Three-Dimensional Corrective Osteotomy for Cubitus Varus Deformity with Use of Custom-Made Surgical Guides.

INTRODUCTION: We present a detailed description of our preoperative planning and surgical technique for three-dimensional (3-D) corrective osteotomy with use of custom-made surgical guides for cubitus varus deformity after supracondylar fracture. STEP 1 CREATE COMPUTER BONE MODELS FROM CT DATA: Obtain CT data of both upper extremities and create computer bone models from these data. STEP 2 EVALUATE THE 3-D DEFORMITY: Evaluate the deformity in three dimensions by comparing the affected humerus with the mirror image of the contralateral, normal humerus. STEP 3 PLAN THE 3-D CORRECTIVE OSTEOTOMY: Simulate a 3-D corrective osteotomy on the basis of information obtained from the deformity evaluation. STEP 4 OPERATIVE SETUP: Order the custom-made surgical guides that will assist you in reproducing the preoperative simulation during the actual surgery. STEP 5 PERFORM THE 3-D OSTEOTOMY USING THE CUSTOM-MADE SURGICAL GUIDES: Perform the osteotomy using the custom-made surgical guides and achieve anatomical correction using the reduction guides. STEP 6 POSTOPERATIVE CARE: Apply a removable splint and have the patient start active and passive range-of-motion exercise after the splinting period has been completed. RESULTS: In our series of thirty patients, the mean humerus-elbow-wrist angle and tilting angle of the affected side were 18° (varus) and 25°, respectively, before surgery, which significantly improved to 6° (valgus) and 38°, respectively, after surgery.IndicationsContraindicationsPitfalls & Challenges.

Preoperative, computer simulation-based, three-dimensional corrective osteotomy for cubitus varus deformity with use of a custom-designed surgical device.

BACKGROUND: Cubitus varus deformity after a supracondylar fracture classically includes varus, extension, and internal rotation components. However, to our knowledge, no reliable surgical method for three-dimensional corrective osteotomy has been established. We developed an intraoperative guide system involving a custom-made surgical template designed on the basis of a three-dimensional computer simulation incorporating computed tomography (CT) data. We aimed to investigate the feasibility of this novel technique for correcting cubitus varus deformity. METHODS: Thirty consecutive patients (twenty-three males and seven females) with a cubitus varus deformity resulting from the malunion of a distal humeral supracondylar fracture were included in this study. Between October 2003 and May 2011, the patients underwent a three-dimensional corrective osteotomy with use of a custom-made surgical template. The patients were then followed for a minimum of twelve months. We evaluated radiographic parameters, including the humerus-elbow-wrist angle and tilting angle, as well as the ranges of motion of the elbow and shoulder at the time of the most recent follow-up. An overall clinical evaluation was performed. RESULTS: Bone union was achieved at a mean of four months after surgery. The mean humerus-elbow-wrist angle and tilting angle on the affected side improved significantly from 18.2° (varus) and 25.0°, respectively, before surgery, to 5.8° (valgus) and 38.0°, respectively, after surgery. Hyperextension of the elbow and internal rotation of the shoulder were normalized in all patients. Early plate breakage was observed in one patient. One patient had mild recurrence of varus deformity. Twenty-seven patients had an excellent result, three had a good result, and none had a poor result. CONCLUSIONS: Three-dimensional corrective osteotomy with the use of a custom-made surgical template that is designed and produced on the basis of computer simulation is a feasible and useful treatment option for cubitus varus deformity.

Three-dimensional analysis of cubitus varus deformity after supracondylar fractures of the humerus.

BACKGROUND: What is thought of as a classic "cubitus varus" deformity usually consists of varus, extension, and internal rotation. However, its 3-dimensional (3D) pattern with 3D imaging has not been reported. This study aimed to obtain such 3D patterns using 3D bone models created from computed tomography data and evaluate the accuracy of conventional radiographic and clinical methods of assessing the deformity. METHODS: Imaging of 25 humeri of 25 patients with cubitus varus deformity caused by previous humeral supracondylar fractures was performed. The deformity was assessed by superimposing the 3D bone model onto a mirror-image model of the contralateral normal humerus. The 3D deformity pattern of cubitus varus was evaluated based on the 3 deformity components. Values obtained from conventional radiographic and physical measurements--that is, humerus-elbow-wrist angle (HEW-A), tilting angle (TA), maximal elbow flexion angle (MEF), and internal rotation angle (IRA)--were compared with those from the 3D technique. RESULTS: Of the patients, 44% had varus, extension, and rotation deformities of 10° or greater; 20% had varus and extension deformities of 10° or greater; 16% had varus and internal rotation deformities of 10° or greater; and 20% had varus deformity only. When the 3D measurements were considered accurate, an error of 10° or greater was found in 8%, 24%, 8%, and 44% of cases in terms of HEW-A, TA, MEF, and IRA values, respectively. CONCLUSION: Of the humeri, 80% had other bony deformities in addition to varus and 20% had isolated varus deformities. HEW-A and MEF showed reasonable accuracy as measures for the degree of deformity, whereas TA and IRA were found to be relatively inaccurate.

Arthroscopic reduction and internal fixation of an avulsion fracture of the posterior horn of the lateral meniscus.

We report a very rare case of an avulsion fracture of the posterior horn of the lateral meniscus associated with ACL tear, which was successfully treated by arthroscopic reduction and pullout fixation of the fragment along with ACL reconstruction.