Session VIII - Pediatrics
Sat, 10/9/04 Pediatrics, Paper #48, 3:44 pm
Dome Osteotomy for Post-Traumatic Cubitus Varus: A Surgical Technique to Avoid Lateral Condylar Prominence
Purpose: The indication for surgery in the majority of children with posttraumatic cubitus varus is the presence of an unsightly deformity, although function is generally not impaired. Lateral closing-wedge supracondylar osteotomy, although the most commonly used corrective procedure, has a tendency to produce lateral condylar prominence, thus jeopardizing the cosmetic outcome. The purpose of our study was to evaluate whether our technique of dome supracondylar osteotomy can avoid this complication and achieve a better cosmetic outcome.
Methods: We employed the dome supracondylar osteotomy as the corrective procedure for cubitus varus in 12 consecutive children between May 1998 and June 2002. The indication for the operation in all the cases was the unacceptable appearance of the elbow. However, in one patient, snapping of the medial portion of the triceps muscle was also associated. The angle of correction was calculated preoperatively as the difference between the carrying angles of the unaffected and affected elbow. The lateral prominence index (LP) was calculated on the affected side as the difference between the measured medial and lateral widths of the bone from the longitudinal mid-humeral axis and was expressed as a percentage of the total width of the distal humerus to minimize errors from magnification and variation of the size of individual humeri. The dome osteotomy was carried out by a single surgeon through the posterior approach to the distal humerus. The distal fragment was rotated according to the angle of correction calculated preoperatively, and the osteotomy was fixed with two K-wires.
Results: The average follow-up was for 2.3 years (range, 1 to 5). There were seven excellent and five good results. None of the children showed prominence of the lateral humeral condyle. Hypertrophic scar formation and ulnar neuropraxia were seen in one patient each. There was no incidence of implant loosening or fixation failure. Our results were comparable to the published results of lateral closing-wedge osteotomy, in terms of correction of carrying angle and preservation of elbow motion, and superior in terms of postoperative appearance of the elbow and overall cosmetic outcome.
Conclusions: The described technique of dome osteotomy for the correction of posttraumatic cubitus varus is a simple, safe, and technically sound procedure that prevents the lateral condyle from becoming prominent and yields a better cosmetic outcome than the lateral closing-wedge osteotomy.