Lateral wedge osteotomy for pediatric post-traumatic cubitus varus: Kirschner-wires or locking angular plate?

Persiani, P.J.; Noia, Giovanni; Cristo, Claudia de; Graci, Jole; Gurzì, Michele Dario; Villani, Ciro

doi:10.1097/bpb.0000000000000300

Cited by 10 publications

(15 citation statements)

References 20 publications

(54 reference statements)

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“…The most common variations to our technique usually differ in fixation or surgical approach. We start to consider plate fixation (rather than Kirschner wires) via a posterior approach in children who are .12 years old, although this is controversial 17,18 (Fig. 6).…”

Section: Resultsmentioning

confidence: 99%

Oblique Lateral Closing-Wedge Osteotomy for Cubitus Varus in Skeletally Immature Patients

Greenhill

Kozin

Kwon

et al. 2019

JBJS Essential Surgical Techniques

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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 fractures 1. 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 fractures 3 , snapping medial triceps, and ulnar nerve instability 4. 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 transposition 5. Alternative osteotomy techniques are described and categorized as simple lateral closing wedge, step-cut 6-9 , dome, 3-dimensional 10 , 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 outcomes 13. Three-Disclosure: The authors indicated that no external funding was received for any aspect of this work. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJSEST/A269).

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Section: Resultsmentioning

confidence: 99%

Oblique Lateral Closing-Wedge Osteotomy for Cubitus Varus in Skeletally Immature Patients

Greenhill

Kozin

Kwon

et al. 2019

JBJS Essential Surgical Techniques

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“…The presentations of the malunited supracondylar humerus in children were described as the appearance of abnormality of elbow ROM with restricted elbow flexion and excessive elbow extension, and the component of malunited internal rotation of distal fragment. The incidence of cubitus varus following malunited supracondylar humerus is notably high, about 10–50% [ 8 , 9 ]. The main complaints of most children's parents are to improve the appearance of the elbow and to correct the limited function of the hand involved in eating and touching their own head for brushing teeth, washing and combing their hair [ 9 ].…”

Section: Literature Review and Discussionmentioning

confidence: 99%

“…The incidence of cubitus varus following malunited supracondylar humerus is notably high, about 10–50% [ 8 , 9 ]. The main complaints of most children's parents are to improve the appearance of the elbow and to correct the limited function of the hand involved in eating and touching their own head for brushing teeth, washing and combing their hair [ 9 ].…”

Section: Literature Review and Discussionmentioning

confidence: 99%

“…While no current evidence clearly describes the comprehensive surgical sequences of the corrective osteotomy at the supracondylar humerus, French et al, in 1959 performed corrective osteotomy of the cubitus varus, and Dome osteotomy was described by Kanaujia et al, in 1988 [ 5 , 10 ]. The improvement of the techniques is still developing until now, whereas biomechanical analysis of implant configuration using the three-dimensional imagery of the distal humerus is still in development [ 8 , 9 , 11 ].…”

Section: Literature Review and Discussionmentioning

confidence: 99%

“…The incision of the original French method was described as a posterior approach, while our technique used Kocher's lateral approach, which subperiosteally exposed the bone by anterior, lateral ridge, and posterior cortex. The difference of the internal fixation technique was precisely decided due to the inferiority of the old techniques that only use single tensioned wire to bind the screw without Kirschner wire for antirotation wire [ 9 ].…”

Section: Literature Review and Discussionmentioning

confidence: 99%

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The lateral curved osteotomy for cubitus varus deformity in children: A case report and literature review

Solichin

Sandjaya

Prabowo

et al. 2021

Annals of Medicine &Amp; Surgery

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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.

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Bone tissue engineering for treating osteonecrosis of the femoral head

Bian

et al. 2023

Exploration

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Osteonecrosis of the femoral head (ONFH) is a devastating and complicated disease with an unclear etiology. Femoral head-preserving surgeries have been devoted to delaying and hindering the collapse of the femoral head since their introduction in the last century. However, the isolated femoral head-preserving surgeries cannot prevent the natural progression of ONFH, and the combination of autogenous or allogeneic bone grafting often leads to many undesired complications. To tackle this dilemma, bone tissue engineering has been widely developed to compensate for the deficiencies of these surgeries. During the last decades, great progress has been made in ingenious bone tissue engineering for ONFH treatment. Herein, we comprehensively summarize the state-of-the-art progress made in bone tissue engineering for ONFH treatment. The definition, classification, etiology, diagnosis, and current treatments of ONFH are first described. Then, the recent progress in the development of various bone-repairing biomaterials, including bioceramics, natural polymers, synthetic polymers, and metals, for treating ONFH is presented. Thereafter, regenerative therapies for ONFH treatment are also discussed. Finally, we give some personal insights on the current challenges of these therapeutic strategies in the clinic and the future development of bone tissue engineering for ONFH treatment. K E Y WO R D S biomaterials, bone tissue engineering, osteonecrosis of the femoral head, regenerative therapy  Yixin Bian and Tingting Hu contributed equally to this work.

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Lateral wedge osteotomy for pediatric post-traumatic cubitus varus: Kirschner-wires or locking angular plate?

Cited by 10 publications

References 20 publications

Oblique Lateral Closing-Wedge Osteotomy for Cubitus Varus in Skeletally Immature Patients

Oblique Lateral Closing-Wedge Osteotomy for Cubitus Varus in Skeletally Immature Patients

The lateral curved osteotomy for cubitus varus deformity in children: A case report and literature review

Bone tissue engineering for treating osteonecrosis of the femoral head

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