ABSTRACT
Objective To investigate the feasibility and clinical effectiveness of modified humeral supracondy-lar step－cut osteotomy(M－HSSCO)for cubitus varus in children.Methods Between June 2016 and June 2017,the study included 25 children (20 boys and 5 girls)presenting cubitus varus at the age of (8.5 ± 0.3)years old (6－11 years old)in the Children's Hospital of Nanjing Medical University.M－HSSCO was used in the osteotomy operation. The initial osteotomy was performed as a right triangle osteotomy.The inferior margin of this right triangle was outlined parallel to the joint line 0.5－1.0 cm above the olecranon fossa.Then,they were incised from the medial end of this parallel line,which made an angle between the first and second lines equal to the desired corrective humerus elbow－wrist angle.Next,from the lateral end of the second line,the third line perpendicular to the first line was cut.Finally, desired right triangle was outlined and removed.The second right triangle osteotomy from proximal line of osteotomy was similar as the above.The medial cortex and periosteum was used as a hinge and rotated to make two osteotomy parts combined steadily.The Bellemore evaluation system was used to evaluate the difference in carrying angle degree be-tween the affected side and normal side after osteotomy,and the different degree of flexion and extension in the elbow joint between preoperation and post－operation.Residual varus deformity and other complications were also evaluated. Results All patients were followed up for 6－18 months (mean 12 months).The preoperative ipsilateral carrying an-gle was－(15°－30°)[－(22.20 ± 1.40)°],the postoperative was 5°－10°[(7. 60 ± 0.47)°]and the final follow－up was 5°－9°[(7.30 ± 0.40)°].There were statistically significant differences in the flexion angles before surgery and after surgery (t＝23.34,P＝0.000).There were statistically significant differences in the flexion angles before surgery and at final follow－up (t＝23.14,P＝0.000).The mean range of joint motion of the elbow was －5°－130° [(132.5 ± 0.5)°]before surgery,0°－125°[(123.6 ± 1.4)°]after surgery and 0°－130°[(126.8 ± 1.3)°]at fi-nal follow－up.The carrying angle reduced did not happen by the final follow－up.There was no statistically significant difference between the flexion angles before surgery and after surgery or by final follow－up(P＞0. 05).Twenty－three (92.0%)patients got an excellent result,2 cases(18.0%)got a good result and no patient (0)got worse according to the criteria described by Bellemore.The first－class incision healing were achieved in all patients.There was no case with postoperative infection,instabilities,vascular and neural injury or any significant postoperative complications. Conclusions M－HSSCO is an effective osteotomy procedure which shows good feasibility and apparent therapeutic effect in treating cubitus varus in children.
ABSTRACT
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.
Subject(s)
Humans , Young Adult , Congenital Abnormalities , Drainage , Elbow , Follow-Up Studies , Osteotomy , Range of Motion, ArticularABSTRACT
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.
Subject(s)
Humans , Young Adult , Congenital Abnormalities , Drainage , Elbow , Follow-Up Studies , Osteotomy , Range of Motion, ArticularABSTRACT
PURPOSE: evaluate the radiologic and clinical results of modified step-cut osteotomy for correction of cubitus varus deformity in children. MATERIALS AND METHODS: We analysed 16 children who had varus deformity preoperatively and received modified step-cut osteotomy. The results were evaluated by final follow-up radiographs and clinical results, which were humeral-elbow-wrist angle, lateral prominence, range of motion and complications. RESULTS: The average preoperative humeral-elbow-wrist (HEW) angle was -15.8degrees and average last follow-up HEW angle was +6.7degrees Lateral prominence under 5 mm occurred in 3 cases and one children showed limited motion and transient ulna neuropathy. CONCLUSION: The results demonstrate that modified step-cut osteotomy achieve good correction of cubitus varus without lateral bony prominence or complications.
Subject(s)
Child , Humans , Congenital Abnormalities , Follow-Up Studies , Humerus , Osteotomy , Range of Motion, Articular , UlnaABSTRACT
We studied the technical problems of step-cut osteotomy and a method to improve the problem. When a bony fragment is removed from distal humerus in step cut osteotomy, we obtain a bony defect of the shape of a right triangle. The distal part of this defect is right angled(90 degrees) but the proximal part inserted in it is less 2than 90 degrees, they do not correspond to each other. There is, however, no explanation on this in the original article. By personal communication with DeRosa, he said he would remove a part of the small bony spike of the lateral side after osteotomy. However, it is technically difficult to remove a part of the distal bony spike because it is tiny and it can cause a fracture on the bony spike. Even in a successful 1case, there arises a problem of fixing with a cortical screw. To solve this problem, we instead removed a part of the lateral cortex of proximal part so that we made possible the contact of medullary canal at the osteotomy site without removing the lateral spike of distal bony spike. This way, a more stable fixation and a faster bony union were made possible. This modified method was performed on 17 cases, in which the average age of the patients was 13 years old(9 to 18). For 4-6 weeks after the operation, they were immobilized the upper extremity in a cast, and after that, then were allowed to do exercises. We obtained the complete bony union between the 10th and 16th week after the operation. In the follow-up cases of minimum 1 year, 12 cases were proven excellent, 3 cases were good, and 2 cases were poor by Oppenheim's criteria. There was one case of radial nerve transient paresis and one case of metal failure. There was no nonunion on osteotomy site. By using the modified method, we made possible the mechanically stable and technically easier fixation to obtain satisfactory results.