Adult cubitus varus treated by lateral closed wedge osteotomy plus locking plating via a small incision and posterior lateral approach / 中华创伤骨科杂志

ABSTRACT

Objective:To explore the effects of lateral closed wedge osteotomy plus locking plating via a small incision and posterior lateral approach on adult cubitus varus.Methods:A retrospective analysis was conducted of the 19 adults with cubitus varus who had been admitted to Department of Hand Surgery, Wuhan Fourth Hospital from July 2013 to September 2017.They were 3 males and 16 females, aged from 17 to 27 years (average, 20.3 years). The left side was affected in 13 cases and the right side in 6 ones. The angle of cubitus varus was 20.7°±2.8°. The lifting angle on the healthy side and the cubitus angle on the affected side were accurately measured on the Medical Image Archiving and Transmission System (PACS) to calculate the osteotomy angle. Lateral closed wedge osteotomy plus locking plating was conducted to correct the deformity via a small incision and posterior lateral approach. The lifting angle on the affected side was measured at the last follow-up. The Mayo elbow performance scores(MEPS) was used to evaluate the elbow function and the Bellemore scoring system the effects of elbow correction surgery.Results:The 19 patients were followed up for 9 to 32 months (mean, 14 months). A good healing was observed at the osteotomy site in all patients. At the last follow-up, the elbow lifting angle was 11.4°±1.6° and the surgical scars averaged 4 cm (from 3 to 5 cm). The cubitus varus was significantly improved after operation, leading to fine elbow function. According to the MEPS, 10 cases were excellent, 7 good and 2 moderate. According to the Bellemore scoring system, 13 cases were excellent and 6 good. After operation, injury to partial ulnar nerve was observed in 2 cases and one patient developed mild elbow stiffness. Follow-ups revealed no implant failure like loosening or breakage and none cases of delayed fracture union or non-union.Conclusions:The osteotomy angle should be accurately measured on the PACS before operation. Lateral closed wedge osteotomy plus locking plating should be performed via a small incision and posterior lateral approach. These procedures can ensure the orthopedic angle and postoperative recovery of the elbow joint, resulting in a limited surgical scar, beautiful appearance and fine efficacy.