A Simple Dual-Planar Osteotomy to Correct Cubitus Varus Deformity in Children

Abstract

Objectives: To report the outcomes when performing a dual-planar osteotomy of the distal humerus via a posterior approach for gunstock deformity in children.

Design: A retrospective review.

Setting: Penn State Hershey Pediatric Bone and Joint Institute.

Patients/participants: Sixteen patients were reviewed. The average patient age was 8 years (range, 5-13 years).

Intervention: A complete dual-planar closing wedge osteotomy was performed with the patient in the prone position via a posterior triceps-splitting approach. Fixation with buried smooth K wires was utilized.

Main outcome measurements: Valgus correction obtained, final elbow range of motion, radiographic and clinical correction of the deformity, the patient's satisfaction, and elbow function were evaluated.

Results: Preoperative radiographs showed the average humeral-ulnar angle (HUA) was 17 degrees of varus (range, 10-26 degrees varus). The average wedge removed wallow-up clinical exam demonstrated that the carrying angle was in valgus in 15 cases and neutral in 1 case. The average carrying angle was 5 degrees of valgus (range, 0-11 degrees valgus). The average hyperextenss 25 degrees (range, 20-40 degrees). Duration of follow-up averaged 51 months (range, 12-126 months). Final foion deformity improved from 9 degrees preoperatively to 1 degree postoperatively. Outcomes were classified by the grading scale described by Oppenheim: 14 cases had excellent results and 2 cases had good results.

Conclusions: This method provides clear visualization and excellent correction of the deformities. The posterior scar is cosmetically acceptable. We recommend this technique for the treatment of gunstock deformity in children.

Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.