The closed wedge counter shift osteotomy for the correction of post-traumatic cubitus varus

Abstract

A variety of osteotomies have been proposed to correct post-traumatic cubitus varus deformity. Each one of them has advantages and disadvantages or limitations. A new technique for correcting post-traumatic cubitus varus with closed wedge counter shift osteotomy of the distal humerus is described and the preliminary results in six cases are reported. Five patients showed excellent results and one patient showed good result. We believe that the described technique is an alternative to the other procedures for the treatment of post-traumatic cubitus varus with minimal internal rotation and hyperextension deformities. It has the advantages of being a simple, safe, inherently stable, technically sound procedure, and yields an excellent cosmetic outcome.

Correction of Pediatric Cubitus Varus by Centralization of the Distal Humeral Fragment: A Surgical Technique to Avoid Lateral Condylar Prominence

“…24 Although complications, including loss of reduction and pin infection, have been reported in the literature, 4,5 Kirschner wires fixation has been proven to be a practical, effective, reliable, safe, and simple method in the treatment of pediatric cubitus varus. 6,15,16,20,25 As is known that the tenant of maximizing the spread of k-wire fixation for construct stability would be beneficial to reinforce the biomechanical principle and minimize the potential for complications. Nerve injury is perhaps the most feared complication of humeral osteotomies, which occurred in 2.53% of cases 26 and is related to surgical approaches, especially to the posterior, triceps splitting approach.…”

“…Although the oblique lateral closing wedge osteotomy described by Greenhill et al 19 is safe and reproducible, the additional cuts still mandate uniplanar osteotomies and are not suitable for younger children ( ≤ 5 y), and it is difficult to fix with the crossed Kirschner wire which can provide maximum mechanical stability. The closed wedge counter shift osteotomy described by Abdelmotaal et al 20 theoretically minimizes lateral prominence while enhancing inherent stability. However, it was performed through a standard posterior approach in the lateral decubitus position and demands more extensive dissection and higher surgical technology.…”

“…Furthermore, external fixation, such as Ilizarov method, may have a risk of nerve injuries 24. Although complications, including loss of reduction and pin infection, have been reported in the literature,4,5 Kirschner wires fixation has been proven to be a practical, effective, reliable, safe, and simple method in the treatment of pediatric cubitus varus 6,15,16,20,25. As is known that the tenant of maximizing the spread of k-wire fixation for construct stability would be beneficial to reinforce the biomechanical principle and minimize the potential for complications.…”

Neural wedge osteotomy method of correction for cubitus varus deformity in children

“…[12] Osteotomies currently used in the clinic include lateral closed wedge osteotomy, medial open wedge osteotomy, step-cut osteotomy, and dome-shaped osteotomy. [13] After osteotomy, most of the osteotomy ends are fixed with Kirschner wires. U-shaped nails and screws combined with steel wires are also used for fixation.…”

“…However, this method leads to an inconsistent diameter of the proximal and distal ends of the osteotomy and results in obvious deformity of the distal humerus, which is manifested by the appearance of the steps of the distal humerus on imaging. [8] The center of rotation of angulation (CORA) method and the neutral wedge osteotomy are widely used in the correction of lower limb deformity 13 . With the assistance of CORA, the neutral wedge osteotomy corrects the varus deformity.…”