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Translation step-cut osteotomy for the treatment of posttraumatic cubitus varus
Jon R Davids1, David Chad Lamoreaux, Reginald Christopher Brooker
1Shriners Hospital for Children, 950 West Faris Road, Greenville, SC 29601, USA. jdavids@shrinenet.org
Background:
Cubitus varus deformity is the most common complication after the treatment of displaced supracondylar humerus fractures.
Methods:
A retrospective analysis was performed evaluating patients who had undergone a translation step-cut osteotomy for correction of cubitus varus deformity between 1993 and 2008. Postoperative radiographs to union were reviewed for all patients. Subjective information and range of motion measures were documented from the medical records. Patients and their families were also contacted through telephone and administered a questionnaire as well as the QuickDash functional outcome measure to assess their function and satisfaction.
Results:
Thirty-seven participants were identified and reviewed. Average age at the time of surgery was 8 years and 10 months, with an average follow-up of 2 years and 4 months. Outcomes were assessed in terms of technical, functional, and satisfaction domains. Technical Domain: Average humeroulnar angle (radiographic carrying angle) correction was 26 degrees. Bauman's angle improved 21 degrees on average in patients who were skeletally immature. Functional Domain: Elbow range of motion was maintained in all planes with few exceptions. The clinical carrying angle improved 26 degrees on average, and was symmetric with the unaffected side in 22 of 25 cases in which it was documented. The QuickDash was applied to 15 participants. Eight participants had perfect scores for the symptoms/disability section, and 7 had scores in the top 20% for function. Satisfaction Domain: A study-specific questionnaire was applied to 16 participants. All patients and parents questioned would recommend the procedure to other parents/patients.
Conclusion:
The translation step-cut osteotomy reliably corrects the coronal plane angular deformity associated with cubitus varus, resulting in excellent outcomes in technical, functional, and satisfaction domains. The osteotomy is relatively simple to perform, and is inherently more stable than other proposed methods. It also minimizes the prominence of the lateral condyle associated with simple lateral closing wedge osteotomy.
