Twelve children were included with malunion deformity of the distal humerus with a mean age of 5 years at the time of injury and 8 years at the time of osteotomy. Standard preoperative assessment was done. The surgical technique consisted of a dome supracondylar osteotomy as described by Tien et al. The angular correction was designed and marked on the humerus prior to completion of the dome. A posterior surgical approach was used with a tongue-shaped flap from the triceps aponeurosis with splitting of the triceps muscle. Fixation was accomplished with Kirschner wires in a crossed-fashion.
At follow up averaged 2 years, a combination of objective and subjective measures were utilized. The results of the osteotomy were characterized from excellent to poor. Seven patients had excellent result, 5 good and none poor. There was little change in the overall motion including flexion and extension although mild loss of motion did occur averaging approximately 7º. There was some unsightly scar formation noted in two patients and complications included pin tract infection and ulnar neurapraxia. Radiographic assessment showed that there was excellent restoration of the carrying angle with some minor variation between the patients.
This article discusses an alternative technique for osteotomy of the humerus to allow for correction of the cubitus varus without a lateral prominence. The authors report good radiographic and clinical results with restoration of the normal valgus alignment and diminution of the lateral prominence. During the discussion section, the authors attempt to compare this technique with the lateral closing wedge osteotomy. The authors do select articles that report problems with this technique, however, there are multiple articles that do report promising results. The one issue that was not addressed in this paper is the posterior surgical versus the lateral approach. There is no mention of triceps insufficiency, which can occur after a tongue of the triceps is raised.
Cubitus, Varus, Humerus, Dome, Osteotomy, Malunion
Journal of Pediatric Orthopaedics