Characteristics of Elbow Dislocation in Patients with Preexisting Cubitus Varus

Effectiveness of supracondylar dome osteotomy in reducing lateral condylar prominence and enhancing functional outcomes in pediatric cubitus varus: a retrospective study

BACKGROUND

Cubitus varus, a common complication of pediatric supracondylar humerus fractures, presents with internal rotation, extension, and varus angulation. While primarily considered a cosmetic concern, it can lead to significant complications, including chronic pain, ulnar nerve palsy, and posterolateral elbow instability. This study evaluates the effectiveness of supracondylar dome osteotomy in decreasing lateral condylar prominence and improving functional outcomes in patients with cubitus varus.

METHODS

This retrospective cohort study analyzed 65 patients under 18 who underwent dome-shaped corrective osteotomy between 2017 and 2022 at the Hospital and Rehabilitation Center for Disabled Children, Nepal. Inclusion criteria comprised patients with cubitus varus deformity greater than 10 degrees and at least six months post-trauma. Outcomes were assessed using the Mayo Elbow Performance Score (MEPS), Lateral Condylar Prominence Index (LPI), and radiological measurements of carrying angle (CA).

RESULTS

The mean age at surgery was 11.77 years (± 3.76), with an average time since injury of 54.15 months (± 31.76). Post-operatively, the radiological carrying angle improved from 23.90° (± 8.84) varus to 5.14° (± 7.64) valgus. The LPI changed from 0.58 (± 16.68) preoperatively to -3.18 (± 16.39) post-operatively. MEPS improved from 89.54 (± 6.66) to 95.23 (± 5.26). Significant improvements in LPI were observed in patients older than 12 years (p = 0.00) and patients with radiological CA less than 20° (p = 0.02) and with a clinical CA less than 20°(p = 0.04).

CONCLUSIONS

Supracondylar dome osteotomy effectively reduces lateral condylar prominence in cubitus varus, particularly in post-pubertal patients and cases with radiological carrying angles less than 20 degrees. The procedure demonstrates good functional outcomes with acceptable complication rates, making it a viable surgical option for treating cubitus varus deformity.

Arthroscopic Reduction and Fixation of Coronoid Fractures with Bending K-Wire: A New Technique

The ulnar coronoid process plays a key role in maintaining elbow stability; however, there is no gold standard treatment for ulnar coronoid process fractures. We present a novel surgical technique, arthroscopic reduction and bent K-wire fixation, for type II and III coronoid process fractures according to the O’Driscoll classification. Five patients were treated and retrospectively reviewed between January 2016 and December 2019. All the surgeries were performed by a single surgeon. We evaluated clinical outcomes by evaluating a range of motion, disability of arm, shoulder, and hand (DASH) score, Mayo Elbow Performance score (MEPS), and radiographic images. Intraoperative and postoperative radiographs showed that the fractures healed well and were satisfactorily fixed. The average elbow extension/flexion was −3/130, with an average DASH score of 2.42 and MEPS of 97. Coronoid process fractures can be treated successfully with arthroscopic reduction and fixation of bent K-wire, which allows more rigid fixation and early functional exercise, resulting in good outcomes without special tools.