Surgical correction of cubitus varus in children with a lateral closing-wedge osteotomy: a comparison between two different techniques

External fixators and lengthening systems in pediatric upper limb

The use of external fixators is part of the cultural background of orthopedic surgeons in treating numerous clinical conditions. Over the years, fixator design and biomechanical knowledge have led to different solutions and techniques, and bone lengthening and its better understanding come together with the development of external fixators and the application of the biological principle of distraction osteogenesis. The authors conducted a literature review about using external fixators and lengthening systems in pediatric upper limbs. Despite the applications of external fixators in upper limbs remaining much more limited than those of the lower limbs, there are indications of traumatic, congenital, tumor, and infectious etiologies. However, despite the spread of new systems of plate and screws and intramedullary lengthening nails, the problems about when to use external fixation remain unsolved. Another debated point is about using monolateral or circular frames for humeral lengthening and the correction of forearm deformities in multiple hereditary exostoses disease (MHE) or radial longitudinal deficiency sequelae. Monoaxial fixators retain a prominent role for skeletal lengthening in all the districts examined, although their role could be outclassed by the motorized intramedullary nails, especially for humeral lengthening. Hexapod systems are likely to represent the future for the correction of multiplanar forearm deformities; however, multicenter studies on larger series will be necessary to better validate their applications and advantages.

Evaluation of tension-band osteosynthesis for cubitus varus deformity in pediatric patients: A retrospective review

PURPOSE

This study aims to evaluate the effectiveness and safety of lateral closing wedge osteotomy with tension-band wire fixation for correcting cubitus varus deformity in pediatric patients. The primary objective was to assess the bone union rate, functional outcomes, and potential complications associated with this surgical approach.

METHODS

We conducted a retrospective review of 104 pediatric cases (ages 7-15) with post-traumatic cubitus varus deformity treated between January 2018 and December 2019 at the Pediatric Orthopedic Department. The surgical technique involved a lateral closing wedge osteotomy with fixation achieved using an 8-figure tension-band wire on the lateral column of the distal humerus. Follow-up assessments were conducted for bone union, correction stability, range of motion, and any post-surgical complications.

RESULTS

Out of 104 cases, 63 involved left elbows and 41 right elbows, with an average patient age of 8.12 years. The deformity was severe (>30° varus) in 33.65 % of cases. Successful correction and bone union were achieved in 100 % of cases, with an average follow-up duration of 8 months (range: 3-20 months). Complications included minor recurrence in two cases due to early post-operative trauma, limited range of motion in three cases, K-wire protrusion in three cases, and infection in two cases. Functional outcomes rated as excellent in 94.2 % of cases and good in 5.8 %.

CONCLUSION

Lateral closing wedge osteotomy with tension-band wire fixation is a reliable technique for correcting pediatric cubitus varus deformity, offering stable fixation, high success rates in bone healing, and favorable functional outcomes with minimal complications.

Locking plate versus K-wires and cast fixation in lateral closing-wedge osteotomy for cubitus varus deformity

Background

The aim of this study was to assess the clinical and radiographic outcomes of cubitus varus treatments based on different fixation methods: Locking plate vs. Kirschner-wires (K-wires) and cast fixation.

Methods

This retrospective study of 28 patients was performed in lateral-wedge osteotomy for cubitus varus deformity in our hospital from July 2018 to July 2020. 14 patients in group A were treated by locking plate after lateral closing-wedge osteotomy, whereas other 14 patients were treated by K-wires in group B. We measured the bony union and carrying angle. The clinical and radiographic outcomes were assessed according to the Bellemore criteria.

Results

No nonunion, neurovascular injury or myositis ossificans was noted at follow-up. In group A, 1 patient with lateral condylar prominence was found. In group B, 2 patients with pinning site infection were treated successfully with oral antibiotics and 2 patients needed revision surgery for residual varus. According to the Bellemore criteria, statistically significant difference was noted between the two groups (P = 0.0458). In the present study, no statistically significant difference was noted in the length of incision and operation time between the 2 groups (P > 0.05). However, the postoperative carrying angle was significantly different at final follow-up between the 2 groups (P < 0.01).

Conclusions

Compared with K-wires and cast fixation, we recommend the wedge osteotomy with lateral locking plate to treat the cubitus varus deformity because locking plate could achieve better functional and cosmetic results and stabilize the distal humerus rigidly.