Lateral Closing Wedge Supracondylar Osteotomy of the Humerus in Children with Cubitus Varus Deformity

Jong Sup Shim; Eunjin Sul; Haechan Ha; Chang Young Kim

doi:10.4055/jkoa.2008.43.1.17

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Shim, Sul, Ha, and Kim: Lateral Closing Wedge Supracondylar Osteotomy of the Humerus in Children with Cubitus Varus Deformity

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2008; 43(1): 17-23.

Published online: 29 February 2008

DOI: https://doi.org/10.4055/jkoa.2008.43.1.17

Lateral Closing Wedge Supracondylar Osteotomy of the Humerus in Children with Cubitus Varus Deformity

Jong Sup Shim, M.D., Eunjin Sul, M.D., Haechan Ha, M.D., Chang Young Kim, M.D.

Department of Orthopedic Surgery, SungKyunKwan University School of Medicine, Seoul, Korea.

Address reprint requests to Jong Sup Shim, M.D. Department of Orthopedic Surgery, Samsung Medical Center, SungKyunKwan University School of Medicine, 50, Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea. Tel: +82.2-3410-3509, Fax: +82.2-3410-0061, jss3505@skku.edu

Abstract

Purpose

To evaluate the effectiveness, cosmetic and functional improvement of a supracondylar lateral closing wedge osteotomy of the humerus as a treatment for cubitus varus deformity in children.

Materials and Methods

Forty-eight children with cubitus varus underwent a lateral closing wedge osteotomy, and were followed up for at least 1 year.

Results

There were no complications such as a loss of correction, infection, or neurapraxia. The immediate postoperative lateral condylar prominence and secondary lazy S deformity was in proportion to the preoperative severity of the cubitus varus. However, it was lower at the last follow-up, and was related to the extent of preoperative cubitus varus, length of follow-up and age.

Conclusion

A supracondylar lateral closing wedge osteotomy of humerus is an easy and effective surgical treatment for a posttraumatic cubitus varus of children. In addition, it shows good cosmetic results with good remodeling of the lateral condylar prominence of children.

Keywords: Cubitus varus, Lateral condylar prominence, Osteotomy

Figures and Tables

Fig. 1

(A) Lateral closing wedge osteotomy was performed. (B) Lazy 'S' deformity was observed on the radiograph of two months after the operation.

Fig. 2

(A) Humero-ulnar angle was measured on the anteroposterior radiograph of the elbow. (B) Shaft-condylar angle was measured on the lateral radiograph of the elbow.

Fig. 3

(A) The angle of cubitus varus deformity was measured intraoperatively with C-arm fluoroscopy. (B) The operation was performed through a lateral approach. (C) We used two preset Kirschner's wires. (D) Osteotomized site was fixed with Steinmann pins. (E) Cubitus varus was corrected after surgery.

Fig. 4

(A) Lateral prominence index (LPI) is BC/AB. (B) Lateral prominence amount (LPA) is BC/AC × 100 (%).

Fig. 5

(A) A six-year-old boy had the varus humeroulnar angle of 33° on the preoperative radiograph. (B) On the immediate postoperative radiograph, LPI was 3.23 and LPA was 45.3 percent. (C) On the radiograph after a 4-year-follow-up, the LPI was 1.01, and the LPA was zero percent.

Fig. 6

Lateral prominence amount decreased with the increasing follow-up duration.

Fig. 7

The change in the amount of lateral prominence diminished with increasing age when the operation had been performed.

Table 1

Results of Supracondylar Lateral Closing Wedge Osteotomy

^*p<0.05 was regarded as significant by paired t-test.

Table 2

Factors Associated with the Remodeling of the Lateral Prominence

ΔLPI, change of lateral prominence index; ΔLPA, change of lateral prominence amount. ^*p<0.05 indicates that the factor contributed to remodeling of the lateral prominence according to univariate analysis.

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