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Oka K, Miyamura S, Shiode R, Kazui A, Iwahashi T, Tanaka H, Murase T. Three-dimensional corrective osteotomy for cubitus varus deformity using patient-matched instruments. JSES Int 2024; 8:646-653. [PMID: 38707552 PMCID: PMC11064714 DOI: 10.1016/j.jseint.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Background Various methods of two or three-dimensional (3D) corrective osteotomy for cubitus varus deformity have been reported. However, whether 3D correction of cubitus varus deformity is necessary is controversial because of technical difficulties and surgical complications. This study introduced 3D simulations and printing technology for corrective osteotomy against cubitus varus deformities. Moreover, recent studies on the application of these technologies were reviewed. Methods The amount of 3D deformity was calculated based on the difference in 3D shape between the affected side and the contralateral normal side. Patient-matched instruments were created to perform the actual surgery as simulated. Further, a 3D corrective osteotomy was performed using patient-matched instruments for cubitus varus deformity in pediatric and adolescent patients. The humerus-elbow-wrist angle, tilting angle, and elbow ranges of motion were evaluated. Results Humerus-elbow-wrist angle and tilting angle were corrected from -21° to 14° and from 30° to 43°, respectively, in the pediatric patient and from -18° to 10° and from 20° to 40°, respectively, in the adolescent patient. The elbow flexion and extension angles changed from 130° to 140° and from 20° to 10°, respectively, in the pediatric patient and from 120° to 130° and from 15° to 0°, respectively, in the adolescent patient. Conclusion The 3D computer simulations and the use of patient-matched instruments for cubitus varus deformity are reliable and can facilitate an accurate and safe correction. These technologies can simplify the complexity of 3D surgical procedures and contribute to the standardization of treatment for cubitus varus deformity.
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Affiliation(s)
- Kunihiro Oka
- Department of Orthopaedic Biomaterial Science, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Satoshi Miyamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Ryoya Shiode
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Arisa Kazui
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Toru Iwahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Hiroyuki Tanaka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Bellland General Hospital, Sakai, Osaka, Japan
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Schlauch AM, Manske MC, Leshikar HB, Davids JR. Posttraumatic Cubitus Varus: Respect the Columns. J Pediatr Orthop 2024:01241398-990000000-00520. [PMID: 38515131 DOI: 10.1097/bpo.0000000000002671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Posttraumatic cubitus varus is a multiplanar deformity that results from an improperly reduced supracondylar humerus fracture. The prevention of posttraumatic cubitus varus hinges on the stable restoration of all 3 columns of the distal humerus while avoiding malrotation. The collapse of any column leads to varying degrees of deformity in the coronal, sagittal, and/or axial plane. The purpose of this article is to explain the pattern of the deformity and use this to summarize preventative tactics for avoiding its described sequelae. We also summarize, illustrate, and present case examples for the various osteotomies used to correct the deformity, and speculate future directions.
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Affiliation(s)
- Adam M Schlauch
- Department of Orthopaedic Surgery, San Francisco Orthopaedic Residency Program/St. Mary's Medical Center, San Francisco
| | - Mary Claire Manske
- Department of Orthopaedic Surgery, Shriners Hospitals for Children-Northern California
- Department of Orthopaedic Surgery, University of California Davis Health, Sacramento, CA
| | - Holly B Leshikar
- Department of Orthopaedic Surgery, Shriners Hospitals for Children-Northern California
- Department of Orthopaedic Surgery, University of California Davis Health, Sacramento, CA
| | - Jon R Davids
- Department of Orthopaedic Surgery, Shriners Hospitals for Children-Northern California
- Department of Orthopaedic Surgery, University of California Davis Health, Sacramento, CA
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Khurana A, Kumar N, Chugh V, Pattabiraman K, Singh J, Verma G. A systematic review of techniques for step cut osteotomy in cubitus varus: A comprehensive analysis. J Orthop 2024; 49:81-89. [PMID: 38144240 PMCID: PMC10746393 DOI: 10.1016/j.jor.2023.11.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/17/2023] [Accepted: 11/19/2023] [Indexed: 12/26/2023] Open
Abstract
Background Cubitus varus, a common post-traumatic deformity of the elbow in children, poses challenges for both patients and surgeons. Step cut osteotomy has emerged as a reasonable surgical technique to address this condition, offering multiple approaches and modifications. Methods We present a comprehensive systematic review of techniques for step cut osteotomy in cubitus varus, analyzing 13 studies that meet our inclusion criteria. These studies encompass diverse patient populations, including pediatric and adult cases, and span different geographical regions. Results Our systematic review explores three primary osteotomy techniques-Classic Step-Cut Osteotomy, Reverse V Osteotomy, and Modified Step Cut Osteotomy-along with their modifications, providing surgeons with valuable options for individualized correction. Functional outcomes showcase improvements in range of motion, functional scores, and carrying angle, highlighting the technique's efficacy in restoring elbow function and enhancing quality of life. Radiological evaluations demonstrate successful corrections of various angles and achievement of bony union, reinforcing the stability and anatomical improvements achieved through step cut osteotomy. Conclusions Complication rates are notably low, with transient nerve palsies being the most commonly encountered, often resolving within months. Implant failure and other complications are infrequent, underlining the safety and reliability of step cut osteotomy as a surgical intervention for cubitus varus.While the predominance of retrospective studies and heterogeneity across included studies warrant caution, our systematic review provides a robust and diverse synthesis of evidence. It underscores the significance of step cut osteotomy in managing cubitus varus deformity, emphasizing its versatility, favourable outcomes, and safety profile. Further research with rigorous designs and longer follow-up periods will enhance our understanding of step cut osteotomy's role in cubitus varus correction.
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Affiliation(s)
- Ankit Khurana
- Dr. BSA Medical College and Hospital, Orthopaedics, India
| | - Nitin Kumar
- Dr. BSA Medical College and Hospital, Orthopaedics, India
| | - Vandana Chugh
- Dr. BSA Medical College and Hospital, Anaesthesia, India
| | | | - Jujhar Singh
- Dr. BSA Medical College and Hospital, Orthopaedics, India
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Masquijo J, Artigas C, Hernández Bueno JC, Sepúlveda M, Soni J, Valenza W, Fazal F, Shah AS. Surgical correction of cubitus varus in children with a lateral closing-wedge osteotomy: a comparison between two different techniques. J Pediatr Orthop B 2024; 33:167-173. [PMID: 37158126 DOI: 10.1097/bpb.0000000000001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVES The primary objective of the present study is to compare the radiographic outcomes and complications of two different techniques for lateral closing-wedge osteotomy in pediatric patients with cubitus varus. METHODS We retrospectively identified patients treated at five tertiary care institutions: 17 underwent the Kirschner-wire (KW) technique, and 15 patients were treated with the mini external fixator (MEF) technique. Demographic data, previous treatment, pre- and postoperative carrying angle (CA), complications and additional procedures were recorded. Radiographic evaluation included assessment of the humerus-elbow-wrist angle (HEW), and the lateral prominence index (LPI). RESULTS Patients treated with both KW and MEF achieved significant improvements in clinical alignment (mean pre-op CA -16 ± 6.1 degrees to mean post-op 8.9 ± 5.3 degrees, P < 0.001). There were no differences in final radiographic alignment or radiographic union time; however, time to achieve full elbow motion was faster in the MEF group (13.6 versus 34.3 weeks, P = 0.4547). Two patients (11.8%) in the KW group experienced complications, including one superficial infection and one failed correction that required unplanned revision surgery. Eleven patients in the MEF group underwent a planned second surgical procedure for hardware removal. CONCLUSIONS Both fixation techniques are effective at correcting cubitus varus in the pediatric population. The MEF technique may have the advantage of shorter recovery of elbow range of motion but may require sedation for hardware removal. The KW technique may present a slightly higher complication rate.
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Affiliation(s)
- Javier Masquijo
- Department of Pediatric Orthopaedics, Sanatorio Allende, Córdoba, Argentina
| | | | | | | | - Jamil Soni
- Hospital del Trabalhador, Curitiba, Brazil
| | | | - Faris Fazal
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Apurva S Shah
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Hoffman B, Lee A, DiGiacomo D, Maag S, Liu J, Skie M. A systematic review of the operative techniques for treating cubitus varus deformity in children. J Pediatr Orthop B 2024:01202412-990000000-00180. [PMID: 38375863 DOI: 10.1097/bpb.0000000000001167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
A systematic review of the operative techniques for treating cubitus varus deformity in children was performed using research databases including PubMed and Embase. Outcome measurements included mean angular correction of the humerus-elbow-wrist angle, complications, revisions and outcome scores. A total of 45 papers and 911 patients were included. Lateral closing wedge osteotomy (LCWO) (427 patients) was the most common procedure and 5.56% of these patients experienced lateral condylar prominence. This technique had the highest revision rate at 3%. The step-cut osteotomy (111 patients) yielded zero postoperative infections or loss of motion. Distraction osteogenesis (92 patients) was the least common technique. Superficial pin tract infections occurred in 18% of patients and 88.04% of patients reported excellent results, the highest of any technique in this study. The infection rate of dome osteotomy (151 patients) was 9.45% and 4.72% of patients experienced loss of motion. 3D osteotomy (130 patients) had no infections, 87.78% of patients reported excellent outcomes, and 2.22% of patients reported poor outcomes, the lowest of all techniques. For unidimensional correction, LCWO provides a technically simple procedure and reasonable outcomes. Step-cut osteotomy has less lateral condylar prominence but is more complicated than LCWO. Distraction osteogenesis is a minimally invasive alternative to LCWO and step-cut osteotomy, but it has more superficial infections and can be bothersome to patients. For a multidimensional correction, 3D osteotomy is superior to dome osteotomy due to its lower infection rate and higher rate of functionally excellent outcomes.
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Affiliation(s)
- Brett Hoffman
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio, USA
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Martínez-Álvarez S, Galán-Olleros M, Alonso-Hernández J, Vara-Patudo I, Miranda-Gorozarri C, Palazón-Quevedo Á. Guided Growth for the Treatment of Cubitus Varus in Children: Medium- to Long-Term Results. J Clin Med 2023; 12:jcm12072632. [PMID: 37048715 PMCID: PMC10095142 DOI: 10.3390/jcm12072632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/08/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023] Open
Abstract
Correction of cubitus varus is commonly attempted through supracondylar humeral osteotomy. We hypothesized that lateral distal humeral hemiepiphysiodesis (LDHH) could be used to gradually correct this deformity in children. We conducted a retrospective study including all patients who underwent LDHH with the eight-Plate system between 2008 and 2018, with a minimum 4-year follow-up. We collected demographic, fracture-related, pre- and postoperative clinical (carrying angle (CA), ROM), and radiological data (humeral-ulnar angle (HUA), Baumann angle (BA), shaft-condylar angle (SCA), lateral capitellohumeral angle (LCHA)), as well as data on complications and satisfaction at last follow-up. Fifteen patients were included, with a median follow-up of 81 (64–103) months. All the variables had improved significantly as follows: CA −16 (−18 to −9)°, HUA −16 (−19 to −12)°, BA −11 (−17 to −7)°, SCA 7.5 (3.3 to 13.8)°, LCHA −4.8 (−6.8 to 0.6), flexion 10 (0 to 24)°, and extension 10 (0 to 10)°. The annual correction rate in terms of HUA was 2.41° (1.9 to 3.2). There were 5 cases of aseptic screw loosening, 4 of them requiring replacement, without relation to age at surgery (p = 0.324). Most patients (86.67%) were satisfied, and a relationship was found with younger age at surgery (p = 0.037). In conclusion, preliminary results show that LDHH with the eight-Plate system is an effective technique for mild to moderate cubitus varus deformity correction in children. Patients should be advised of the relatively long duration of implant retention and the possibility of reoperation for screw replacement or implant removal.
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Affiliation(s)
- Sergio Martínez-Álvarez
- Pediatric Orthopaedics, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Av. de Menéndez Pelayo 65, 28009 Madrid, Spain
| | - María Galán-Olleros
- Pediatric Orthopaedics, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Av. de Menéndez Pelayo 65, 28009 Madrid, Spain
| | - Javier Alonso-Hernández
- Pediatric Orthopaedics, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Av. de Menéndez Pelayo 65, 28009 Madrid, Spain
| | - Isabel Vara-Patudo
- Pediatric Orthopaedics, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Av. de Menéndez Pelayo 65, 28009 Madrid, Spain
| | - Carlos Miranda-Gorozarri
- Pediatric Orthopaedics, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Av. de Menéndez Pelayo 65, 28009 Madrid, Spain
| | - Ángel Palazón-Quevedo
- Pediatric Orthopaedics, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Av. de Menéndez Pelayo 65, 28009 Madrid, Spain
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Singh P, Krishna A, Arora S, Mehta R, Gupta V, Kumar V. Shortening dome osteotomy for correction of severe cubitus varus secondary to malunited supracondylar fractures in children. Arch Orthop Trauma Surg 2023; 143:1371-1378. [PMID: 35039914 DOI: 10.1007/s00402-021-04288-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 11/27/2021] [Indexed: 11/02/2022]
Abstract
The results of conventional corrective procedures remain suboptimal for severe cubitus varus deformities (> 30°) in children. We present the results of shortening dome osteotomy for the correction of such deformities. PATIENTS AND METHODS We present retrospective review of prospectively collected data of 18 patients (11 boys and 7 girls) who underwent shortening dome osteotomy between January 2011 and December 2019 for severe cubitus varus deformities (> 30°) secondary to malunited supracondylar fracture. The procedure involved the removal of convexo-concave bone (5-8 mm wide) between the two domes. Humero-ulnar angles, lateral condylar prominence index (LCPI), and elbow range of movements were recorded preoperatively and postoperatively. RESULTS Mean age was 7.5 years (range 5 years-11 years). Indication for surgery was poor cosmesis in all the patients and tardy ulnar nerve symptoms in three patients. Mean preoperative humero-ulnar angle was 26.1° varus (range 22°-34°), while it was 7.1° valgus (range 0°-12°) for contralateral normal elbow. They were followed for a mean duration of 2.2 years (range 12 months-5.8 years). The mean postoperative valgus angle achieved was 7.3° (range 2°-12°) as total angular correction achieved was 34.4° (range 30°-44°) (p < 0.001). Radiological healing was observed in all the patients at mean duration of 7.1 weeks (range 5 weeks-9 weeks). Mean preoperative and postoperative LCPI were - 2.4 (range +4.7 to - 10.5) and - 1.7 (range +4.5 to - 5.1), respectively (p = 0.595). Three patients had pin tract infections and two of them responded to aseptic dressings and oral antibiotics, while another required early pin removal and additional protection in splint. All patients regained preoperative arc of motion within 6 months after the procedure. CONCLUSION Shortening dome osteotomy is a safe and effective method for correcting severe cubitus varus deformities (> 30°) secondary to malunited supracondylar fracture in children.
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Affiliation(s)
- Pritish Singh
- Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi, 110002, India
| | - Anant Krishna
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, Delhi, 110029, India
| | - Sumit Arora
- Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
| | - Rohan Mehta
- Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi, 110002, India
| | - Vikas Gupta
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Associated Safdarjung Hospital, New Delhi, 110029, India
| | - Vinod Kumar
- Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi, 110002, India
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Wu X, Lin R, Chen J, Chen S. Closed reduction with percutaneous Kirschner wire drill-and-pry for pediatric supracondylar humeral fractures with bony callus formation and delayed presentation. Injury 2023; 54:547-551. [PMID: 36529549 DOI: 10.1016/j.injury.2022.11.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Supracondylar humeral fractures are the most common type of pediatric elbow fractures, and are primarily treated using closed reduction and percutaneous pinning. For patients who are treated ≥14 days after the injury, after callus formation has occurred, closed reduction is usually not possible. The purpose of this study is to report the clinical outcomes of closed reduction with percutaneous Kirschner wire (K-wire) drill-and-pry for the delayed treatment of pediatric supracondylar humeral fractures with bony callus formation. METHODS We retrospectively reviewed the data of 16 patients who underwent percutaneous K-wire drill-and-pry between November 2019 and August 2021 for the treatment of supracondylar humeral fractures with bony callus formation ≥14 days after the injury. Clinical outcomes were assessed using the Flynn criteria. The postoperative Baumann angle and pin configuration were evaluated using x-ray examinations. RESULTS All patients were followed up for 8-28 months (average, 16.63 months). The fractures healed in 4-6 weeks (average, 4.38 weeks). The operative time ranged from 10 to 124 min (average, 35.12 min). No iatrogenic vascular or nerve injury occurred. No patient developed cubitus varus. According to the Flynn criteria, 12 patients had excellent outcomes, 2 patients had good outcomes, 1 patient had a fair outcome and 1 patient had a poor outcome. CONCLUSION Closed reduction with percutaneous K-wire drill-and-pry is a mini invasive technique for supracondylar humeral fractures with bony callus formation in children. Most patients had a good clinical and cosmetic outcomes without scarring.
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Affiliation(s)
- Xinwu Wu
- Department of Orthopedics, Fuzhou Second Hospital, Fuzhou 350007, China; Department of Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou 350007, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou 350007, China; Fuzhou Trauma Medical Center, Fuzhou 350007, China
| | - Ran Lin
- Department of Orthopedics, Fuzhou Second Hospital, Fuzhou 350007, China
| | - Jinchen Chen
- Department of Orthopedics, Fuzhou Second Hospital, Fuzhou 350007, China
| | - Shunyou Chen
- Department of Orthopedics, Fuzhou Second Hospital, Fuzhou 350007, China; Department of Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou 350007, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou 350007, China; Fuzhou Trauma Medical Center, Fuzhou 350007, China.
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Supracondylar Dome Osteotomy With a Posterior Triceps-splitting Approach for Acute Correction of Posttraumatic Cubital Axis Deformities in Adolescent Patients. J Pediatr Orthop 2023; 43:e17-e24. [PMID: 36509455 DOI: 10.1097/bpo.0000000000002289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Fractures around the elbow are common in children. Their management remains challenging. Inadequate treatment often leads to malunion, causing growth disturbance or avascular necrosis. This can develop into cubital axis deformities. This study evaluated our modified supracondylar dome osteotomy technique for acute correction of posttraumatic cubital axis deformities in adolescent patients. METHODS Eighteen cases of posttraumatic cubital axis deformity that underwent acute correction through supracondylar dome osteotomy in our department between 2012 and 2019 were retrospectively evaluated. The radiologic results were measured through the carrying angle. The clinical functional outcomes were assessed using the Mayo Elbow Performance Index. RESULTS No neurovascular injuries occurred and there was no notable loss of muscular strength or functional deficiencies in any of the patients. Symmetrical cubital axes were achieved in all cases. All cases were consolidated in a timely matter and no malunion was observed upon consolidation. Besides 1 case of hardware damage caused by a severe fall due to heavy alcohol intoxication, there was no correction loss, no secondary displacement, and no implant-related discomfort. None of the patients were left with a limited range of motion or reduced weight-bearing capacity. An excellent level of elbow functionality was achieved in all cases, with an average Mayo Elbow Performance Index of 97.8. CONCLUSIONS The supracondylar dome osteotomy technique showed promising results in both radiologic outcomes and clinical performance, with a low complication rate. The dome-shaped osteotomy allows simultaneous multiplanar correction of not only varus or valgus deformities but also additional extension or flexion deformities. This technique also enables translation of the distal fragment in the frontal plane, which contributes to a more balanced anatomic geometry of the distal humerus. We consider the posterior triceps-splitting approach to be a safe technique that preserves muscle strength and improves the cosmetic appearance of the surgical scar. We recommend a cast-free plate fixation to allow early movement after surgery. We believe any residual deformities that present 18 months after the initial trauma should be addressed through surgical correction before clinical symptoms become apparent to avoid the chronic manifestation of functional deficiencies. LEVEL OF EVIDENCE Level IV, therapeutic study, case series.
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10
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Klahs KJ, Polmear MM, Transtrum B, Rodriguez E, Abdelgawad A, Thabet AM. Correction of Cubitus Varus Using Computer-Assisted Hexapod Multiplanar External Fixators: A Report of 3 Cases. JBJS Case Connect 2023; 13:01709767-202303000-00009. [PMID: 36821393 DOI: 10.2106/jbjs.cc.22.00284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
CASE Three male patients, 8-, 13-, and 18-year-old, all developed posttraumatic cubitus varus elbow deformity after distal humerus supracondylar fractures. Each underwent a distal humerus osteotomy with application of a hexapod external fixator to gradually correct the deformity. CONCLUSION In patients with cubitus varus malunion, the stability of the hexapod external fixation, percutaneous nature of the osteotomy, and availability of running a residual computer-assisted program provides a consistent technique for deformity correction.
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Affiliation(s)
- Kyle J Klahs
- Texas Tech University Health Science Center, Paul Foster School of Medicine, El Paso, Texas.,William Beaumont Army Medical Center, Fort Bliss, El Paso, Texas
| | - Michael M Polmear
- Texas Tech University Health Science Center, Paul Foster School of Medicine, El Paso, Texas.,William Beaumont Army Medical Center, Fort Bliss, El Paso, Texas
| | | | | | | | - Ahmed M Thabet
- Texas Tech University Health Science Center, Paul Foster School of Medicine, El Paso, Texas
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11
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Shi Q, Yan H, Chen S, Cao Q, Xu Y. Effect of a functional brace in combination with physical therapy for early correction of cubitus varus in young children. BMC Pediatr 2022; 22:523. [PMID: 36057568 PMCID: PMC9440591 DOI: 10.1186/s12887-022-03578-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to assess the clinical and radiologic outcomes of a functional brace in combination with physical therapy (FBPT) for early correction of cubitus varus in young children. Methods Eighteen consecutive patients with cubitus varus secondary to supracondylar fractures were enrolled between July 2017 and March 2019. We used the FBPT technique to correct varus and sagittal plane deformity for early cubitus varus in young children. The clinical evaluation included measurement of varus angulation, sagittal plane, and range of motion at three, six, and twelve months post-intervention. The clinical and radiographic results were assessed according to the Bellemore criteria. Results Pre-treatment humerus-elbow-wrist (HEW) angle measured on the affected side (varus deformity) ranged between -38° and -12° (average, -23.2°) while the post-treatment HEW angle ranged between -10° and + 15° (average, 8.8°). Compared with the unaffected side, no statistically significant difference was found in the affected side post-intervention (P > 0.05). According to the Bellemore criteria, we got excellent results in fourteen patients (77.8%), good results in three patients (16.7%), and poor result in one patient (5.5%). All patients and their parents (except one patient with residual varus deformities) were satisfied with the functional and cosmetic outcomes. Conclusions The FBPT is effective for the treatment of cubitus varus in children, especially for young children within 6 months of the injury.
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Affiliation(s)
- Qiang Shi
- Department of Spine Surgery, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, 410018, People's Republic of China
| | - Hua Yan
- Department of Pediatric Orthopedics, Shantou University Guangzhou Huaxin Orthopedic Hospital, Guangzhou, 510507, People's Republic of China
| | - Shu Chen
- Department of Pediatric Orthopedics, Shantou University Guangzhou Huaxin Orthopedic Hospital, Guangzhou, 510507, People's Republic of China
| | - Qian Cao
- Department of Orthopedics, Xiangtan Chinese Medicine Hospital, Xiangtan, 411100, People's Republic of China.
| | - Yuxia Xu
- Department of Spine Surgery, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, 410018, People's Republic of China.
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Greve F, Müller M, Wurm M, Biberthaler P, Singer G, Till H, Wegmann H. Standalone Axial Malrotation after Pediatric Supracondylar Fracture Does Not Seem to Be an Indication for Immediate Postoperative Revision Surgery. CHILDREN 2022; 9:children9071013. [PMID: 35883997 PMCID: PMC9322951 DOI: 10.3390/children9071013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022]
Abstract
Rotational spurs as evidence for post-surgical malrotation are frequently observed when treating pediatric supracondylar humeral fractures (SCHFs). This study aimed to investigate the long-term outcome of a pediatric cohort with unrevised axial malrotation and to discuss the indication for revision surgery. Postoperative radiographs of children treated for SCHFs over eight years were retrospectively analyzed. Children with radiological signs of malrotation (von Laer malrotation quotient) were invited for a follow-up clinical and radiological examination. Among 338 treated children, 39 (11.5%) with a mean age of 5.3 years (range 1.8–11.7 years) showed radiological signs for postoperative malrotation and were not revised and therefore invited to participate in the study. Twelve patients (31%) with a mean age of 11.3 years (range 8.8–13.8 years) took part in the follow-up examination after a mean of 7.1 years (range 5.4 to 11.3 years). The mean postoperative van Laer malrotation quotient was 0.15 (range 0.11–0.2). At follow-up, the range of motion of the elbow joint was not significantly different compared to the contralateral side. Apart from the humeral ulnar angle (p = 0.023), there were no significant differences in the radiological axes. The Flynn criteria were excellent and good in 90% of the cases. The mean was 1.7 points indicating excellent subjective results. Standalone postoperative malrotation did not lead to an adverse long-term outcome in a small cohort of pediatric patients with SCHFs and did not indicate immediate postoperative revision surgery. However, further investigations with larger cohorts should verify whether additional criteria such as stability of the osteosynthesis and signs for increasing valgus or varus displacement in the follow-up radiographs should get more importance in decision making.
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Affiliation(s)
- Frederik Greve
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.M.); (M.W.); (P.B.); (H.W.)
- Correspondence: ; Tel.: +49-89-41402126
| | - Michael Müller
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.M.); (M.W.); (P.B.); (H.W.)
| | - Markus Wurm
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.M.); (M.W.); (P.B.); (H.W.)
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.M.); (M.W.); (P.B.); (H.W.)
| | - Georg Singer
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, 8063 Graz, Austria; (G.S.); (H.T.)
| | - Holger Till
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, 8063 Graz, Austria; (G.S.); (H.T.)
| | - Helmut Wegmann
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.M.); (M.W.); (P.B.); (H.W.)
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Shi Q, Yan H, Yang M, Chen S, Lu B. Comparative evaluation of pinning and cast fixation vs. external fixation after lateral closing-wedge osteotomy for cubitus varus in children. J Shoulder Elbow Surg 2022; 31:481-487. [PMID: 34052443 DOI: 10.1016/j.jse.2021.04.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cubitus varus has been regarded as a poor functional and cosmetic consequence of supracondylar humerus fracture in children. The aim of this study was to assess the clinical and radiologic outcomes of cubitus varus treatments based on fixation methods: Kirschner (K)-wire and cast fixation or external fixation. METHODS Forty consecutive patients with cubitus varus secondary to supracondylar fractures were retrospectively enrolled between October 2015 and December 2018. Following lateral closing-wedge osteotomy, those undergoing K-wire and cast fixation were included in group A (n = 21) and those who were treated with external fixation comprised group B (n = 19). We measured the bony union, elbow joint range of motion, and carrying angle. The clinical and radiographic results were assessed according to the Bellemore criteria. RESULTS No significant difference was found between the 2 groups in terms of age, gender, operation duration, union time, and postoperative elbow range of motion (P > .05). A significant difference was noted, however, in postoperative carrying angle and results according to Bellemore criteria in group B (P < .05). No nonunion, myositis ossificans, or neurovascular injury was found at follow-up in the 2 groups. In group A, revision surgery was needed for residual varus in 1 patient and lateral condylar prominence was found in 2 patients. In group B, a superficial pin-site infection occurred in 2 patients, who were treated successfully with oral antibiotics. CONCLUSIONS Both K-wire and external fixation after lateral closing-wedge osteotomy are reliable and effective for the treatment of cubitus varus in children. Compared with the K-wire method, external fixation achieves better functional and cosmetic results with a shorter learning curve.
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Affiliation(s)
- Qiang Shi
- Department of Spine Surgery, the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Hua Yan
- Department of Pediatric Orthopedics, Women and Children's Hospital of Guangdong Province, Guangzhou, China
| | - Ming Yang
- Department of Pediatric Orthopedics, Shantou University Guangzhou Huaxin Orthopedic Hospital, Guangzhou, China
| | - Shu Chen
- Department of Pediatric Orthopedics, Women and Children's Hospital of Guangdong Province, Guangzhou, China
| | - Bangbao Lu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China.
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Miura Y, Shimura H, Fujita K, Nimura A. Understanding the susceptibility to lateral condyle fracture by analyzing unaffected Baumann's angle in children with distal humeral fracture. J Orthop Sci 2022; 27:211-214. [PMID: 33423856 DOI: 10.1016/j.jos.2020.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/04/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Previous studies have shown that posttraumatic cubitus varus deformity in children is somehow related to subsequent humeral lateral condyle fracture. Moreover, we had previously encountered an exactly similar case. In this study, we aim to understand whether there is a morphological difference between pediatric supracondylar and lateral condyle fracture of the humerus by comparing Baumann's angle of the unaffected elbow. METHODS We conducted a retrospective evaluation of 40 cases of supracondylar fractures (36 boys, 4 girls) and 20 cases of lateral condyle fractures (16 boys, 4 girls) at a single facility between January 2014 and December 2018. The unaffected Baumann's angles and lateral capitellohumeral angles of both groups were measured by two orthopedic surgeons and analyzed using Welch's t-test. The effect size was also calculated using Cohen's d, and intraclass correlation coefficients were applied for intra-rater and inter-rater reliability. RESULTS The average age of patients in the supracondylar fracture group was 6.78 years and that in the lateral condyle fracture group was 5.70 years. No significant differences were observed between gender and fracture type, between laterality and fracture type, and in the lateral capitellohumeral angles between the groups. Baumann's angle was significantly less in the lateral condyle fracture group (17.27° ± 4.68°) than in the supracondylar fracture group (20.28° ± 3.10°) as analyzed by Welch's t-test (p = 0.015). The effect size was 0.76. Each of the intra-rater reliabilities were 0.97 and 0.96, whereas the inter-rater reliability was 0.75. CONCLUSIONS A significant morphological difference was found between the supracondylar fracture group and the lateral condyle fracture group. The loss of Baumann's angle which tends to occur after the healing of supracondylar fracture may increase the susceptibility to lateral condyle fracture. Orthopedic surgeons should repair and fix supracondylar fractures appropriately to avoid an ipsilateral second fracture, such as lateral condyle fracture.
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Affiliation(s)
- Yugo Miura
- Department of Orthopedic Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 279-0001, Japan; Department of Applied Regenerative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Haruhiko Shimura
- Department of Orthopedic Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 279-0001, Japan.
| | - Koji Fujita
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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Wu J, Tao R, Wei K, Yu B, Li J. [Application of picture archiving and communication systems in lateral wedge osteotomy for cubitus varus deformity in teenagers]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:836-840. [PMID: 34308590 DOI: 10.7507/1002-1892.202101059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate effectiveness of picture archiving and communication systems (PACS) in lateral wedge osteotomy for cubitus varus deformity in teenagers. Methods A clinical data of 16 teenagers with cubitus varus deformity between July 2014 and July 2016 was retrospectively analyzed. All patients were treated with lateral wedge osteotomy and fixed with plate. Before operation, the osteotomy design (the osteotomy angle and length) was done in the PACS, including the carrying angle of healthy limb and the varus angle of affected side. There were 10 males and 6 females, with an average age of 11.4 years (range, 10-17 years). The disease duration ranged from 2 to 10 years (mean, 5.6 years). The preoperative X-ray film showed that the supracondylar fractures of the humerus had all healed, and 9 cases had internal rotation deformity; the varus angle of the affected side was 19.5°-33.5°. After operation, the fracture healing and cubitus varus deformity correction were observed by X-ray films, the elbow function was evaluated by Mayo scoring, and the elbow range of motion was detected. Results There was no significant difference between the actual intraoperative osteotomy angle and length and the preoperative design ( P>0.05). The hospital stay was 2-8 days, with an average of 4.5 days. No complication such as incision infection or ulnar nerve injury occurred. All 16 cases were followed up 12-18 months, with an average of 14 months. X-ray films showed that the osteotomy healed at 2-7 months after operation, with an average of 2.5 months. The internal fixators were removed within 8-14 months after operation (mean, 12.0 months). X-ray films measurement showed that the carrying angle of the affected side recovered to (10.3±2.0)° at 1 day after operation, which was not significantly different from that of the healthy side [(10.6±1.5)°] before operation ( t=0.480, P=0.637). The carrying angle of the affected side was (9.8±2.6)° at 1 year after operation, which was not significantly different from that of the healthy side [(10.4±1.6)°] at the same time point ( t=0.789, P=0.438). At 1 year after operation, the ranges of flexion and extension of affected side were (131.6±8.4)° and (6.4±2.6)°, respectively; and the ranges of flexion and extension of healthy side were (134.2±6.3)° and (5.9±2.2)°, respectively. There was no significant difference between the healthy and affected sides ( t=1.143, P=0.262; t=0.587, P=0.561). The elbow joint function at 1 year after operation evaluated by Mayo scoring standard rated as excellent in 9 cases, good in 6 cases, and fair in 1 case, and the excellent and good rate was 93.7%. Conclusion Before lateral wedge osteotomy, the PACS is used to design the osteotomy angle and length, which can guide the operation and make the osteotomy more accurate and simple.
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Affiliation(s)
- Jianqun Wu
- Department of Bone and Joint, the First Affiliated Hospital (Shenzhen People's Hospital), School of Medicine, Southern University of Science and Technology, Shenzhen Guangdong, 518055, P.R.China
| | - Rui Tao
- Department of Orthopedics and Traumatology, Zengcheng Branch of Nanfang Hospital, Southern Medical University, Guangzhou Guangdong, 511325, P.R.China
| | - Kuanhai Wei
- Department of Orthopedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou Guangdong, 510515, P.R.China
| | - Bin Yu
- Department of Orthopedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou Guangdong, 510515, P.R.China
| | - Jianwei Li
- Department of Orthopedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou Guangdong, 510515, P.R.China
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Lahoti O, Akilapa O. Not Kidding! Sequalae of elbow trauma in children. J Clin Orthop Trauma 2021; 20:101471. [PMID: 34194970 PMCID: PMC8217682 DOI: 10.1016/j.jcot.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022] Open
Abstract
Elbow injuries are common in children and while majority heal very well, some result in deformities of the elbow. Although deformities such as cubitus varus and non-progressive cubitus valgus are considered cosmetic by the paediatric orthopaedic surgeons and intentionally ignored, they are not always benign and can result in functional deficit due to instability, pain, tardy nerve palsies and osteoarthritis later in life. Similarly congenital and developmental conditions that do not cause major functional loss in childhood, become very disabling in adults due to increasing functional demands. Congenital radial head dislocation and radioulnar synostosis fall into this category. In this paper we discuss clinical presentation, treatment options and outcomes of common elbow conditions presenting later in the life.
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Affiliation(s)
- Om Lahoti
- Diploma in Gait Analysis (Stratchclyde), Consultant Adult and Paediatric Orthopaedic Surgeon, King's College Hospital, London, SE5 9RS, United Kingdom,Corresponding author. King's College Hospital, London, SE5 9RS, United Kingdom.
| | - Oluwasegun Akilapa
- Sports/Exercise Medicine, Specialist Registrar in Orthopaedics, King's College Hospital, London, SE5 9RS, United Kingdom
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Solichin I, Sandjaya G, Prabowo I, Dwi Putra NH, Rhatomy S. The lateral curved osteotomy for cubitus varus deformity in children: A case report and literature review. Ann Med Surg (Lond) 2021; 65:102315. [PMID: 33996051 PMCID: PMC8091879 DOI: 10.1016/j.amsu.2021.102315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Cubitus 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 case Two 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. Conclusions The combination of French and Dome osteotomy for treatment of cubitus varus deformity can provide an easy, safe, and reproducible result. Cubitus varus deformity. Malunited supracondylar humerus. French osteotomy. Dome osteotomy.
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Affiliation(s)
- Iman Solichin
- Orthopaedic Hospital Purwokerto, Network Hospital of Department Orthopaedics and Traumatology, Cipto Mangunkusumo General Hospital, Indonesia
| | - Gede Sandjaya
- Soedarso Hospital Pontianak, Network Hospital of Department Orthopaedics and Traumatology, Cipto Mangunkusumo General Hospital, Indonesia
| | - Ido Prabowo
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Nurmansyah Hata Dwi Putra
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Sholahuddin Rhatomy
- Sport and Adult Reconstruction Division, Department of Orthopedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Hong P, Liu R, Rai S, Li J. Case Report: Locking Plate for Cubitus Varus Correction in a 7-Year-Old Girl With Osteogenesis Imperfecta. Front Pediatr 2021; 9:781703. [PMID: 35096704 PMCID: PMC8790532 DOI: 10.3389/fped.2021.781703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Cubitus varus deformity is a common complication of untreated elbow fractures in children. However, cubitus varus in osteogenesis imperfecta (OI) children is a rare but challenging situation. To the author's knowledge, this is the first study discussing the correction of cubitus varus deformity in patient with OI. Case Presentation: Here we report a case of a 7-year-old OI girl with cubitus varus deformity due to a supracondylar fracture of humerus 3 year ago. The patient's parent gave a history of supracondylar fracture of left humerus in 2015. Without medical intervention, the patient was admitted into our institution for corrective surgery with the diagnosis of osteogenesis imperfecta and cubitus varus deformity in the left arm. Result: Medications including calcium, vitamin D and bisphosphonates were administered before the corrective surgery of cubitus varus, and a single locking plate was used to fixate the osteotomy. After the surgery, the appearance and range of motion (ROM) of the left arm was almost normal. Combined with gradual rehabilitation, the ROM of the left arm was normal without pain during daily use within the 1-year follow up. The hardware was removed as the nailing of the forearm fractures was performed at the same time. In the latest follow-up in September 2021, the appearance and ROM of the left arm was normal. Conclusion: Cubitus varus is a common deformity in children with elbow injuries, but it presents a challenging situation in compound fractures in OI patients. Locking plate combined with meticulous pharmacological intervention provides a good option for corrective surgery of cubitus varus in patients with OI.
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Affiliation(s)
- Pan Hong
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruikang Liu
- First School of Clinical Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Saroj Rai
- Department of Orthopaedics and Trauma Surgery, Blue Cross Hospital, Kathmandu, Nepal
| | - Jin Li
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Wan W, Wu W, Li G, Pan S, He E, Hu B, Shan B, Chen C. A modified rotating isosceles triangle osteotomy using a 3D-printed patient-specific guide for the treatment of cubitus varus in children: a case report and literature review. Transl Pediatr 2021; 10:215-222. [PMID: 33633956 PMCID: PMC7882299 DOI: 10.21037/tp-20-101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
After corrective osteotomy of cubitus varus, the lateral condylar prominence is a common problem, which is believed to be due to the unequal relative cuts of the lateral base wedge osteotomy. Therefore, several related solutions have been proposed, such as dome osteotomy and step-cut osteotomies, which solve the above problems to a certain extent. This study aimed to: (I) use a modified corpectomy to correct the deformity, and (II) present a new corpectomy method that uses a 3D-printed specific guide with an isosceles triangle osteotomy. A 12-year-old male presented with a -30-degree cubitus varus deformity 5 years after a supracondylar fracture of the right humerus. The degree of correction was determined from the varus angle and the normal carrying angle on the normal side. A rotating isosceles triangle osteotomy was determined by using Mimics software. The accuracy of the osteotomy angle was confirmed by postoperative radiography. The mean postoperative carrying angle was found to be preserved at the 10-month follow-up, with no complications. A rotating isosceles triangle osteotomy with a 3D-printed patient-specific guide may be providing a relative accurate result. However, in order to obtain more rigorous research conclusions, more cases should be added to examine this methodology for bone deformity surgery in the near future.
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Affiliation(s)
- Wenbing Wan
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Department of Orthopaedic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weidong Wu
- State Key Laboratory of Material Processing and Die and Mould Technology and School of Materials Science and Engineering, Huazhong University of Science and Technology, Wuhan, China
| | - Guodong Li
- Orthopaedic Department, Wuzhou Red Cross Hospital, Wuzhou, China
| | - Shixin Pan
- Orthopaedic Department, Wuzhou Red Cross Hospital, Wuzhou, China
| | - Enmou He
- Orthopaedic Department, Wuzhou Red Cross Hospital, Wuzhou, China
| | - Bin Hu
- State Key Laboratory of Material Processing and Die and Mould Technology and School of Materials Science and Engineering, Huazhong University of Science and Technology, Wuhan, China
| | - Bin Shan
- State Key Laboratory of Material Processing and Die and Mould Technology and School of Materials Science and Engineering, Huazhong University of Science and Technology, Wuhan, China
| | - Chun Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Azzam W, Catagni MA, Ayoub MA, El-Sayed M, Thabet AM. Early correction of malunited supracondylar humerus fractures in young children. Injury 2020; 51:2574-2580. [PMID: 32843147 DOI: 10.1016/j.injury.2020.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/11/2020] [Accepted: 08/16/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Supracondylar 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 METHODS Thirty 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. RESULTS All 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. CONCLUSION Early 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.
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Affiliation(s)
- Wael Azzam
- Assistant Professor of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Tanta University, Department of Orthopaedic Surgery and Traumatology, Tanta University Hospital, El-Geish Street, Tanta 31111, Egypt.
| | - Maurizio A Catagni
- Former Chief of the Ilizarov Unit and the Department of Orthopaedic Surgery and Traumatology, "Alessandro Manzoni" Hospital, Via dell'Eremo, 9/11, 23900 Lecco, Italy. Professor at the Milano University, Medical School. Director of the Ilizarov Unit at Mangioni Hospital - Lecco - Italy. Lecco - 42/H, Via C. Cattaneo, 23900.
| | - Mostafa A Ayoub
- Professor of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Tanta University, Department of Orthopaedic Surgery and Traumatology, Tanta University Hospital, El-Geish Street, Tanta 31111, Egypt.
| | - Mohamed El-Sayed
- Professor and Head of Paediatric Orthopaedic Unit, Faculty of Medicine, Tanta University, Department of Orthopaedic Surgery and Traumatology, Tanta University Hospital, El-Geish Street, Tanta 31111, Egypt.
| | - Ahmed M Thabet
- Assistant Professor, orthopaedic trauma, paediatric orthopaedic, limb lengthening, and deformity correction at Texas Tech University Health Sciences Center, El Paso, 4801 Alberta Avenue, El Paso, TX 79905, USA; Assistant Professor of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Benha University, Farida Nada Street, Benha 13512, Qalubia, Egypt.
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21
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Hu X, Zhong M, Lou Y, Xu P, Jiang B, Mao F, Chen D, Zheng P. Clinical application of individualized 3D-printed navigation template to children with cubitus varus deformity. J Orthop Surg Res 2020; 15:111. [PMID: 32192482 PMCID: PMC7081535 DOI: 10.1186/s13018-020-01615-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/26/2020] [Indexed: 12/13/2022] Open
Abstract
Background Cubitus varus deformity is a common sequela of elbow fractures in children. Cubitus varus deformity treatment is tending toward 3D correction, which is challenging for orthopedic surgeons. This study aims to explore whether individualized 3D-printed navigation templates can assist with accurate and effective corrective treatment of children with cubitus varus deformity. Methods Thirty-five patients were treated for cubitus varus deformity from June 2015 to April 2017, including 21 boys and 14 girls, aged 4.6–13.2 years (average, 7.5 years). Of these cases, 17 deformities were on the left side and 18 were on the right side. All were treated with wedge osteotomy of the lateral distal humerus. 3D-printed navigation templates were used in 16 cases, while traditional surgery was used in 19 cases. All patients underwent computed tomography scans before surgery. Computer software was used to analyze the measurements and design and print individualized navigation templates. The navigation templates were matched, and surgery was initially simulated. Intraoperative individualized navigation templates were used to assist with accurate osteotomy and Kirschner wire fixation. Operation times were recorded in all cases, the carrying angles before and after surgery were assessed by computer, and postoperative elbow joint function was evaluated using Bellemore criteria. All measurement data were presented as means ± SD, and Student’s t test was used to examine differences between groups. All count data between both groups were compared using the chi-square test or Fisher’s exact test analysis. Results All individualized navigation templates matched well with the corresponding anatomical markers and were consistent with preoperative planning, simulated surgery, and intraoperative procedures. Average operation times from clear exposure to fixed Kirschner wire were 11.69 min (9.6–13.5 min) for the individualized navigation template group and 22.89 min (17.7–26.8 min) for the traditional operation group (p < 0.001). Average differences in postoperation carrying angles between affected and healthy sides were 1.13° (0–2.0°) and 4.21° (0–7.5°), respectively (p < 0.001). Follow-up 6–12 months postoperation showed that elbow function did not differ significantly between groups using the Bellemore criteria (p > 0.05). Conclusions Individualized navigation templates simplify procedures, reduce operation time, and improve accuracy when used in orthopedic surgery to treat children with cubitus varus deformity.
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Affiliation(s)
| | | | - Yue Lou
- Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210000, Jiangsu Province, China
| | - Peng Xu
- Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210000, Jiangsu Province, China
| | - Bo Jiang
- Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210000, Jiangsu Province, China
| | - Fengyong Mao
- Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210000, Jiangsu Province, China
| | - Dan Chen
- Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210000, Jiangsu Province, China.
| | - Pengfei Zheng
- Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210000, Jiangsu Province, China.
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Alrabaa RG, Simhon M, Kadiyala RK. Outerbridge-Kashiwagi Procedure for the Treatment of a Supracondylar Humerus Fracture Malunion (O-K Procedure). Arthrosc Tech 2020; 9:e339-e344. [PMID: 32226740 PMCID: PMC7093704 DOI: 10.1016/j.eats.2019.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 11/14/2019] [Indexed: 02/03/2023] Open
Abstract
The Outerbridge-Kashiwagi (O-K) procedure has conventionally been used for the treatment of osteoarthritis of the elbow and to treat posttraumatic sequelae including posttraumatic arthritis, stiffness, contracture, and ulnar neuritis. The procedure involves exposure of the posterior elbow joint as well creating a window posteriorly through the olecranon fossa to target anterior aspects of the elbow. Several case series have shown the O-K procedure to have good functional outcomes with minimal complications. Used mostly for the surgical treatment of adult osteoarthritis, the O-K procedure has not been previously described for the treatment of a pediatric supracondylar humerus fracture malunion. This article and accompanying video will present the pearls and discuss the technique of the O-K procedure used to treat the loss of elbow flexion as a sequelae of supracondylar humerus fracture malunion.
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Affiliation(s)
- Rami George Alrabaa
- Address correspondence to Rami George Alrabaa, M.D., Department of Orthopedic Surgery, Columbia University Medical Center, 622 West 168th Street, PH-11, New York, NY 10032.
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Zhang YW, Xiao X, Gao WC, Xiao Y, Zhang SL, Ni WY, Deng L. Efficacy evaluation of three-dimensional printing assisted osteotomy guide plate in accurate osteotomy of adolescent cubitus varus deformity. J Orthop Surg Res 2019; 14:353. [PMID: 31706346 PMCID: PMC6842546 DOI: 10.1186/s13018-019-1403-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/03/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This present study is aimed to retrospectively assess the efficacy of three-dimensional (3D) printing assisted osteotomy guide plate in accurate osteotomy of adolescent cubitus varus deformity. MATERIAL AND METHODS Twenty-five patients (15 males and 10 females) with the cubitus varus deformity from June 2014 to December 2017 were included in this study and were enrolled into the conventional group (n = 11) and 3D printing group (n = 14) according to the different surgical approaches. The operation time, intraoperative blood loss, osteotomy degrees, osteotomy end union time, and postoperative complications between the two groups were observed and recorded. RESULTS Compared with the conventional group, the 3D printing group has the advantages of shorter operation time, less intraoperative blood loss, higher rate of excellent correction, and higher rate of the parents' excellent satisfaction with appearance after deformity correction (P < 0.001, P < 0.001, P = 0.019, P = 0.023). Nevertheless, no significant difference was presented in postoperative carrying angle of the deformed side and total complication rate between the two groups (P = 0.626, P = 0.371). CONCLUSIONS The operation assisted by 3D printing osteotomy guide plate to correct the adolescent cubitus varus deformity is feasible and effective, which might be an optional approach to promote the accurate osteotomy and optimize the efficacy.
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Affiliation(s)
- Yuan-Wei Zhang
- Department of Orthopedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, No.152 Aiguo Road, Nanchang, 330006, Jiangxi, China.,Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Xin Xiao
- Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Wen-Cheng Gao
- Department of Orthopedics, Dongguan Houjie Town People's Hospital, Dongguan, 523900, Guangdong, China
| | - Yan Xiao
- Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Su-Li Zhang
- Department of Operating room, Wujin Hospital Affiliated to Jiangsu University, Changzhou, 213161, Jiangsu, China
| | - Wen-Yan Ni
- Department of Operating room, Wujin Hospital Affiliated to Jiangsu University, Changzhou, 213161, Jiangsu, China
| | - Liang Deng
- Department of Orthopedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, No.152 Aiguo Road, Nanchang, 330006, Jiangxi, China.
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Abstract
Distal humeral extension-type malunions may occur as a complication following improper reduction of supracondylar humerus fractures. We evaluated results after distal humeral flexion osteotomies for sagittal realignment of the humeral condyle in children. Medical records and radiographs of all patients younger than 18 years of age, who underwent this procedure because of a clinically relevant lack of elbow flexion, were evaluated. In a cohort of 18 children with a mean age of 8 years at the time of surgery and a mean follow-up duration of 1 year, elbow flexion increased significantly from a mean of 101° preoperatively to 126° at the final follow-up; established radiographic parameters (e.g. anterior humeral line, humerocondylar angle) were normalized as well. The distal humeral flexion osteotomy is a reliable method to efficiently correct extension-type malunions and improve impaired elbow flexion in children.
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Gemalmaz HC, Sarıyılmaz K, Ozkunt O, Sungur M, Kaya İ, Dikici F. A new osteotomy for the prevention of prominent lateral condyle after cubitus varus correctional surgery-made possible by a 3D printed patient specific osteotomy guide: A case report. Int J Surg Case Rep 2017; 41:438-442. [PMID: 29546011 PMCID: PMC5702871 DOI: 10.1016/j.ijscr.2017.10.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/25/2017] [Indexed: 11/19/2022] Open
Abstract
Skeletal deformity surgery is a difficult procedure which requires meticulous planning. Good results demand precise application of the surgical plan during the surgery. 3D software helps to make precise surgical plans and design case specific surgical tools. 3D printing of case specific tools renders surgery easy and precise.
Introduction Skeletal deformity correction is a procedure of high aesthetic and functional demand. Therefore, meticulous surgical planning has always been mandatory. However, it is known that during the surgery things may often get slippery, leaving the surgeon no chance but improvisation. Because of this shortcoming it is not a rare occasion to find unhappy patients that have undergone deformity correction surgery. Presentation of case Our patient was an eighteen-year-old male who had 40° cubitus varus deformity (with 20° flexion and extension deficits) due to a right humerus supracondylar fracture, obtained eight years ago. He had two prior surgeries at the year of injury. Considering the severity of the deformity we decided to plan the surgery with 3D software, obtain 3D printed models (to further help with surgical fixation options) and finally, use a custom 3D printed resection guide to apply the plan during the surgery. Discussion Traditional methods of skeletal deformity correction lack the preoperative precision and tools to perform the plan during the surgery. Deformity correction with 3D images and 3D printed patient specific instruments do help the surgeon to accomplish correct deformities with results identical to surgical plan. Conclusion Superior precision of the 3D planning and very easy utilization of the patient specific 3D printed instruments during the skeletal deformity surgery provides unparalleled and foreseeable results. This methodology is prone to be gold standard for deformity surgery in the near future.
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Affiliation(s)
- Halil Can Gemalmaz
- Mehmet Ali Aydınlar Acıbadem University School of Medicine, Kerem Aydinlar Kampusu Kayisdagi Cad. 32 Atasehir, Istanbul, Turkey.
| | - Kerim Sarıyılmaz
- Mehmet Ali Aydınlar Acıbadem University School of Medicine, Kerem Aydinlar Kampusu Kayisdagi Cad. 32 Atasehir, Istanbul, Turkey.
| | - Okan Ozkunt
- Mehmet Ali Aydınlar Acıbadem University School of Medicine, Kerem Aydinlar Kampusu Kayisdagi Cad. 32 Atasehir, Istanbul, Turkey.
| | - Mustafa Sungur
- Mehmet Ali Aydınlar Acıbadem University School of Medicine, Kerem Aydinlar Kampusu Kayisdagi Cad. 32 Atasehir, Istanbul, Turkey.
| | - İbrahim Kaya
- Mehmet Ali Aydınlar Acıbadem University School of Medicine, Kerem Aydinlar Kampusu Kayisdagi Cad. 32 Atasehir, Istanbul, Turkey.
| | - Fatih Dikici
- Mehmet Ali Aydınlar Acıbadem University School of Medicine, Kerem Aydinlar Kampusu Kayisdagi Cad. 32 Atasehir, Istanbul, Turkey.
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Zhang C, Zhang Z, Cai H, Chang Z, Yang L, Zhao M, Li X, Feng R, Wang G, Duan X. [Dual-planar osteotomy and lateral column anatomic locking plate fixation in the treatment of adult cubitus varus deformity]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:1173-1178. [PMID: 29806316 DOI: 10.7507/1002-1892.201702102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the effectiveness of distal humeral dual-planar osteotomy followed with distal humeral lateral column anotomical locking plate fixation in the treatment of adult cubitus varus deformity combined with flexion restriction. Methods The clinical data of 6 adult patients with cubitus varus deformity and flexion restriction treated with dual-planar osteotomy and internal fixation between April 2012 and September 2014 were reviewed. There were 3 males and 3 females with an average age of 22.2 years (range, 18-35 years). All the patients had history of elbow injury in childhood, the age being injured was 6.5 years on average (range, 2-13 years). There was no nerve injury, elbow strength weak, or unstable complications before admission. The preoperative elbow flexion was (107.50±5.24)°, elbow extension was (-12.17±3.48)°; the carring angle was (-19.50±4.46)°, the contralateral elbow carrying angle was (11.50±2.67)°; the length of humerus was (0.42±0.38) cm shorter than the unaffected humerus. The postoperative carrying angles, elbow flexion and extension, and humerus length were recorded. The modified Laupattarakasem criteria in which the comparison of bilateral elbow range of motion excluded was used to evaluate the results. Results Primary healing of incision was got in all patients and there was no early postoperative complications. All the patients were followed up 19-27 months (mean, 20.8 months). During the follow-up, there was no complication such as loosening and breakage of the internal fixators and all fractures were healed within 3 months after operation. At last follow-up, the elbow flexion was (124.17±5.85)°, the elbow extension was (0.83±2.04)°, the carrying angle was (12.00±4.19)°, and the humerus shortening was (1.88±0.45) cm, all showing significant difference when compared with preoperative ones ( t=-6.742, P=0.001; t=-11.068, P=0.000; t=-20.400, P=0.000; t=-13.914, P=0.000). According to the modified Laupattarakasem criteria, 1 case was excellent, 4 were good, and 1 was fair with an excellent and good rate of 83.3%. Conclusion Normal carrying angle can be restored and elbow flexion can be increased by coronal closing wedge and sagittal trapezoid dual-planar osteotomy, single lateral anatomical locking plate fixation is available for early mobilization.
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Affiliation(s)
- Chuan Zhang
- No. 1 Department of Upper Limb Injury, Luoyang Orthopedic Hospital of Henan Province (Orthopedic Hospital of Henan Province), Luoyang Henan, 471002, P.R.China
| | - Zuojun Zhang
- No. 1 Department of Upper Limb Injury, Luoyang Orthopedic Hospital of Henan Province (Orthopedic Hospital of Henan Province), Luoyang Henan, 471002,
| | - Hongmin Cai
- No. 1 Department of Upper Limb Injury, Luoyang Orthopedic Hospital of Henan Province (Orthopedic Hospital of Henan Province), Luoyang Henan, 471002, P.R.China
| | - Zhongxiao Chang
- No. 1 Department of Upper Limb Injury, Luoyang Orthopedic Hospital of Henan Province (Orthopedic Hospital of Henan Province), Luoyang Henan, 471002, P.R.China
| | - Linping Yang
- No. 1 Department of Upper Limb Injury, Luoyang Orthopedic Hospital of Henan Province (Orthopedic Hospital of Henan Province), Luoyang Henan, 471002, P.R.China
| | - Ming Zhao
- No. 1 Department of Upper Limb Injury, Luoyang Orthopedic Hospital of Henan Province (Orthopedic Hospital of Henan Province), Luoyang Henan, 471002, P.R.China
| | - Xingxing Li
- No. 1 Department of Upper Limb Injury, Luoyang Orthopedic Hospital of Henan Province (Orthopedic Hospital of Henan Province), Luoyang Henan, 471002, P.R.China
| | - Ruiping Feng
- No. 1 Department of Upper Limb Injury, Luoyang Orthopedic Hospital of Henan Province (Orthopedic Hospital of Henan Province), Luoyang Henan, 471002, P.R.China
| | - Guojie Wang
- No. 1 Department of Upper Limb Injury, Luoyang Orthopedic Hospital of Henan Province (Orthopedic Hospital of Henan Province), Luoyang Henan, 471002, P.R.China
| | - Xiaobo Duan
- No. 1 Department of Upper Limb Injury, Luoyang Orthopedic Hospital of Henan Province (Orthopedic Hospital of Henan Province), Luoyang Henan, 471002, P.R.China
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Abstract
Although cubitus varus has been regarded as a purely cosmetic problem in the pediatric population, symptomatic elbow instability, and ulnar neuropathy from the mechanical axis malalignment have been reported in adults. This overview discusses the biomechanical axis disruption that leads to soft tissue and morphologic bony alterations in the elbow and offers a compelling argument for corrective osteotomy to treat pediatric cubitus varus.
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