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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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Liu X, Liu K, Yang J. A Modified Reverse Right-angled Triangle Osteotomy Using the Lateral Approach for the Treatment of Posttraumatic Cubitus Varus Deformity in Children. J Pediatr Orthop 2023; 43:355-361. [PMID: 36914266 PMCID: PMC10234315 DOI: 10.1097/bpo.0000000000002389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Cubitus varus deformity is a complex 3-dimensional deformity. Various osteotomies have been introduced to correct this deformity, however, there is no consensus on the best procedure to correct the deformity while avoiding complications. In this retrospective study, we used a modified inverse right-angled triangle osteotomy to treat 22 children with posttraumatic cubitus varus deformity. The primary objective was to evaluate this technique by presenting its clinical and radiologic results. METHODS Twenty-two consecutive patients with a cubitus varus deformity underwent a modified reverse right-angled triangle osteotomy between October 2017 and May 2020 and were then followed for a minimum of 24 months. We evaluated its clinical and radiologic results. Functional outcomes were assessed using Oppenheim criteria. RESULTS The average follow-up period was 34.6 months (range, 24.0 to 58.1 months). The mean range of motion was 4.32 degrees (range, 0 degrees to 15 degrees)/122.73 degrees (range, 115 degrees to 130 degrees) (hyperextension/flexion) before surgery and 2.05 degrees (range, 0 degrees to 10 degrees)/127.27 degrees (range, 120 degrees to 145 degrees) at the final follow-up. There were significant ( P < 0.05) differences between the flexion and hyperextension angles before surgery and at the final follow-up. Based on Oppenheim criteria, results were excellent for 20, good for 2, and none of the patients had poor results. The mean humerus-elbow-wrist angle improved from 18.23 degrees (range, 10 degrees to 25 degrees) varus preoperatively to 8.45 degrees (range, 5 degrees to 15 degrees) valgus postoperatively ( P < 0.05). The mean of the preoperative lateral condylar prominence index was 3.52 (range, 2.5 to 5.2) and the average postoperative lateral condylar prominence index was -3.28 (range, -1.3 to -6.0). All patients were pleased with the overall appearance of their elbows. CONCLUSIONS The modified reverse right-angled triangle osteotomy can precisely and stably correct the deformity in the coronal and sagittal planes, we recommend this technique as a simple, safe, and reliable correction of cubitus varus deformity. LEVEL OF EVIDENCE Level IV; case series; therapeutic studies-investigating the results of treatment.
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Affiliation(s)
- Xiping Liu
- Department of Orthopaedics, Hunan Children’s Hospital
| | - Kun Liu
- Department of Orthopaedics, Hunan Children’s Hospital
| | - Jun Yang
- Department of Orthopaedics, The Third Hospital of Changsha, Yuhua, Changsha, HN, China
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Liu Y, Kan L, Sun J, Chu X. Correction of Pediatric Cubitus Varus by Centralization of the Distal Humeral Fragment: A Surgical Technique to Avoid Lateral Condylar Prominence. J Pediatr Orthop 2023; 43:111-116. [PMID: 36607926 DOI: 10.1097/bpo.0000000000002286] [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: 01/07/2023]
Abstract
BACKGROUND Cubitus varus is a well-recognized late complication of supracondylar humerus fractures in children. Various osteotomies have been described to correct this deformity, but each has disadvantages. The purpose of this study was to investigate the outcomes of a surgical technique, lateral closing wedge osteotomy combined with centralization of the distal humeral fragment, in cubitus varus. Meanwhile, the occurrence of postoperative lateral condylar prominence was observed. METHODS From January 2015 to December 2019, 36 pediatric cubitus varus deformity patients who were treated with lateral closing wedge osteotomy combined with centralization of the distal fragment in our institution were included. The corrective osteotomies were performed through a standard lateral approach and fixed with crossed Kirschner wires. The preoperative and postoperative full-length anteroposterior and lateral radiographs of bilateral upper limbs were assessed. At the same time, clinical and radiologic parameters were reviewed. Lateral condylar prominence index (LCPI) and any other complications were evaluated. RESULTS The mean preoperative humerus-elbow-wrist angle (HEWA) on the affected side was 20.9 degrees of varus, which was significantly improved to 9.2 degrees of valgus postoperatively. The mean postoperative value of LCPI was -0.047. Postoperative LCPI and HEWA was compared with the normal side, and there was no significant difference. All of the patients had excellent clinical and radiographic alignment. No surgical complications and limitation of range of motion were noted. No patient complained of lateral bony prominence. CONCLUSION Lateral closing wedge osteotomy by centralization of distal fragment is a safe and highly effective method and prevents lateral prominence with a minimal complication rate. We recommend this technique for the treatment of cubitus varus in children. LEVEL OF EVIDENCE Level IV Case series.
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Affiliation(s)
- Yong Liu
- Department of Pediatric Orthopedics, The Affiliated Provincial Pediatric Hospital of Anhui Medical University, Hefei, China
| | - Lisheng Kan
- Military Hospital of Chinese PLA, Dalian, China
| | - Jun Sun
- Department of Pediatric Orthopedics, The Affiliated Provincial Pediatric Hospital of Anhui Medical University, Hefei, China
| | - Xiangjun Chu
- Department of Pediatric Orthopedics, The Affiliated Provincial Pediatric Hospital of Anhui Medical University, Hefei, China
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Su Y, Xie Y, Nan G. A novel method of lateral closing wedge osteotomy for cubitus varus deformity in children. BMC Surg 2022; 22:408. [PMID: 36434582 PMCID: PMC9701051 DOI: 10.1186/s12893-022-01854-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Humeral osteotomy is the best method for treatment of severe cubitus varus in children. Many osteotomy methods have been developed in the past. In this study, we describe a novel corrective technique by applying the principles described by Paley involving lateral osteotomy using Kirschner wires (K-wires). Vertices of the osteotomy should be located at the center of rotation of angulation. The anatomical and mechanical axes can be corrected with precision. PATIENTS AND METHODS In this retrospective study, 21 patients (17 male, 4 female) who fulfilled the study criteria and underwent lateral closing osteotomy for cubitus varus deformity from July 2015 to October 2017 were included into the study. The osteotomy line of all patients was designed according to Paley's principles. An isosceles triangle template was made according to the design preoperatively. The lateral osteotomy was made with the assistance of C-arm radiographs. The osteotomy was fixed by K-wires laterally. Patients were followed up, and elbows were evaluated by radiography and using the Mayo Elbow Performance Index (MEPI) score. RESULTS The mean correction angle obtained was 32.33°±2.83°. According to the MEPI score assessment, 19 of the 21 patients had an excellent outcome and two had a good outcome. Two patients complained of conspicuous scars; however, no further cosmetic surgery was performed. The range of motion was 135.0° preoperatively and 133.7° postoperatively, showing no significant difference (p = 0.326). None showed evidence of neurovascular injury or complained of prominence of the lateral humerus. CONCLUSION Paley's principles for correcting cubitus varus deformity in children are effective and reliable for treating such a condition. LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Yuxi Su
- grid.488412.3Department of Orthopaedics, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Yuzhong District Zhongshan 2road 136#, 400014 Chongqing, China
| | - Yan Xie
- Lab Medicine Department, Chongqing Yubei Maternal and Children Health Hospital, 73# Shuanghu Branch Road, Yubei District, Chongqing, China
| | - Guoxin Nan
- grid.488412.3Department of Orthopaedics, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Yuzhong District Zhongshan 2road 136#, 400014 Chongqing, China
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Kumar R, Rangasamy K, Raj Gopinathan N, Sudesh P, Goni VG. Is modified reverse step-cut osteotomy better than Yun's reverse V osteotomy in paediatric cubitus varus deformity correction? A prospective, double-blinded, randomized controlled trial. INTERNATIONAL ORTHOPAEDICS 2022; 46:2041-2053. [PMID: 35536366 DOI: 10.1007/s00264-022-05429-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/01/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Various corrective osteotomy techniques have been described in the literature for correcting paediatric cubitus varus. But we are still in search of the perfect technique that gives maximum possible deformity correction and cosmetic appearance that satisfies parents with minimal complications. We compared the outcomes of two technically sound osteotomy techniques having minimal postoperative lateral condyle prominence described in the literature. RESEARCH QUESTION Is modified reverse step-cut osteotomy (MRSO) better in terms of clinical, radiological, and cosmetic outcomes than Yun's reverse V osteotomy (RVO) in pediatric cubitus varus deformity correction? METHODS In total, 20 children with unilateral cubitus varus resulting from malunited supracondylar humerus fractures were included. Randomization was done by computer-generated random slips. A total of ten cases each were operated by MRSO and RVO techniques, respectively. Clinical, radiological, and cosmetic appearance assessments were done at the final two year follow-up and compared between the two groups. RESULTS The mean age of children in the MRSO and RVO groups is 9.9 years (3-16) and 8.6 years (3-16), respectively. The mean pre-operative carrying angle in the deformed elbow of MRSO and RVO group was - 20.5° and - 19.5°, respectively, and the mean pos-toperative carrying angle in the corrected elbow of MRSO and RVO group was + 6.8° and + 6.5°, respectively. Regarding the lateral prominence index (LPI), a positive correlation was noted between pre-operative and post-operative periods with a value of 0.855 and 0.844 (p value: 0.001 and 0.03, respectively) in both MRSO and RVO groups, respectively. However, the change was statistically not significant when compared between the two groups (p = 0.63). There was no statistically significant difference (p > 0.05) when the clinical, radiological, and cosmetic outcomes were compared between the groups at final follow-up. CONCLUSION The surgeon can choose either one of these techniques based on their expertise since the results of both the techniques are comparable in terms of clinical, radiological, and cosmetic outcomes.
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Affiliation(s)
- Ramesh Kumar
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Karthick Rangasamy
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Nirmal Raj Gopinathan
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pebam Sudesh
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vijay G Goni
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Gigi R, Gortzak Y, Barriga Moreno J, Golden E, Gabay R, Rumack N, Yaniv M, Dadia S, Segev E. 3D-printed Cutting Guides for Lower Limb Deformity Correction in the Young Population. J Pediatr Orthop 2022; 42:e427-e434. [PMID: 35200209 DOI: 10.1097/bpo.0000000000002104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Three-dimensional (3D) virtual surgical planning technology has advanced applications in the correction of deformities of long bones by enabling the production of 3D stereolithographic models, patient-specific instruments and surgical-guiding templates. Herein, we describe the implementation of this technology in young patients who required a corrective osteotomy for a complex 3-plane (oblique plane) lower-limb deformity. PATIENTS AND METHODS A total of 17 patients (9 males, average age 14.7 y) participated in this retrospective study. As part of preoperative planning, the patients' computerized tomographic images were imported into a post-processing software, and virtual 3D models were created by a segmentation process. Femoral and tibial models and cutting guides with locking points were designed according to the deformity correction plan. They were used for both planning and as intraoperative guides. Clinical parameters, such as blood loss and operative time were compared with a traditional surgical approach group. RESULTS All osteotomies in the 3D group were executed with the use intraoperative customized cutting guides which matched the preoperative planning simulation and allowed easy fixation with prechosen plates. Surgical time was 101±6.2 minutes for the 3D group and 126.4±16.1 minutes for the control group. The respective intraoperative hemoglobin blood loss was 2.1±0.2 and 2.5+0.3 g/dL.Clinical and radiographic follow-up findings showed highly satisfactory alignment of the treated extremities in all 3D intervention cases, with an average time-to-bone union (excluding 2 neurofibromatosis 1 patients) of 10.3 weeks (range 6 to 20 wk). CONCLUSION The use of 3D-printed models and patient-specific cutting guides with locking points improves the clinical outcomes of osteotomies in young patients with complex bone deformities of the lower limbs. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Roy Gigi
- Department of Pediatric Orthopedic Surgery, Dana Dwek Children's Hospital
| | | | - Juan Barriga Moreno
- Orthopedics Division, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University
| | - Eran Golden
- Surgical Innovation and 3D Printing Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ronnie Gabay
- Surgical Innovation and 3D Printing Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Netta Rumack
- Surgical Innovation and 3D Printing Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Moshe Yaniv
- Department of Pediatric Orthopedic Surgery, Dana Dwek Children's Hospital
| | - Solomon Dadia
- National Unit of Orthopedic Oncology
- Surgical Innovation and 3D Printing Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Eitan Segev
- Department of Pediatric Orthopedic Surgery, Dana Dwek Children's Hospital
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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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Kasirajan S, Govindasamy R, Lokayah SK. Functional outcome of modified French osteotomy fixed with recon-locking compression plate in older children. J Clin Orthop Trauma 2021; 16:202-207. [PMID: 33680833 PMCID: PMC7919942 DOI: 10.1016/j.jcot.2021.01.008] [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: 10/15/2020] [Revised: 01/13/2021] [Accepted: 01/19/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Modified French osteotomy is commonly used method for the correction of cubitus varus deformity. Fixation of the osteotomy with figure of 8 wiring or 3.5 mm cortical screws were found to be insufficient in holding the distal fragment in children above 8 years. In this study we used a Reconstruction locking plate for the fixation of osteotomy in those children and evaluated the results. MATERIALS AND METHODS Modified French osteotomy and fixation with reconstruction locking compression plate was performed for eighteen cases of cubitus varus deformity within the time period of 5 years starting from March 2014 to February 2019. RESULTS The outcome of the study was assessed with Flynn's criteria, where 12 cases had excellent and 6 cases had good outcome. There were no complications and no revision surgeries were performed. CONCLUSION Reconstruction locking plate fixation of a modified French osteotomy in older children (above 8 years) provided excellent results in our study.
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Affiliation(s)
- Saravanan Kasirajan
- Department of Orthopaedics, Vinayaka Missions Medical College Hospital and Research Institute, Karaikal, India
| | - Rajesh Govindasamy
- Department of Orthopaedics, Vinayaka Missions Medical College Hospital and Research Institute, Karaikal, India
| | - Suresh Krishna Lokayah
- Department of Orthopaedics, Vinayaka Missions Medical College Hospital and Research Institute, Karaikal, India
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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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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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11
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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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12
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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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13
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Greenhill DA, Kozin SH, Kwon M, Herman MJ. Oblique Lateral Closing-Wedge Osteotomy for Cubitus Varus in Skeletally Immature Patients. JBJS Essent Surg Tech 2019; 9:ST-D-18-00107. [PMID: 32051776 DOI: 10.2106/jbjs.st.18.00107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background We perform an oblique lateral closing-wedge osteotomy of the distal end of the humerus to correct cubitus varus deformity in children. This deformity is often the consequence of undertreatment, malreduction, or malunion of supracondylar humeral fractures1. Although standard arcs of motion may be altered, cosmesis was traditionally considered a primary surgical indication. However, uncorrected cubitus varus leads to posterolateral rotatory instability of the elbow (PLRI)2, lateral condylar fractures3, snapping medial triceps, and ulnar nerve instability4. A contemporary understanding of these delayed sequelae has expanded our current indications. Detailed parameters predictive of late sequelae are needed to further specify surgical indications. Description We remove an oblique lateral closing wedge from the distal end of the humerus via a standard lateral approach. The osteotomy is angled away from the varus joint line such that lateral cortices after reduction lack prominence. Kirschner wires provide adequate fixation in young patients. In older children, extension is simultaneously corrected, and fragments are stabilized via plate osteosynthesis. Alternatives Patients who decline surgery are counseled regarding risks of delaying treatment until symptoms are present. PLRI manifests as lateral elbow pain or instability while rising from a chair. Once symptomatic, the lateral ulnar collateral ligament (LUCL) is irreversibly attenuated and morphologic changes in the ulnohumeral joint necessitate more extensive surgery to include distal humeral osteotomy, LUCL reconstruction, and possibly ulnar nerve transposition5. Alternative osteotomy techniques are described and categorized as simple lateral closing wedge, step-cut6-9, dome, 3-dimensional10, or distraction osteogenesis. Simple closing-wedge osteotomies include a distal cut parallel to the joint line and retain a problematic lateral prominence (if the medial cortex is intact or the distal end of the humerus is not translated medially)11,12. Step-cut osteotomies theoretically minimize this lateral prominence while enhancing inherent stability. However, these additional cuts mandate wide surgical exposure despite similar outcomes13. Three-dimensional planning employs computed tomography to create expensive anatomic cutting guides that address varus, extension, and internal rotation. However, residual internal rotation is generally well tolerated, derotation is associated with loss of fixation, and the extension deformity will successfully remodel in patients who are <10 years old14. We employ 3-dimensional planning in skeletally mature patients with complex deformity and no remodeling potential. Rationale The oblique lateral closing wedge is ideal for skeletally immature patients because it is simple, reproducible, and efficient. It avoids the lateral prominence without increasing complexity or complications.
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Affiliation(s)
| | - Scott H Kozin
- Shriners Hospital for Children, Philadelphia, Pennsylvania
| | - Michael Kwon
- St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Martin J Herman
- St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
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14
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Abstract
Cubitus varus deformity is common in children. The purpose of this study was to assess the usefulness of computer simulation based on three-dimensional computed tomography (3D-CT) reconstruction with regard to preoperative planning and surgical treatment in children with traumatic cubitus varus deformity.The study included 13 patients with traumatic cubitus varus deformity between January 2012 and January 2015. The original 3D-CT data were transferred to Mimics 10.01 software. Special tools were used for simulation of supracondylar lateral wedge osteotomy of the humerus. Intraoperative elbow arthrography was used to identify the articular surface of the elbow joint for assisting the judgment of the osteotomy site. Kirschner wires were used to determine the osteotomy plane and angle. The osteotomy site was fixed by crossing Kirschner wires and steel wire tension band.Of the 13 patients, 11 were male and 2 were female. The left side was affected in 8 patients, and the right side was affected in 5 patients. The patient age ranged from 2 years to 14 years (mean age, 6 years and 7 months). The varus angle ranged from 12° to 35° (mean angle, 20°). The carrying angle on the contralateral side ranged from 5° to 18° (mean angle, 10°). The varus deformities showed good correction. The 13 patients were followed up for 24 to 60 months (mean follow-up, 38 months). According to the Flynn score of elbow joint function after surgery: 10 patients had excellent function, 2 had good function, and 1 had fair function. The excellent rate was 92.3%. At the final follow-up, the ipsilateral carrying angle ranged from 4° to 15° (mean angle, 11°).Computer simulation based on 3D-CT reconstruction can provide good information on the right humeral osteotomy position and osteotomy angle. It can guide the actual operation and provide better results after surgery. Intraoperative elbow arthrography is useful to determine the level of elbow joint osteotomy, and it can assist in the operation.Level of evidence: Level IV-retrospective case, treatment study.
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Affiliation(s)
- Hai Jiang
- Department of Pediatric Orthopedics, Northwest Women's and Children's Hospital
| | - Min Li
- Department of Pediatric Orthopedics, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Shaanxi, Xi’an, China
| | - Yongtao Wu
- Department of Pediatric Orthopedics, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Shaanxi, Xi’an, China
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Oura K, Shigi A, Oka K, Tanaka H, Murase T. Corrective osteotomy for hyperextended elbow with limited flexion due to supracondylar fracture malunion. J Shoulder Elbow Surg 2018; 27:1357-1365. [PMID: 29776819 DOI: 10.1016/j.jse.2018.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/17/2018] [Accepted: 03/25/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Extension deformity of the distal humerus after a malunited supracondylar fracture can restrict elbow flexion. Here we report a computer-assisted operative procedure and review the results of clinical cases in which corrective surgery was performed. METHODS The medical records of the patients who underwent corrective osteotomy for hyperextended elbow malunion of the distal humerus with limited elbow flexion (flexion angle ≤100°) were reviewed retrospectively. Osteotomy was performed using patient-specific instruments designed based on preoperative 3-dimensional computer simulation. RESULTS Three patients, a 55-year-old woman and two 12-year-old boys, met the inclusion criteria. The angles of hyperextension of the affected distal humerus were 29°, 29°, and 25°, respectively. The range of flexion/extension of the elbow motion in the first patient improved from 95°/25° preoperatively to 140°/-10° postoperatively, in the second patient from 100°/20° to 145°/5°, and in the third patient from 80°/25° to 140°/10°. Bone union was achieved in all patients. There were no major complications. The corrective operations not only improved elbow flexion but also increased the total range of motion in the elbow by rebuilding the anterior curve of the distal humerus. CONCLUSIONS Correction of the extension deformity of the distal humerus after a malunited supracondylar fracture is a reasonable option for patients older than 10 years with restricted elbow flexion. Preoperative computer simulation and the use of patient-specific instruments can be a useful alternative that enables accurate deformity correction and improves the total range of motion.
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Affiliation(s)
- Keiichiro Oura
- Department of Orthopaedic Surgery, Japan Community Health Care Organization, Osaka Hospital, Osaka, Japan
| | - Atsuo Shigi
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kunihiro Oka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroyuki Tanaka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
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