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Translation Step-Cut Osteotomy Versus Pentagonal Osteotomy for Pediatric Cubitus Varus Deformity: Does Dual-Triangle
Rahul Baishya1, Vivek Singh, Rahul Mishra
1Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Background:
Post-traumatic cubitus varus is a 3-dimensional deformity that may result in cosmetic dissatisfaction and, in a minority of patients, functional impairment. Translation step-cut osteotomy (TSCO) provides stable correction but may be associated with residual lateral condylar prominence. A modified spike translation step-cut configuration, referred to as the pentagonal osteotomy, has been proposed to enhance medial translation and improve cosmetic contour. This study prospectively compares the clinical, radiologic, and cosmetic outcomes of TSCO and pentagonal osteotomy in pediatric cubitus varus deformity.
Methods:
This prospective comparative study included 24 children (<16y) with post-traumatic cubitus varus deformity, alternately allocated to TSCO (n=12) or pentagonal osteotomy (n=12). Patients were followed for at least 12 months. Clinical outcomes included elbow range of motion and carrying angle. Radiologic assessment comprised Baumann angle, humerus-elbow-wrist (HEW) angle, and lateral prominence index (LPI). Cosmetic outcomes were evaluated at final follow-up using the Barrett criteria, while overall functional results were graded using Oppenheim criteria. Complications were prospectively recorded.
Results:
Both techniques achieved significant correction of deformity, restoring the physiological carrying angle and the HEW angle. Postoperative carrying angle was comparable between the TSCO (+6.5±9.08 degrees) and pentagonal groups (+7.91±1.97 degrees; P =0.603). Radiologic parameters, including the Baumann and HEW angles, improved significantly in both groups, with no significant intergroup differences. LPI improved in both cohorts, with a more negative mean value in the pentagonal group (-9.53±2.44 vs. -5.86±8.71), although this difference was not statistically significant ( P =0.174). A statistically significant difference in postoperative extension deficit of 4 degrees was observed in favor of the TSCO group ( P =0.046), while flexion and rotational correction were comparable. Excellent cosmetic satisfaction was reported by 83.3% of TSCO patients and 91.7% of patients undergoing pentagonal osteotomy ( P =0.592).
Conclusion:
Both translation step-cut osteotomy (TSCO) and pentagonal osteotomy are safe and effective techniques for the correction of pediatric cubitus varus deformity, with comparable clinical, radiologic, and cosmetic outcomes. Further studies with larger cohorts and longer follow-up are required to determine the long-term advantages of the pentagonal osteotomy, if any.
Level Of Evidence:
Level II-prospective comparative study.
