Oblique closing wedge osteotomy and lateral plating for cubitus varus in adults

Abstract

Corrective osteotomy around the elbow can require longer recovery time in adults than in children because of the longer healing period and the propensity for stiffness. We hypothesized a lateral oblique closing wedge osteotomy with a larger contact area and fixation with a lag screw plus early motion would provide stable fixation and early motion recovery in adults with cubitus varus deformity. Twelve consecutive patients who needed surgery were treated using this procedure. They were allowed active motion exercises 1 week postoperatively. The age of the patients at the time of surgery averaged 39 years (range, 31-48 years). The minimum followup was 15 months. All patients achieved healing of the osteotomy, and regained preoperative arcs of elbow motion at a mean of 7.3 weeks (range, 2-12 weeks) postoperatively. The average humerus-elbow-wrist angle improved from -23.3 degrees to 8 degrees (p < 0.002) by a mean gain of 29.6 degrees . The mean lateral prominence index did not increase postoperatively. The final MEPI and DASH score averaged 95.4 points and 5.5 points. No patient experienced nerve palsy. Oblique osteotomy and fixation with a lag screw and lateral plating is a reasonable alternative technique for cubitus varus in adults, with early recovery of elbow motion and satisfactory deformity correction.

Level of evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Fig. 1A–D

(A) The humerus-elbow-wrist angle was measured, and surgical planning was performed using the Adobe Photoshop program (version 7.0; Adobe Systems, San Jose, CA). (B) The wedge to be resected was drawn with its apex facing proximally, and the angle of the wedge was identical to the desired correction angle. (C) The distal part of the osteotomy was repositioned. (D) Screws were drawn to simulate optimal fixation angle.

Fig. 2A–B

The lateral prominence index (%) was measured on the (A) preoperative and (B) postoperative radiographs using the formula, (CB-AB)/AC × 100. It is usually negative in normal elbows.

Fig. 3A–D

Different types of osteotomies are shown based on the preoperative radiographs of a patient with cubitus varus deformity. The arrow indicates translocation of the distal part after bone cutting, and the black line indicates contact surfaces of cancellous bone after (A) an oblique closing wedge, (B) a step-cut translational, (C) a transverse closing wedge, and (D) a dome osteotomy.

Fig. 4A–D

Simulated postoperative radiographs after different types of osteotomy show that (A) the oblique closing wedge osteotomy has a larger cancellous bone contact surface than (B) a step-cut translational, (C) a transverse closing wedge, and (D) a dome osteotomy. Joint line elevation is also largest in the oblique closing wedge osteotomy, indicating shortening of the humerus.