Experience with supracondylar humeral osteotomy [SCHO] for correction of late cubitus varus deformity [CVD] clinical and practical consideration

ABSTRACT

Seventeen corrective supracondylar humeral osteotomy [S.C.H.O] was performed for post traumatic late cubitus varus deformity [CVD] in 16 patients. The average age at injury was 4.5 years [range 3-10 years] and at S.C.H.O was 8 years [range 4-16 years] and the average follow up period was 2.5 years [range 6 months-5 years].The main indication for operation was the unsightly deformity caused by malunion. Early correction is advisable because deformity will not going to be corrected by remodelling and to provide prophylaxis against late ulnar nerve palsy S.C.H.O was a difficult operation and had significant incidence of complications and operative risk. Difficulty was encountered in maintainence of the correction [14 cases had K. wire fixation and 3 had only external plaster immobilisation]. The average varus deformity was 20 degrees [range 10-40 degrees]. Refinement of the technique was necessary simple wedge corrective osteotomy was carried out with no attempt for correction of mild rotational deformity. The average correction was 30 degrees. Relative higher success rate [47% excellent result] was attributed to equal limb osteotomy, varus correction alone, preservation of intact medial hinge, preoperative wedge tracing and accurate pin placing the operation is deceptively simple but it had a significant complication rate [47%] including recurrence [255], neuropraxia [18%], sepsis [18%], bad scarring [11%] but no case had non union. Post operative well filled back elbow slab in extension was important and highly recommended to achieve good hold of the fragments and higher satisfactory result. Cosmetic result could have been improved by operative medial shift of the distal fragment. The result of the study stress on the prevention or C.V.D. to avoid unnecessary secondary difficult operation