LATERAL CLOSING WEDGE OSTEOTOMY FOR TREATMENT OF TRAUMATIC CUBITUS VARUS DEFORMITY IN CHILDREN_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Jian , HE Taozhen , LIU Shaofeng , PENG Mingxing , LIU Min.

Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China.;

Corresponding author：

Keywords：

Traumatic cubitus varus deformity; Lateral closing wedge osteotomy; Children

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Objective To investigate the effectiveness of lateral closing wedge osteotomy for treatment of traumatic cubitus varus deformity in children. Methods Between July 1996 and June 2010, 20 cases of traumatic cubitus varus deformity after humeral supracondylar fracture were treated by lateral closing wedge osteotomy. There were 13 boys and 7 girls, aged from 7 to 14 years (mean, 10.6 years). The left elbow was involved in 12 cases and right elbow in 8 cases. Thirteen
cases had received closed reduction, percutaneous Kirschner wire fixation, and external fixation in other hospital, and 7 cases misdiagnosed as elbow luxation and soft tissue injury had given external fixation. Cubitus varus deformity occurred at 2-12 years after injury. Preoperatively, the elbow range of motion (ROM) in flexion and extension was 100-150° (mean, 133.0°) and 0-24° (mean, 11.7°), respectively. The angle of cubitus varus deformity was 20-50° (mean, 32.1°). Results All incisions healed by first intention, and no related complication occurred. A total of 17 patients were followed up 1-14 years (mean, 5 years). X-ray films revealed that bone union was achieved in all cases within 5-8 weeks after operation (mean, 6 weeks). The deformity of cubitus varus was corrected in all cases. At last follow-up, the elbow ROM in flexion and extension was 110-150° (mean, 135.9°) and 0-27° (mean, 12.9°), respectively. According to Jupiter et al. elbow score system, the results were excellent in 14 cases, good in 2 cases, and fair in 1 case; the excellent and good rate was 94.1%. One patient underwent recurrence at 1 month after removal of the Kirschner wire, and lateral closing wedge osteotomy was performed again after 1 year. Conclusion Lateral closing wedge osteotomy is a safe and effective surgical procedure in correcting traumatic cubitus varus deformity in children, which is easy to operate and can be effective in reducing the complications.

Citation： YANG Jian,HE Taozhen,LIU Shaofeng,PENG Mingxing,LIU Min.. LATERAL CLOSING WEDGE OSTEOTOMY FOR TREATMENT OF TRAUMATIC CUBITUS VARUS DEFORMITY IN CHILDREN. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(6): 657-660. doi: Copy

1.	潘少川. 实用小儿骨科学. 2版. 北京: 人民卫生出版社, 2005: 443-450.
2.	Storm SW, Williams DP, Khoury J, et al. Elbow deformities after fracture. Hand Clin, 2006, 22(1): 121-129.
3.	Murase T, Oka K, Moritomo H, et al. Three-dimensional corrective osteotomy of malunited fractures of the upper extremity with use of a computer simulation system. J Bone Joint Surg (Am), 2008, 90(11): 2375-2389.
4.	Husban FM, Odat MM, Dwiri MD. Lateral closing wedge supracondylar humeral osteotomy for treatment of post-traumatic cubitus varus. JRMS, 2010, 17(3): 33-38.
5.	Takeyasu Y, Murase T, Miyake J, et al. Three-dimensional analysis of cubitus varus deformity after supracondylar fractures of the humerus. J Shoulder Elbow Surg, 2011, 20(3): 440-448.
6.	Jupiter JB, Neff U, Holzach P, et al. Intercondylar fractures of the humerus. An operative approach. J Bone Joint Surg (Am), 1985, 67(2): 226-239.
7.	严世贵, 潘志军. 临床小儿骨科学. 北京: 中国医药科技出版社, 2010: 115-118.
8.	郭跃明, 王志远, 邹勇根, 等. 肱骨髁上骨折并发肘内翻畸形病理形态学分析. 中国矫形外科杂志, 2004, 12(10): 725-727.
9.	Davids JR, Lamoreaux DC, Brooker RC, et al. Translation step-cut osteotomy for the treatment of posttraumatic cubitus varus. J Pediatr Orthop, 2011, 31(4): 353-365.
10.	Zhang YZ, Lu S, Chen B, et al. Application of computer-aided design osteotomy template for treatment of cubitus varus deformity in teenagers: a pilot study. J Shoulder Elbow Surg, 2011, 20(1): 51-56.
11.	张金哲, 潘少川, 黄澄如. 实用小儿外科学. 杭州: 浙江科学技术出版社, 2003: 1290-1300.
12.	Cho CH, Song KS, Min BW, et al. Long-term results of remodeling of lateral condylar prominence after lateral closed-wedge osteotomy for cubitus varus. J Shoulder Elbow Surg, 2009, 18(3): 478-483.
13.	张问广, 胡月光. 肱骨髁上骨折并发肘内翻的临床与应用解剖研究. 临床小儿外科杂志, 2008, 7(3): 43-44.
14.	Buß FR, Schulz AP, Lill H, et al. Supracondylar osteotomies of posttraumatic distal humeral deformities in young adults——technique and results. Open Orthop J, 2011, 5: 389-394.
15.	Skaggs DL, Glassman D, Weiss JM, et al. A new surgical technique for the treatment of supracondylar humerus fracture malunions in children. Journal of Children’s Orthopaedics, 2011, 5(4): 305-312.
16.	Bali K, Sudesh P, Krishnan V, et al. Modified step-cut osteomy for post-traumatic cubitus varus: our experience with 14 children. Orthop Traumatol Surg Res, 2011, 97(7): 741-749.
17.	Mangwani J, Nadarajah R, Paterson JM. Supracondylar humeral fractures in children: ten years’ experience in a teaching hospital. J Bone Joint Surg (Br), 2006, 88(3): 362-365.
18.	Feng C, Gou Y, Zhu Z, et al. Biomechanical analysis of supracondylar humerus fractures pinning for fractures with coronal lateral obliquity. J Pediatr Orthop, 2012, 32(2): 196-200.
19.	Srivastava AK, Srivastava D, Gaur S. Lateral close wedge osteotomy for cubitus varus deformity. Indian J Orthop, 2008, 42(4): 466-470.
20.	Hamdi A, Poitras P, Louati H, et al. Biomechanical analysis of lateral pin placements for pediatric supracondylar humerus fractures. J Pediatr Orthop, 2010, 30(2): 135-139.
21.	Takagi T, Takayama S, Nakamura T, et al. Supracondylar osteotomy of the humerus to correct cubitus varus: do both internal rotation and extension deformities need to be corrected? J Bone Joint Surg (Am), 2010, 92(7): 1619-1626.
22.	Moon MS, Kim SS, Kim ST, et al. Lateral closing wedge osteotomy with or without medialisation of the distal fragment for cubitus varus. J Orthop Surg (Hong Kong), 2010, 18(2): 220-223.

1. 潘少川. 实用小儿骨科学. 2版. 北京: 人民卫生出版社, 2005: 443-450.
2. Storm SW, Williams DP, Khoury J, et al. Elbow deformities after fracture. Hand Clin, 2006, 22(1): 121-129.
3. Murase T, Oka K, Moritomo H, et al. Three-dimensional corrective osteotomy of malunited fractures of the upper extremity with use of a computer simulation system. J Bone Joint Surg (Am), 2008, 90(11): 2375-2389.
4. Husban FM, Odat MM, Dwiri MD. Lateral closing wedge supracondylar humeral osteotomy for treatment of post-traumatic cubitus varus. JRMS, 2010, 17(3): 33-38.
5. Takeyasu Y, Murase T, Miyake J, et al. Three-dimensional analysis of cubitus varus deformity after supracondylar fractures of the humerus. J Shoulder Elbow Surg, 2011, 20(3): 440-448.
6. Jupiter JB, Neff U, Holzach P, et al. Intercondylar fractures of the humerus. An operative approach. J Bone Joint Surg (Am), 1985, 67(2): 226-239.
7. 严世贵, 潘志军. 临床小儿骨科学. 北京: 中国医药科技出版社, 2010: 115-118.
8. 郭跃明, 王志远, 邹勇根, 等. 肱骨髁上骨折并发肘内翻畸形病理形态学分析. 中国矫形外科杂志, 2004, 12(10): 725-727.
9. Davids JR, Lamoreaux DC, Brooker RC, et al. Translation step-cut osteotomy for the treatment of posttraumatic cubitus varus. J Pediatr Orthop, 2011, 31(4): 353-365.
10. Zhang YZ, Lu S, Chen B, et al. Application of computer-aided design osteotomy template for treatment of cubitus varus deformity in teenagers: a pilot study. J Shoulder Elbow Surg, 2011, 20(1): 51-56.
11. 张金哲, 潘少川, 黄澄如. 实用小儿外科学. 杭州: 浙江科学技术出版社, 2003: 1290-1300.
12. Cho CH, Song KS, Min BW, et al. Long-term results of remodeling of lateral condylar prominence after lateral closed-wedge osteotomy for cubitus varus. J Shoulder Elbow Surg, 2009, 18(3): 478-483.
13. 张问广, 胡月光. 肱骨髁上骨折并发肘内翻的临床与应用解剖研究. 临床小儿外科杂志, 2008, 7(3): 43-44.
14. Buß FR, Schulz AP, Lill H, et al. Supracondylar osteotomies of posttraumatic distal humeral deformities in young adults——technique and results. Open Orthop J, 2011, 5: 389-394.
15. Skaggs DL, Glassman D, Weiss JM, et al. A new surgical technique for the treatment of supracondylar humerus fracture malunions in children. Journal of Children’s Orthopaedics, 2011, 5(4): 305-312.
16. Bali K, Sudesh P, Krishnan V, et al. Modified step-cut osteomy for post-traumatic cubitus varus: our experience with 14 children. Orthop Traumatol Surg Res, 2011, 97(7): 741-749.
17. Mangwani J, Nadarajah R, Paterson JM. Supracondylar humeral fractures in children: ten years’ experience in a teaching hospital. J Bone Joint Surg (Br), 2006, 88(3): 362-365.
18. Feng C, Gou Y, Zhu Z, et al. Biomechanical analysis of supracondylar humerus fractures pinning for fractures with coronal lateral obliquity. J Pediatr Orthop, 2012, 32(2): 196-200.
19. Srivastava AK, Srivastava D, Gaur S. Lateral close wedge osteotomy for cubitus varus deformity. Indian J Orthop, 2008, 42(4): 466-470.
20. Hamdi A, Poitras P, Louati H, et al. Biomechanical analysis of lateral pin placements for pediatric supracondylar humerus fractures. J Pediatr Orthop, 2010, 30(2): 135-139.
21. Takagi T, Takayama S, Nakamura T, et al. Supracondylar osteotomy of the humerus to correct cubitus varus: do both internal rotation and extension deformities need to be corrected? J Bone Joint Surg (Am), 2010, 92(7): 1619-1626.
22. Moon MS, Kim SS, Kim ST, et al. Lateral closing wedge osteotomy with or without medialisation of the distal fragment for cubitus varus. J Orthop Surg (Hong Kong), 2010, 18(2): 220-223.

Chinese Journal of Reparative and Reconstructive Surgery

LATERAL CLOSING WEDGE OSTEOTOMY FOR TREATMENT OF TRAUMATIC CUBITUS VARUS DEFORMITY IN CHILDREN

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