1
|
Schlauch AM, Manske MC, Leshikar HB, Davids JR. Posttraumatic Cubitus Varus: Respect the Columns. J Pediatr Orthop 2024; 44:e518-e529. [PMID: 38515131 DOI: 10.1097/bpo.0000000000002671] [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: 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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Indications and Timing of Guided Growth Techniques for Pediatric Upper Extremity Deformities: A Literature Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020195. [PMID: 36832323 PMCID: PMC9954695 DOI: 10.3390/children10020195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
Osseous deformities in children arise due to progressive angular growth or complete physeal arrest. Clinical and radiological alignment measurements help to provide an impression of the deformity, which can be corrected using guided growth techniques. However, little is known about timing and techniques for the upper extremity. Treatment options for deformity correction include monitoring of the deformity, (hemi-)epiphysiodesis, physeal bar resection, and correction osteotomy. Treatment is dependent on the extent and location of the deformity, physeal involvement, presence of a physeal bar, patient age, and predicted length inequality at skeletal maturity. An accurate estimation of the projected limb or bone length inequality is crucial for optimal timing of the intervention. The Paley multiplier method remains the most accurate and simple method for calculating limb growth. While the multiplier method is accurate for calculating growth prior to the growth spurt, measuring peak height velocity (PHV) is superior to chronological age after the onset of the growth spurt. PHV is closely related to skeletal age in children. The Sauvegrain method of skeletal age assessment using elbow radiographs is possibly a simpler and more reliable method than the method by Greulich and Pyle using hand radiographs. PHV-derived multipliers need to be developed for the Sauvegrain method for a more accurate calculation of limb growth during the growth spurt. This paper provides a review of the current literature on the clinical and radiological evaluation of normal upper extremity alignment and aims to provide state-of-the-art directions on deformity evaluation, treatment options, and optimal timing of these options during growth.
Collapse
|