Medial Approach for Corrective Osteotomy of Cubitus Varus: A Cosmetic Incision

Author(s): Hui, J H P, Torode, I P, Chatterjee A

Source:  J Pediatr Orthop 24:477-481, 2004

Summary:

Cubitus varus is a fairly common complication following displaced supracondylar elbow fractures in children.  There are multiple osteotomy techniques that have been described to correct any cosmetic deformity and/or functional deficits. Medial opening wedge osteotomy has been described in the past, but was abandoned due to nerve palsies and suboptimal results.  This study describes a laterally based closing wedge osteotomy via a medial surgical approach.  Fourteen patients were included in the series.  The mean age at osteotomy was 8.4 years, and the mean follow-up was almost two years.  The dimension of the wedge to be removed was planned according to the preoperative radiographs with comparison to the contralateral elbow.  The technique involved the use of  K-wires as guides for wedge removal.  The distal fragment was translated medially to reduce the lateral condylar prominence.  Definitive fixation was also performed with K-wires.  The ulnar nerve was not transposed, but mobilized to prevent injury.  The patients were immobilized in a long arm cast for approximatley four weeks, and the transfixing K-wires were then removed.

The average surgical time was 73 minutes.  The follow-up carrying angle corrected to 2 degrees of valgus from a preoperative angle of 19 degrees of varus.  A variety of other radiographic parameters also improved.  There was no increase in the lateral condylar prominence index compared to preoperative measurements.

This report describes an additional approach for correcting cubitus varus deformity after supracondylar fractures of the humerus.  The medial approach is more cosmetic and allows for ample correction.  The operation can also be carried out from the lateral approach, maybe with more technical ease.  However, the lateral incision tends to yield a poor cosmetic outcome with a more visible scar, which tends to widen and thicken.  The authors stress the need to protect the ulnar nerve during this procedure to prevent inadvertent injuries. Overall, the results are exceptional and this approach should be considered in future management of cubitus varus deformity.

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