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Various Corrective Osteotomy Techniques for Cubitus Varus in Children: Systematic Review
Aryadi Kurniawan1, Indah S Widyahening2, Bram Swandika3
1Department of Orthopaedics and Traumatology, Consultant Pediatric Orthopaedic Surgeon.
Background:
Supracondylar humerus fractures are common in children, often leading to malunion and cubitus varus. Corrective osteotomy techniques for cubitus varus include lateral closing-wedge, step-cut, dome, distraction osteogenesis, and computer-assisted multiplanar 3D osteotomies. This study seeks to determine the most effective corrective osteotomy technique for pediatric malunion of the supracondylar humerus through a systematic review, as there is currently no up-to-date review on this topic.
Methods:
A literature search was conducted across the PubMed, EMBASE, ProQuest, Scopus, and Cochrane Library databases on April 2, 2023, following the PRISMA guidelines. Selected articles underwent a review process by 2 independent reviewers to reassess their eligibility based on predefined inclusion criteria. The quality and potential biases of each article were assessed utilizing the Newcastle-Ottawa Scale (NOS) for nonrandomized studies and the Cochrane Risk of Bias Tool for randomized studies.
Results:
This systematic review included 39 out of 754 articles, involving 863 patients who underwent various osteotomies. The patients were followed up for an average of 27.3 months, and data on range of motion, angle correction, and clinical outcomes were collected. Different assessment criteria were used for functional outcomes. Complications included infections, nerve injuries, reoperations, residual deformity, and absence of lateral condyle prominence. The systematic review revealed a shortage of randomized controlled trials (RCTs) due to challenges in randomization, surgical technique variations, and ethical considerations.
Conclusions:
Various osteotomy techniques can be used to achieve favourable outcomes in cases of pediatric supracondylar malunion. These techniques include lateral closing wedge osteotomy, step-cut osteotomy, dome osteotomy, distraction osteogenesis, and multiplanar 3D osteotomy. Each osteotomy technique has its own advantages and disadvantages for specific outcomes. Lateral closing wedge osteotomy is recommended for patients with preoperative range of motion deficits. Step-cut osteotomy excels in correcting the humerus-elbow-wrist angle. A meta-analysis favoured the lateral closing wedge over the dome osteotomy for satisfactory outcomes.
Level Of Evidence:
Level III.
