Lateral Closing Wedge Osteotomy with or without Medialisation of the Distal Fragment for Cubitus Varus

Abstract

Purpose.To compare treatment outcomes after closing wedge osteotomy and plate fixation for cubitus varus deformity undertaken with or without medialisation of the distal fragment. Methods. Records of 21 men and 16 women aged 20 to 34 years who underwent closing wedge osteotomy and plate fixation for cubitus varus deformity with (n=21) or without (n=16) medialisation of the distal fragment were reviewed. A daily alternate flexionextension splinting was applied for one week for early restoration of full range of motion. The carrying angle and range of motion of the elbow were measured. Results. All patients regained the normal carrying angle and range of motion; none had loss of fixation or limitation in range of motion exceeding 10º. Outcomes were excellent in 23 patients and good in 9. A small bony prominence over the lateral condylar region ('lazy S' deformity) was noted in group-1 but not group-2 patients. Conclusion.Closing wedge supracondylar osteotomy with medialisation of the distal fragment was an effective treatment for cubitus varus deformity and minimised the risk of 'lazy S' deformity.

Utilization of a 3D-printed model for preoperative planning and operative osteotomy of a pediatric cubitus varus deformity

“…Supracondylar osteotomies are common procedures for the correction of posttraumatic cubitus varus in pediatric patients 16, 19. Multiple surgical techniques are described in the literature, and it is difficult to determine if one technique is verifiably superior to the others 1, 4, 7, 12, 14, 16, 19, 22. Regardless, almost all stress the importance of detailed preoperative planning as complications are common and patient satisfaction with cosmetic outcomes remains a concern 2, 3, 15…”

“…The multiplanar nature of this deformity frequently causes cosmetic issues and occasionally compromises function or results in a tardy ulnar nerve palsy 9 . Several types of corrective osteotomies have been described in the literature 1, 4, 6, 7, 11, 12, 14, 16, 19, 22. Axial imaging, typically with computed tomography, has been used to aid in preoperative planning 6, 13, 18, 20, 21, 23, 24.…”

“…However, computed tomography has many limitations compared to magnetic resonance imaging (MRI), especially with regard to the visualization of cartilage and other nonossified tissues in the skeleton of pediatric patients. With the development and increasing prevalence of 3-dimensional (3D) printing, this modality has great advantages for use in planning deformity correction 1, 6, 7, 11, 12, 14, 16, 19, 22. This study describes the use of MRI with 3D modeling and printing for the preoperative planning and operative execution of a supracondylar humerus osteotomy for correction of cubitus varus.…”

Cubitus varus complicated by snapping medial triceps and posterolateral rotatory instability

“…Other authors have described several surgical techniques for PRLI in the setting of cubitus varus deformity. 3,12 Lateral-based closing wedge osteotomies are commonly performed and stabilized with 1 or 2 plates. Distal fragment medialization is necessary to avoid accentuation of the lateral prominence, which could produce a lateral roundness of the elbow and make the cosmetic issue more pronounced.…”

“…Distal fragment medialization is necessary to avoid accentuation of the lateral prominence, which could produce a lateral roundness of the elbow and make the cosmetic issue more pronounced. 12,23 An osteotomy in 2 planes can be performed if extension or flexion deformities have to be corrected as well. The rotational component does not need to be addressed unless >10°of rotation is noted.…”