Computer-simulated osteotomy based on health-side combined with guide plate technique in treatment of cubitus varus deformity in adolescents / 中国修复重建外科杂志

OBJECTIVE@#To explore the feasibility and early effectiveness of computer-simulated osteotomy based on the health-side combined with guide plate technique in the treatment of cubitus varus deformity in adolescents.@*METHODS@#The clinical data of 23 patients with cubitus varus deformity who met the selection criteria between June 2019 and February 2023 were retrospectively analyzed. There were 17 males and 6 females, ranging in age from 4 to 16 years with an average of 8.5 years. The time from injury to operation was 1-4 years. The angle of distal humerus rotation was defined by humeral head posterior inclination angle using low radiation dose CT to scan the patient's upper extremity data at one time, and the preoperative rotation of the distal humerus on the affected side was (33.82±4.39)°. The CT plain scan data were imported into 9yuan3D digital orthopaedic system (V3.34 software) to reconstruct three-dimensional images of both upper extremities. The simulated operation was performed with the healthy upper extremity as the reference, the best osteotomy scheme was planned, overlapped and compared, and the osteotomy guide plate was prepared. The patients were followed up regularly after operation, and the formation of callus in the osteotomy area was observed by X-ray examination. Before and after operation, the carrying angle of both upper extremities (the angle of cubitus valgus was positive, and the angle of cubitus varus was negative) and anteversion angle were measured on X-ray and CT images. At the same time, the flexion and extension range of motion of elbow joint and the external rotation range of motion of upper extremity were measured, and Mayo score was used to evaluate the function of elbow joint.@*RESULTS@#The operation time ranged from 34 to 46 minutes, with an average of 39 minutes. All patients were followed up 5-26 months, with a mean of 14.9 months. All the incisions healed by first intention after the operation; 2 patients had nail path irritation symptoms after Kirschner wire fixation, which improved after dressing change; no complication such as breakage and loosening of internal fixators occurred after regular X-ray review. Continuous callus formed at the osteotomy end at 4 weeks after operation, and the osteotomy end healed at 8-12 weeks after operation. At last follow-up, the carrying angle, anteversion angle, external rotation range of motion, and extension and flexion range of motion of the elbow joint of the affected side significantly improved when compared with preoperative ones ( P<0.05). Except for the extension range of motion of the healthy elbow joint ( P<0.05), there was no significant difference in other indicators between the two sides ( P>0.05). At last follow-up, the Mayo elbow score was 85-100, with an average of 99.3; 22 cases were excellent, 1 case was good, and the excellent and good rate was 100%.@*CONCLUSION@#Computer-simulated osteotomy based on health-side combined with guide plate technique for treating cubitus varus deformity in adolescents can achieve precise osteotomy, which has the advantages of short operation time and easy operation, and the short-term effectiveness is satisfactory.

New Fixation Method Using Two Crossing Screws and Locking Plate for Cubitus Varus Deformity in Young Adult Elbow: Case Report

Many types of osteotomy have been proposed for the treatment of cubitus varus deformity of the elbow, and various methods for fixation of the osteotomy site have also been described. However, no method has been perfect. We treated two cases of cubitus varus elbow deformity with step-cut osteotomy using a new fixation method with two crossing screws and an anatomically designed locking plate. Active assisted elbow range of motion (ROM) exercise was permitted at postoperative 3 days, after removal of the drainage. Preoperative and postoperative humerus-elbow-wrist angles and ranges of motion of the two patients were compared. At 3 months follow-up, each patient had recovered the preoperative elbow ROM, and achieved the complete bony union of the osteotomy site and proper correction of the cubitus varus deformity. In addition, the appropriate remodeling of the lateral bony protrusion was observed. Therefore, we introduce a new fixation method for achievement of stable fixation allowing immediate postoperative elbow motion after corrective osteotomy for cubitus varus deformity in young adults.

New Fixation Method Using Two Crossing Screws and Locking Plate for Cubitus Varus Deformity in Young Adult Elbow: Case Report

Many types of osteotomy have been proposed for the treatment of cubitus varus deformity of the elbow, and various methods for fixation of the osteotomy site have also been described. However, no method has been perfect. We treated two cases of cubitus varus elbow deformity with step-cut osteotomy using a new fixation method with two crossing screws and an anatomically designed locking plate. Active assisted elbow range of motion (ROM) exercise was permitted at postoperative 3 days, after removal of the drainage. Preoperative and postoperative humerus-elbow-wrist angles and ranges of motion of the two patients were compared. At 3 months follow-up, each patient had recovered the preoperative elbow ROM, and achieved the complete bony union of the osteotomy site and proper correction of the cubitus varus deformity. In addition, the appropriate remodeling of the lateral bony protrusion was observed. Therefore, we introduce a new fixation method for achievement of stable fixation allowing immediate postoperative elbow motion after corrective osteotomy for cubitus varus deformity in young adults.

A New Radiologic Assessment Method in Supracondylar Fracture of the Humerus / 대한정형외과학회잡지

Cubitus varus deformity following supracondylar frscture of the humerus in children is one of the major complications. The angle between long axis of humeral shaft and the line formed by connecting lower margin of trochlea and capitellum has been described by authors as a new method of radiological assessment for the indirect measurement of carrying angle. From the author's retrospective radiological study in 115 normal children and 41 supracondylar fractured children, the results were as follows;1. In the 115 normal arms, the mean vslue of T-C angle was 1049±3.8° 2. In the 115 normal arms, a significant relationship was found between the Baumann angle and T-C angle. 3. In the 115 normal arms, a significant relationship was found between the Baumsnn angle and the Carrying angle. 4. In the 115 normal arms, a significant relationship was found between the T-C angle and the Carrying angle. 5. In the 41 injured arms, reliability test was performed for the excluding of effect of the environment. The results was that T-C angle was more reliable than Baumann angle as a indirect measurement method of the Carrying angle. From above results, it is suggested that T-C angle can be reliably used to predict the Carrying angle and prevent cubitus varus deformity in supracondylar fracture of humerus.

Cubitus Varus Deformity following Long-term Crutch Walking in Crippled Children (Crutch Elbow) / 대한정형외과학회잡지

Cubitus varus deformity caused usually by malunion in supracondylar fracture or epiphyseal injuries of the elbow joint, but the other causes of cubitus varus deformity have not been reported. 7 cases of cubitus varus deformity were found among the patients in Sam Yook Childrens Rehabilitation Center in Oct. 1981 all of whom used crutches in order to ambulate due to late sequele of poliomyelitis. The results were as follows. l. After long-term crutch walking, cubitus varus deformity and bowing around the proximal forearm were seen among the patients who mis-used the crutches. 2. Gross carrying angle was greater than radiographic carrying angle and it caused by hypertrophy of the extensor muscle group in forearm and bowing around the proximal forearm. 3. Etiologic factors of the cubitus varus deformity were considered to be improper measurement of the crutches, degree of paralysis of lower extremity and duration of the crutch walking, etc. 4. The mechanism of this deformity could be explained biomechanically by the abnormal axial loading onto the elbow following long-term crutch walking. 5. The correct measurement of the crutches and proper flexion of the elbow during crutch walking were stressed.