Several osteotomies and various fixation techniques are described for its correction. The purpose of this study was to evaluate the effectiveness of supracondylar lateral closingwedge osteotomy of the humerus in children and the postoperative remodeling of the lateral condylar prominence. This study aims to explore whether individualized 3dprinted navigation templates can assist with accurate and effective corrective treatment of children with cubitus varus deformity. The medial cortical periosteal hinge was left intact and the osteotomy stabilized with two kirschner wires and a tensionband wire loop. The authors evaluated the results of a medial approach for the corrective osteotomy of 14 consecutive children mean age 8. Possible procedural steps are explored for how to treat pediatric cases of cubitus varus. Historically, it is a complication of supracondylar fractures with a frequency as high as 30%. Analysis of tardy ulnar nerve palsy associated with. Cubitus varus deformity treatment is tending toward 3d correction, which is challenging for orthopedic surgeons.
The management of cubitus varus and valgus using the. We treated 11 elbows in 11 patients by osteotomy and gradual controlled coordinated stretching using the ilizarov method. This complication is associated more with conservative treatment of displaced supracondylar fractures. Cubitus varus gunstock deformity is the most common complication of supracondylar fracture of the humerus. We have performed the lateral closing wedge french osteotomy to correct the varus for 27 years. Remodeling after lateral closingwedge osteotomy in. Tardy posterolateral rotatory instability of the elbow due. Pdf french osteotomy for cubitus varus in children. All patients had surgical management of their ulnar nerve palsy. Coxa vara y valga pdf coxa vara and vertical physis increases etiologies of coxa vara neck looks like invertedy radiolucency. Cubitus varus deformity was seen in seven cases, and six of them had a partial defect of the medial condyle that was avascular necrosis. Modified stepcut osteotomy for posttraumatic cubitus. However, recently, it has been implicated in several late complications, including osteoarthritis oa4, 5.
The fixation of osteotomy is required to prevent loss of correction achieved. This may be noticeable during an activity such as using a computer mouse. In two patients, the ulnar nerve was entrapped by scar. Cubitus varus is a common delayed complication of supracondylar fracture of humerus in childhood. Figure 2 postoperative clinical and radiological pictures of the same patient. Cubitus valgus is a deformity in which the forearm is angled out away from the body when the arm is fully extended. A cubitus varus deformity is more cosmetic than limiting of any function, however internal rotation of the radius over the ulna may be limited due to the overgrowth of the humerus. Pdf clinical application of individualized 3dprinted navigation. Original study the equal limbs lateral closing wedge osteotomy. Preoperative planning software for corrective osteotomy in. Utilization of a 3dprinted model for preoperative planning and. Four patients with cubitus valgus had a tardy ulnar nerve palsy. Pdf reverse v osteotomy and treatment of cubitus varus. Various combinations of osteotomy and fixation have been described to correct these deformities but each is associated with significant complications.
Reverse v osteotomy and treatment of cubitus varus deformity results and experience article pdf available in journal of clinical orthopaedics and trauma 7suppl 2. Cubitus varus deformity, as the most common complication of the distal humeral frac. Cubitus varus deformity has been described to alter the musculoskeletal planes and can contribute to snapping triceps syndrome. Symposium international journal of paediatric orthopaedics. Cubitus varus deformity cvd is a common complication after. The opposite deformation, where the twist or angulation is directed medially, toward the center of the body, is called varus. The most commonly used is the lateral closingwedge osteotomy, also known as french osteotomy with variable results. Cubitus varus is the most common delayed complication that results following supracondylar fracture of humerus in children. Lateral closingwedge osteotomy for cubitus varus deformity was performed in 52 children. Cubitus varus was long thought to be only a cosmetic problem with the arm angled and appearing crooked gunstock deformity.
The purpose of this paper is to demonstrate a causal relationship between cubitus varus and instability of the elbow. Many types of osteotomy have been proposed for the treatment of cubitus varus and valgus, but they have limitations, such as poor internal fixation, residual protrusion of the lateral or medial condyle, technical difficulty, the need for longterm immobilization, a risk of neurovascular injury, and patient discomfort. Cubitus varus was the result of a supracondylar fracture in each case. Cubitus varus mostly presents as cosmetic deformity but it may also cause posterolateral instability, increased risk of secondary fractures, tardy ulna nerve palsy and snapping elbow. According to the direction of the distal end of the distal bone forming the joint valgus, when distal bone directed laterally varus when distal bone directed medially 3.
Cubitus varus is the most common angular deformity of the supracondylar fracture in children and adults. A valgus deformity is a condition in which the bone segment distal to a joint is angled outward, that is, angled laterally, away from the bodys midline. Lateral closed wedge lcw osteotomy is a commonly accepted method for the correction of the cubitus varus deformity. A malunion as a complication of distal humerus fractures has been frequently linked with aesthetic problems but less frequently with posterolateral rotatory instability. Impact of plate positioning on the lateral closing wedge osteotomy. More complex osteotomies have been described to correct the associated hyperextension and internal rotation deformities and to prevent a. However, recently, it has been implicated in several late complications, including osteoarthritis oa4,5. Varus knee is a condition thats commonly referred to as genu varum. Its what causes some people to be bowlegged it happens when your tibia, the larger bone in your shin, turns inward. Cubitus varus gunstock deformity is one of the commonest complication of supracondylar fractures resulting from malunion of supracondylar fractures ref. Cubitus valgus is a medical deformity in which the forearm is angled away from the body to a. Boolean operations and surface transformations ie, virtual. Osteotomies described previously to correct cubitus varus had been associated with unsatisfactory results such as a prominent lateral scar and condyle and injury to the triceps. In this video, doctor mackenzie discusses the indications and etiology of cubitus varus.
The treatment of cubitus valgus using the ilizarov method. There are many relevant factors that contribute toward. Cubitus varus and valgus are the most common complications of supracondylar and lateral condylar fractures. There is deviation of the forearm toward the midline of the body. Cubitus valgus occurred after a fracture of the lateral condyle in 11 patients. Current trend is to offer surgical correction for cubitus varus deformity in form of supracondylar osteotomy of the humerus. Pdf tardy ulnar nerve palsy due to cubitus varus deformity. Cubitus varus or gunstock deformity as it is commonly known is the most common complication of displaced supracondylar fractures in children with an incidence ranging from 3% to 57%. Cubitus varus deformity rationale of treatment and methods. Gunstock deformity definition of gunstock deformity by.
Cubitus varus is the commonest complication of supracondylar humerus fractures in children. A deformity of the elbow resulting in an increased carrying angle so that, with the arm extended at the side and the palm facing forward, the forearm and hand are held at greater than 15 degrees. Cubitus varus deformity, as the most common complication of the distal. Elbow posterolateral rotatory instability due to cubitus. In 8 cases the osteotomy was fixed with 2 parallel kirschner wies group k. There were 16 boys and seven girls with a mean age of 12. The methods of treatment, age of injury, and the type of epiphyseal injury had no influence on the development of cubitus varus, but avascular necrosis of the medial condyle was related to the cubitus varus. Efficacy evaluation of threedimensional printing assisted osteotomy.
Lateral closed wedge osteotomy for cubitus varus deformity ncbi. Cubitus varus deformity has been reported to cause ulnar neuropathy. Medial approach for corrective osteotomy of cubitus varus. Cubitus varus gunstock deformity is the most common longterm complication of supracondylar fractures of the humerus in children. There was cubitus valgus in elbows and cubitus varus in 11. One patient had a cubitus varus on the right side and a cubitus valgus on the left and required bilateral operations. Untreated cubitus varus has a no effect on the function of elbow hence it is usually ignored.
Computed tomography ct is superior to conventional radiography in the assessment of the position of fracture fragments and was used to study 20 patients with supracondylar fractures after reduction. Cubitus varus has long been considered merely a cosmetic deformity. Cubitus varus is the most common late complication of a supracondylar fracture of the humerus in children. However, some researchers think that the biomechanical axis disruption includes internal rotation deformity, which leads to soft tissue and morphologic bony. Altered bone density and stress distribution patterns in. Cubitus varus deformity may occur after both pediatric supracondylar and lateral condyle fractures. Cubitus varus is a challengingtotreat complication following pediatric fractures of the elbow. A case report prakriti raj kandel, rajiv baral, niva chitrakar, gyaneshwar prasad singh, laxmi pathak journal of universal college of medical sciences 2016 vol. Among those, for the cubitus varus, the most common is the supracondylar fracture of the humerus, thanks to an incorrect reduction of the bone or even from the loss of the one made morrissy and weinstein 2006 reduction corresponds to the procedure to restore the fracture or alignment of the bone. In twentyfour patients twentyfive limbs with a cubitus varus deformity following a pediatric. The osteotomy was fixed by three different methods. Correction can be performed using one of a number of techniques of osteotomy but. Background cubitus varus is a cosmetically unacceptable complication of supracondylar fractures of the elbow in children. We report 2 cases of childhood posttraumatic cubitus varus with subsequent posterolateral rotatory instability and their treatment with a minimum of 2 years of followup.
Rotation of the distal fracture fragment in the supracondylar fracture is a contributing factor in the development of the cubitus varus deformity. Cubitus varus deformity, threedimensional printing, osteotomy guide plate, humeral supracondylar wedge osteotomy background distal humeral fracture is the most usual upper limb fracture in adolescents, with an incidence of about 60% in all elbow fractures 1. Clinical outcome of dome osteotomy in cubitus varus. Recurrent tardy ulnar collateral ligament insufficiency due to cubitus. We present five cases of tardy ulnar nerve palsy due to cubitus vus and analyzed the factors related to the nerve. A lateral closing wedge osteotomy was performed in 39 children with cubitus varus deformity resulting from a supracondylar fracture. There were 8 boys and 3 girls with a mean age of years 7 to 16. Cubitus varus gunstock deformity is a malalignment of the distal humerus that results in a change of carrying angle from the physiologic valgus alignment 515 degrees of the arm and forearm to varus malalignment. A deformity of the elbow resulting in a decreased carrying angle so that, with the arm extended at the side and the palm facing forward, the forearm and hand are held at less than 5 degrees. Efficacy evaluation of threedimensional printing assisted. Cubitus varus deformity is a common sequela of elbow fractures in.
However, it has a definitive impact on cosmetic appearance. Cubitus varus classification and external resources icd 10 m21. Lateral closed wedge osteotomy for cubitus varus deformity. Cubitus valgus can be due to a congenital malformation, as in turner syndrome and noonan syndrome, or be due to a fracture. Singleplane rotational osteotomy for cubitus varus deformity based. Cubitus varus can also result following a lateral condylar fracture and is related to overgrowth. Cubitus varus deformity is a common complication after supracondylar fracture in children, with a reported incidence ranging from 10% to 57%1, 2, 3 and was long considered a mere cosmetic deformity. Cubitus varus is a common deformity in which the extended forearm is deviated towards midline of the body.
Cubitus varus deformity is a common complication after supracondylar fracture in children, with a reported incidence ranging from 10% to 57%1e3 and was long considered a mere cosmetic deformity. Cubitus definition of cubitus by medical dictionary. Four cases of tardy ulnar nerve palsy associated with a cubitus varus deformity of the elbow secondary to a supracondylar fracture of the humerus are presented. Cubitus varus deformity, threedimensional printing, osteotomy guide plate, humeral. The osteotomies healed within 2 months, without any. Pdf the management of cubitus varus and valgus using the.