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A systematic review of the operative techniques for treating cubitus varus deformity in children
Brett Hoffman1, Anderson Lee, Dominique DiGiacomo
1Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio, USA.
Insights
This review compares surgical methods for cubitus varus in children. Three-dimensional osteotomy offers the best outcomes with no infections, while lateral closing wedge osteotomy is common but has higher revision rates.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Surgical Techniques
Background:
- Cubitus varus deformity in children requires effective surgical correction.
- Various operative techniques exist, each with distinct advantages and disadvantages.
Purpose of the Study:
- To systematically review and compare operative techniques for treating pediatric cubitus varus.
- To evaluate outcomes including angular correction, complications, revisions, and patient-reported scores.
Main Methods:
- Systematic review of PubMed and Embase databases.
- Inclusion of 45 papers involving 911 pediatric patients.
- Analysis of data on lateral closing wedge osteotomy, step-cut osteotomy, distraction osteogenesis, dome osteotomy, and 3D osteotomy.
Main Results:
- Lateral closing wedge osteotomy (LCWO) was most common (427 patients) with a 3% revision rate.
- Step-cut osteotomy showed no infections or loss of motion.
- Distraction osteogenesis had high excellent results (88.04%) but 18% superficial infections.
- 3D osteotomy had no infections and the lowest poor outcomes (2.22%).
Conclusions:
- For unidimensional correction, LCWO is simple, while step-cut osteotomy reduces prominence but is more complex.
- Distraction osteogenesis is minimally invasive but has higher infection rates.
- 3D osteotomy is superior to dome osteotomy for multidimensional correction due to lower infection and higher excellent outcome rates.
Abstract:
A systematic review of the operative techniques for treating cubitus varus deformity in children was performed using research databases including PubMed and Embase. Outcome measurements included mean angular correction of the humerus-elbow-wrist angle, complications, revisions and outcome scores. A total of 45 papers and 911 patients were included. Lateral closing wedge osteotomy (LCWO) (427 patients) was the most common procedure and 5.56% of these patients experienced lateral condylar prominence. This technique had the highest revision rate at 3%. The step-cut osteotomy (111 patients) yielded zero postoperative infections or loss of motion. Distraction osteogenesis (92 patients) was the least common technique. Superficial pin tract infections occurred in 18% of patients and 88.04% of patients reported excellent results, the highest of any technique in this study. The infection rate of dome osteotomy (151 patients) was 9.45% and 4.72% of patients experienced loss of motion. 3D osteotomy (130 patients) had no infections, 87.78% of patients reported excellent outcomes, and 2.22% of patients reported poor outcomes, the lowest of all techniques. For unidimensional correction, LCWO provides a technically simple procedure and reasonable outcomes. Step-cut osteotomy has less lateral condylar prominence but is more complicated than LCWO. Distraction osteogenesis is a minimally invasive alternative to LCWO and step-cut osteotomy, but it has more superficial infections and can be bothersome to patients. For a multidimensional correction, 3D osteotomy is superior to dome osteotomy due to its lower infection rate and higher rate of functionally excellent outcomes.
