Abstract
Purpose
The purpose of this study was to report double dome osteotomy used to correct paediatric cubitus varus and to avoid lateral prominence after correction.
Methods
Eighteen children with cubitus varus underwent double dome osteotomy. Preoperative templating created from radiographs was used to determine the bone cuts. Double dome osteotomy created a proximal and distal cut, then varus deformity and sagittal alignment were corrected. The osteotomies were fixed with K-wires and immobilised in a long-arm cast. Radiographics and clinical histories were evaluated. Ulno-humeral angle pre and postoperative, range of motion and lateral prominent index were evaluated.
Results
The osteotomy was performed in 18 patients, with an average age of 7.5 years. All patients ended up with flexion of 130° or greater with full and symmetrical pronation and supination. The average ulno-humeral angle difference compared to the uninjured side was 3.27°. The mean of the lateral prominent index was −0.91. The mean follow up was 50.3 months (30–115 months). All of the patients had excellent clinical and radiographic alignment. No revisions were made in this series. One transient radial nerve palsy and one superficial infection occurred.
Conclusion
This series demonstrates that double dome osteotomy can provide reliable correction of varus deformity and prevent lateral prominence with a minimal complication rate.
Similar content being viewed by others
References
Beaty JH, Kasser JR (2010) Rockwood and Wilkins’ fractures in children, 7th edn. Lippincott Williams & Wilkins, Philadelphia, pp 488–532
Davids JR, Lamoreaux DC, Brooker RC, Tanner SL, Westberr DE (2011) Translation step-cut osteotomy for the treatment of posttraumatic cubitus varus. J Pediatr Orthop 31:353–365
Usui M, Ishii S, Miyano S et al (1995) Three-dimensional corrective osteotomy for treatment of cubitus varus after supracondylar fracture of the humerus in children. J Should Elb Surg 4:17–22
O’Driscoll SW, Spinner RJ, McKee MD et al (2001) Tardy posterolateral rotatory instability of the elbow due to cubitus varus. J Bone Joint Surg Am 83:1358–1369
Davids JR, Maguire MF, Mubarak SJ et al (1994) Lateral condylar fracture of the humerus following posttraumatic cubitus varus. J Pediatr Orthop 14:466–470
Abe M, Ishizu T, Morikawa J (1997) Posterolateral rotatory instability of the elbow after posttraumatic cubitus varus. J Should Elb Surg 6:405–409
Gurkan I, Bayrakci K, Tasbas B et al (2002) Posterior instability of the shoulder after supracondylar fractures recovered with cubitus varus deformity. J Pediatr Orthop 22:198–202
Abe M, Ishizu T, Shirai H et al (1995) Tardy ulnar nerve palsy caused by cubitus varus deformity. J Hand Surg Am 20:5–9
Spinner RJ, O’Driscoll SW, Davids JR et al (1999) Cubitus varus associated with dislocation of both the medial portion of the triceps and the ulnar nerve. J Hand Surg Am 24:718–726
Beuerlein MJ, Reid JT, Schemitsch EH et al (2004) Effect of distal humeral varus deformity on strain in the lateral ulnar collateral ligament and ulnohumeral joint stability. J Bone Joint Surg Am 86:2235–2242
Banerjee S, Sabui KK, Mondal J, Raj SJ, Pal DK (2012) Corrective dome osteotomy using the paratricipital (triceps-sparing) approach for cubitus varus deformity in children. J Pediatr Orthop 32:385–393
Labelle H, Bunnell WP, Duhaime M et al (1982) Cubitus varus deformity following supracondylar fractures of the humerus in children. J Pediatr Orthop 2:539–546
French PR (1959) Varus deformity of the elbow following supracondylar fractures of the humerus in children. Lancet 2:439–441
Bellemore MC, Barrett IR, Middleton RW et al (1984) Supracondylar osteotomy of the humerus for correction of cubitus varus. J Bone Joint Surg Br 66:566–572
Raney EM, Thielen Z, Gregory S, Sobralske M (2012) Complications of supracondylar osteotomies for cubitus varus. J Pediatr Orthop 32:232–240
Ippolito E, Moneta MR, D’Arrigo C, Post-traumatic cubitus varus (1990) Long-term follow-up of corrective supracondylar humeral osteotomy in children. J Bone Joint Surg Am 72:757–765
Oppenheim WL, Clader TJ, Smith C et al (1984) Supracondylar humeral osteotomy for traumatic childhood cubitus varus deformity. Clin Orthop Relat Res 188:34–39
Wilkins KE (1997) Supracondylar fractures: what’s new? J Pediatr Orthop B 6:110–116
Kumar K, Sharma VK, Sharma R et al (2000) Correction of cubitus varus by French or dome osteotomy: a comparative study. J Trauma 49:717–721
Kim HT, Lee JS, Yoo CI (2005) Management of cubitus varus and valgus. J Bone Joint Surg Am 87:771–780
Yun YH, Shin SJ, Moon JG et al (2007) Reverse V osteotomy of the distal humerus for the correction of cubitus varus. J Bone Joint Surg Br 89:527–531
Higaki T, Ikuta Y (1982) The new operation method of the domed osteotomy for 4 children with varus deformity of the elbow joint. J Jap Ortho 31:30–35
DeRosa GP, Graziano GP (1988) A new osteotomy for cubitus varus. Clin Orthop Relat Res 236:160–165
Miura H, Tsumura H, Kubota H et al (1998) Interlocking wedge osteotomy for cubitus varus deformity. Fukuoka Igaku Zasshi 89:119–125
Matsushita T, Nagano A (1997) Arc osteotomy of the humerus to correct cubitus varus. Clin Orthop Relat Res 336:111–115
Takagi T, Takayama S, Nakamura T, Horiuchi Y, Toyama Y, Ikegami H (2010) Supracondylar osteotomy of the humerus to correct cubitus varus: do both internal rotation and extension deformities need to be corrected? J Bone Joint Surg Am 92:1619–1626
Gadgil A, Hayhurst C, Maffulli N, Dwyer JS (2005) Elevated, straight-arm traction for supracondylar fractures of the humerus in children. J Bone Joint Surg Br 87:82–87
Acknowledgments
Conflict of interest
None of the authors received financial support for this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Eamsobhana, P., Kaewpornsawan, K. Double dome osteotomy for the treatment of cubitus varus in children. International Orthopaedics (SICOT) 37, 641–646 (2013). https://doi.org/10.1007/s00264-013-1815-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-013-1815-7