Abstract
Background
For correction of cubitus varus deformity many types of osteotomies and fixation methods have been described, but besides technical difficulties, they have limitations such as non-union, stiffness of the elbow joint and neurovascular injury. The prominence of the lateral condyle can also give rise to a poor cosmetic result. To overcome these problems, we reviewed the results of simple dome osteotomy with fixation by cross pins.
Methods
From 2003 to 2007, eleven children with cubitus varus deformity having full range of movements and good elbow function had surgery. The average age was 9.2 years (range, 7 to 13) and M:F ratio was 4:1. Through a posterior triceps splitting approach a dome-shaped osteotomy is fashioned, the distal part of humerus is aligned as planned and then fixation by cross pinning is achieved. Patients were followed for two years. Pre-operative and post-operative humeral-elbow angles, ranges of motion and lateral prominence indices were compared. The results were evaluated according to the modified criteria of Oppenheim et al.
Results
There were 8 excellent and 3 good results. The average correction of the humeral-elbow angle was 32.5° (range, 22 to 45), post-operative angle was 10.4°, and 8.4° at final follow-up. The average increase in the lateral prominence index was 20.8%, and when compared to the normal side, it was 12.3% greater. None of the children had lateral prominence of greater than 5 mm. Two of the cases developed transient ulnar nerve neuropraxia.
Conclusion
The dome-shaped osteotomy fixed by crossed pins is a relatively simple procedure and obtains three dimensional correction of the deformity. The osteotomy site is inherently more stable than a lateral wedge osteotomy and less technically demanding as compared to step cut osteotomy. This is also effective in minimising the lateral condylar prominence.
