Modified step-cut osteotomy for correction of post-traumatic cubitus varus deformity: a report of 19 cases

Abstract

We reviewed the outcomes of post-traumatic varus deformity treated with modified step-cut osteotomy in 19 patients (average age, 7.4 years; range, 4.3-16.8 years at time of surgery). The average follow-up period was 29.6 months. The mean range of motion was 15.0°/124.7° (extension/flexion) before surgery and 6.8°/132.6° at final follow-up. The humerus-elbow-wrist angle was -21.1° before surgery and 4.2° at final follow-up, with a loss of 4.4° from the value of the humerus-elbow-wrist angle after the surgery. Osteotomy was fixed with Kirschner wires, and, in five cases, chips of excised bone could be inserted to avoid elbow extension. However, in eight cases, usually concerning younger patients, the elbow was fixed in hyperextension higher than 5°. No patient developed postoperative infections or later complications. Only one patient had transient nerve palsy. The modified step-cut osteotomy can precisely and stably correct the varus deformity in the coronal plane, especially in patients under 10 years of age. To avoid radial nerve palsy, we recommend that the retractors be removed sometimes during the operation.

Reliability and Validity of Radiographic Measurement of the Humerus-Elbow-Wrist Angle in Healthy Children

“…An unbiased population-based large cohort study with an enrollment of healthy volunteers is desirable to obtain true normative data on coronal alignment of the upper limb in the growing child. Second, as described above, the original literature and other previous reports regarding the humerus-elbow-wrist angle did not clearly define the level of the proximal and distal transverse lines of the forearm 4 - 14 . For accurate measurements, we used our own method for measuring the humerus-elbow-wrist angle.…”

“…The axis of the forearm is defined by a line passing through the midpoints of 2 transverse lines connecting the cortices, which help to determine the central axis of the forearm. Although the original literature and other reports regarding the humerus-elbow-wrist angle only described the level of 2 transverse lines across the forearm as “1 proximal and 1 distal,” 4 - 14 we determined the level of these lines at the radial tuberosity and the top of the radial bowing. This definition might lead to good measurement reliability.…”

“…In 1984, Oppenheim et al first described the humerus-elbow-wrist angle, which is also an index of coronal alignment of the humerus and forearm, for the postoperative assessment of the results of humeral osteotomy 4 . In recent years, the humerus-elbow-wrist angle gradually has been adopted for the radiographic assessment of the results of corrective osteotomy for the treatment of cubitus varus deformity or supracondylar humeral fracture 5 - 14 . Some investigators have examined the normal range of the humerus-elbow-wrist angle in the uninjured elbow 9 , 11 - 13 .…”

“…The mean age of the patients in those studies ranged from 9.2 to 28.9 years; therefore, the normal value and range of the humerus-elbow-wrist angle in skeletally immature subjects are not fully known. Furthermore, although recent studies have used the humerus-elbow-wrist angle instead of the carrying angle for the assessment of postoperative results 9 - 14 , the association between these 2 angles is unclear.…”

Application of computer simulation in the treatment of traumatic cubitus varus deformity in children

“…[13–15] Other procedures include step osteotomy, fornix osteotomy, and multiplanar osteotomy. [9,16,17] The important aspect of the procedure is the determination of the angle and length of the wedge-shaped osteotomy, as well as the plane and direction of the osteotomy. The postoperative appearances of different osteotomy planes and directions differ.…”