Cubitus varus: problem and solution |
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Authors: | A K Jain I K Dhammi A Arora M P Singh J S Luthra |
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Institution: | (1) Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdra, Delhi-110095, India Tel.: +91-575-721543/781897, Fax: +91-11-2290495, IN |
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Abstract: | A lateral closing wedge osteotomy was performed in 39 children with cubitus varus deformity resulting from a supracondylar
fracture. All had a deformity of 15° or more, with 5 having more than 30° of varus. The osteotomy was fixed by three different
methods. In 8 cases the osteotomy was fixed with 2 parallel Kirschner wies (group K). A modified French technique (group TBW)
was used in 25 cases and held with a figure-of-8 wire loop tightened over the screw heads. In the last 6 cases the osteotomy
was fixed with an external fixator (group EF). The only poor result (i.e. loss of carrying angle of more than 10° and loss
of flexion and extension of 20° or more) was in group K due to pin tract infection and loosening of the K-wires. In the TBW
group 5 patients lost some degree of correction, and none became infected. In the EF group no patient suffered pin tract infection
or loss of correction. Based on our experience and results, we feel that the best age at which to correct cubitus varus deformity
was 6–11 years and that the external fixator is a safe, effective and reliable method to fix the osteotomy. We propose this
method of fixation as a good alternative method to the modified French technique, especially in cases of severe cubitus varus
deformity, where removal of a large wedge can produce a big step at the osteotomy site, increasing the possibility of disengagement
of the stainless steel wire from the screw head. In addition, minor postoperative modifications of correction, if required,
can also be performed. It also avoids a second operation for implant removal.
Received: 5 August 1999 |
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