Lateral Closing Wedge Osteotomy for Cubitus Varus Deformity in Children
Condition: Deformity; Bone
MeSH terms: Congenital Abnormalities
Study type: Observational

Summary: 
      Humeral osteotomy is the most effective method for evident cubitus varus correction in
      children. Several osteotomy methods and fixation materials have been developed in the past.
      By applying the principles of deformity correction described by Paley, the investigators
      describe a novel corrective technique for cubitus varus involving lateral osteotomy using
      Kirschner wires.
    

Detailed description: 
      Supracondylar humerus fractures (SHFs) account for approximately 10% of all pediatric
      fractures in children. Poorly treated SHFs can lead to the most common cubitus varus
      deformity especially in patients treated conservatively. The cosmetic aspect of this
      deformity is the main concern of patients, together with reduced remodeling ability.
      Inevitably, surgery is the first choice for such patients. Several osteotomy techniques and
      fixation materials have been developed in the last several decades. With the advent of
      three-dimensional printing techniques and computed tomography reconstruction methods, more
      accurate computing designs have been applied in the correction of cubitus varus. These
      techniques make the surgery more complex and require the performance of computed tomography
      (CT), resulting in high radiation exposure in children. Paley described the principles of
      deformity correction that are widely used for the lower limbs. These principles represent an
      alternative with easy application without the need of CT, with less occurrence of prominence
      and good cosmetic outcome. According to the Paley principles, all the vertex of the
      triangular osteotomy should site on the center of rotation of angulation (CORA) line, by
      doing this, the gun-butt deformity was corrected perfectly. More importantly, they help to
      accurately correct the anatomic axis of the upper limb. According to our knowledge, this is
      the first study describes the lateral closing wedge osteotomy for correction cubitus varus
      deformity in children by applying Paley's principles and fixation with K-wires.

      Taken together, the investigators aimed at verifying the feasibility of Paley's principles
      for deformity correction to treat cubitus varus in children.
    

Intervention name(s): Paley's Principle osteotomy
Intervention type(s): Procedure
Intervention description(s): . The osteotomy line of all patients was designed according to Paley's principles. The lateral incision was applied in all patients and the osteotomy lines were marked on the humerus with the assistance of C-arm radiographs. An isosceles triangle template was used for osteotomy, and the medial cortex was left intact. K-wires were used to fix the osteotomy laterally.
Other intervention name(s): Applying Paley's Principles to Lateral Closing Wedge Osteotomy
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        All the patients were performed surgery between July 2015 and October 2017
      
Keywords: cubitus varus; supracondylar humerus fracture; osteotomy