A systematic review of techniques for step cut osteotomy in cubitus varus: A comprehensive analysis

Abstract

Background: Cubitus varus, a common post-traumatic deformity of the elbow in children, poses challenges for both patients and surgeons. Step cut osteotomy has emerged as a reasonable surgical technique to address this condition, offering multiple approaches and modifications.

Methods: We present a comprehensive systematic review of techniques for step cut osteotomy in cubitus varus, analyzing 13 studies that meet our inclusion criteria. These studies encompass diverse patient populations, including pediatric and adult cases, and span different geographical regions.

Results: Our systematic review explores three primary osteotomy techniques-Classic Step-Cut Osteotomy, Reverse V Osteotomy, and Modified Step Cut Osteotomy-along with their modifications, providing surgeons with valuable options for individualized correction. Functional outcomes showcase improvements in range of motion, functional scores, and carrying angle, highlighting the technique's efficacy in restoring elbow function and enhancing quality of life. Radiological evaluations demonstrate successful corrections of various angles and achievement of bony union, reinforcing the stability and anatomical improvements achieved through step cut osteotomy.

Conclusions: Complication rates are notably low, with transient nerve palsies being the most commonly encountered, often resolving within months. Implant failure and other complications are infrequent, underlining the safety and reliability of step cut osteotomy as a surgical intervention for cubitus varus.While the predominance of retrospective studies and heterogeneity across included studies warrant caution, our systematic review provides a robust and diverse synthesis of evidence. It underscores the significance of step cut osteotomy in managing cubitus varus deformity, emphasizing its versatility, favourable outcomes, and safety profile. Further research with rigorous designs and longer follow-up periods will enhance our understanding of step cut osteotomy's role in cubitus varus correction.

Keywords: Cubitus varus; Deformity correction; Step cut osteotomy.

Fig. 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA): The PRISMA flow-diagram for all included and excluded studies. Search string: “Cubitus Varus AND ((STEP CUT) or (Reverse V) or (Modified Step Cut) or (Translational Step Cut) or (Reverse step cut))".

Fig. 2

The results of the Joanna Briggs Institute's (JBI) critical appraisal tool for bias assessment are summarised.

Fig. 3

A: Type 1 Step cut osteotomy showing the original technique of osteotomy devised by Derosa et al. The surgical approach involves creating a template of the distal humerus with its deformity on a sheet of paper. The Humeral-Ulnar-Wrist angle and the valgus angle on the contra-lateral elbow are measured to determine the planned angle of correction. A straight line is drawn on the distal humerus, and another line is drawn at the planned angle of correction. The osteotomy is then performed by removing a wedge of bone, distal fragment lateral part is reduced and the distal fragment is rotated to correct the deformity. Fig. 3 B: Type 1 step cut osteotomy modified by David et al. This modification involves removing a large rectangular piece of bone from the proximal lateral shaft to medially translate the distal fragment, thereby decreasing lateral condylar prominence. Fig. 3 C: Type 1 step cut osteotomy modified by Moradi et al. In this technique, a triangular portion is removed from the proximal lateral shaft to accommodate the bony spike of the lateral distal fragment.

Fig. 4

Type 2 step cut osteotomy (Takagi et al.‘s Modified Step Cut, Yun's Reverse V osteotomy). In this approach, the surgeon calculates the humeral-elbow-wrist angle for both the normal and the deformed elbows. The outline of the deformed elbow is traced onto paper from the radiograph, and a triangular area is marked and resected during surgery. The distal humerus and forearm are then rotated laterally and translated medially to achieve correction of the cubitus varus deformity.

Fig. 5

Type 3 step cut osteotomy (Mishra's Reverse V, JR Kim's Transaltion step cut, Vashisht's Reverse step cut^14,15,17). This technique involves drawing a horizontal line above the olecranon fossa on the X-ray film and a second line towards the proximal humerus at the measured angle of correction. A third perpendicular line intersects the second line, and the triangular bone is removed followed by rotation to correct the deformity.