morrey criteria. Eighteen cases showed excellent results and three cases showed good results. Two cases had superficial pin tract infection.

Conclusion:

The additional fixation by K wires controls rotational forces effectively besides angulation and translation forces and maintains the correction achieved peroperatively.     

Supracondylar humeral osteotomy for traumatic childhood cubitus varus deformity

Between 1958 and 1983, 45 corrective supracondylar osteotomies of the humerus were performed for post-traumatic cubitus varus deformity in 43 children. The average follow-up period was two and one-half years. Excellent or good results were obtained in 33 patients. Unsatisfactory results were seen in 12. The operation, though deceptively simple, had a significant complication rate (24%), including neuropraxia, sepsis, and cosmetically unacceptable scarring. After these problems were analyzed, the important points of technique that were noted were a comprehensive preoperative plan and a simple lateral closing wedge osteotomy, leaving the medial cortex intact and ignoring rotational deformity.     

肱骨髁上截骨张力带固定治疗成人肘内翻畸形

<正>肘内翻是肱骨髁上骨折后常见的晚期并发症[1-4]。自2006年1月至2008年12月,采用肱骨髁上截骨张力带固定治疗成人肘内翻畸形31例,疗效满意,现报告如下。     

Supracondylar osteotomy of the humerus for correction of cubitus varus

Reports of corrective procedures for cubitus varus (gunstock deformity) have emphasized the frequency of loss of position and significant complication. Modifications that have been made to the standard supracondylar osteotomy protocol include correction of the angular deformity only, without correction of rotation; an incomplete wedge osteotomy leaving the medial cortex intact by hinging the osteotomy shut on the intact cortex; and immobilization of the elbow in full extension with the forearm supinated. In a review of 16 patients following this protocol, 11 patients had excellent results, three had good results, and two had unsatisfactory results.     

肱骨髁上楔形截骨钢板内固定治疗儿童肘内翻畸形

目的　探索改进肘内翻手术内固定技术的方法。方法　取上臂远端外侧直切口 ,暴露肱骨截骨面。截骨前在截骨线近侧用 1枚螺钉将钢板固定 ,但不拧紧螺钉。将钢板旋向肱骨近侧 ,露出截骨线后作肱骨髁上楔形截骨。分别自截骨线远侧和近侧各拧入 1枚螺钉。术后用长臂石膏托固定于屈肘 90°、前臂中立位 3周。结果　 12例患儿畸形均矫正并有平均 4 .8°提携角 ,无神经血管损伤等并发症。随访 1～ 3年 ,所有病例无复发。结论　采用三孔小钢板作肘内翻截骨后内固定损伤小、操作简单、固定确实 ,手术效果良好     

Double dome osteotomy for the treatment of cubitus varus in children

Purpose

The purpose of this study was to report double dome osteotomy used to correct paediatric cubitus varus and to avoid lateral prominence after correction.

Methods

Eighteen children with cubitus varus underwent double dome osteotomy. Preoperative templating created from radiographs was used to determine the bone cuts. Double dome osteotomy created a proximal and distal cut, then varus deformity and sagittal alignment were corrected. The osteotomies were fixed with K-wires and immobilised in a long-arm cast. Radiographics and clinical histories were evaluated. Ulno-humeral angle pre and postoperative, range of motion and lateral prominent index were evaluated.

Results

The osteotomy was performed in 18 patients, with an average age of 7.5 years. All patients ended up with flexion of 130° or greater with full and symmetrical pronation and supination. The average ulno-humeral angle difference compared to the uninjured side was 3.27°. The mean of the lateral prominent index was −0.91. The mean follow up was 50.3 months (30–115 months). All of the patients had excellent clinical and radiographic alignment. No revisions were made in this series. One transient radial nerve palsy and one superficial infection occurred.

Conclusion

This series demonstrates that double dome osteotomy can provide reliable correction of varus deformity and prevent lateral prominence with a minimal complication rate.     

Corrective French's osteotomy in treatment of cubitus varus]

Cubitus varus is the most common late complication of supracondylar fracture of the humerus in children. The normal carrying angle can be restored by supracondylar osteotomy. This operation using the technique described by French. was done in 10 patients. During follow up examination motion of the cubitus was assessed and compared with an uninjured side. The x-ray examination included evaluation of the carrying angle. Favourite results were confirmed by restoration of carrying angle with minor loss of mobility of the elbow joint with no recurrence of the varus deformity during follow up.