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Loss of correction in cubitus varus deformity after osteotomy
Chao You1, Yibiao Zhou, Jingming Han
1Department of Orthopedics, Ward II, Shenzhen Children's Hospital, Shenzhen, China.
Insights
Pediatric osteotomy for cubital varus shows significant loss of correction in the humerus-cobb (H-Cobb) angle and Baumman angle post-surgery. Close follow-up is crucial in the early postoperative period to manage this angle loss.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Biomechanical Analysis
Background:
- Cubital varus deformity in children can lead to functional limitations and cosmetic concerns.
- Osteotomy is a surgical procedure to correct bone deformities, including cubital varus.
- Understanding the long-term stability of correction is vital for patient outcomes.
Purpose of the Study:
- To investigate the rate of loss of correction after osteotomy for pediatric cubital varus.
- To identify factors influencing the loss of correction in treated patients.
- To evaluate the stability of surgical correction over time using specific angular measurements.
Main Methods:
- Retrospective review of 30 pediatric patients undergoing osteotomy for cubital varus (July 2008-July 2017).
- Comparison of preoperative and postoperative clinical and imaging findings, including humerus-cobb (H-Cobb) and Baumman angles.
- Postoperative evaluation via telephonic interviews and analysis of imaging at multiple follow-up points.
Main Results:
- Approximately 80% of patients showed loss of H-Cobb angle correction at first follow-up, increasing to 83% at second follow-up.
- 57% and 43% experienced loss of Baumman angle correction at first and second follow-ups, respectively.
- Median survival times for H-Cobb and Baumman angles were 27 and 34 months, respectively, with most loss occurring early post-operation.
Conclusions:
- Postoperative loss of correction is common after osteotomy for pediatric cubital varus, particularly for the H-Cobb angle.
- The majority of correction loss occurs within the initial postoperative follow-up periods.
- Intensified patient monitoring and potential additional interventions are recommended in the early postoperative phase to maintain correction.
Abstract:
We aimed to investigate the rate of loss of correction and the factors thereof in pediatric patients undergoing osteotomy for treatment of cubitus varus deformity.Between July 2008 and July 2017, we treated 30 patients who underwent osteotomy for cubital varus. We compared the preoperative and postoperative clinical and imaging findings, including the H-Cobb and Baumman angles, in all patients. Postoperative evaluation was performed by telephonic interviews.Our patients consisted of 17 males and 13 females. The mean age was 75 months. At the first follow-up, approximately 80% of patients had experienced a loss of correction of the humerus-cobb angle (H-Cobb angle); at the second follow-up, the incidence was 83%. Meanwhile, 57% and 43% of patients experienced a loss of correction of the Baumman angle at the first and second follow-ups, respectively. The average interval between the first and second follow-ups was 24 days, and the mean loss in the H-Cobb angle was 2.4°. There was a significant difference between the H-Cobb angles as measured before and after surgery (P < .05). There was no significant difference between the H-Cobb angles of the affected side and the contralateral healthy elbow at the third postoperative follow-up; however, there was a significant difference between the Baumman angle between before and after surgery (P < .05). The Baumman angles as measured at the second and third postoperative follow-ups differed significantly from those of the contralateral healthy elbow joint. According to the survival curve analysis, the median survival times of the H-Cobb and Baumman angles were 27 and 34 months, respectively.The postoperative loss of the 2 angles occurred mainly during the first and second follow-up periods. Therefore, patient follow-up is particularly important in the period directly following the operation. Additional measures may be necessary to avoid rapid angle loss.
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