Three-dimensional correction of cubitus varus deformity using patient-specific 3D-printed osteotomy guides

Various three-dimensional (3D) corrective osteotomy techniques have been reported for the treatment of cubitus varus deformity. However, achieving accurate correction through a limited lateral incision remains technically challenging. This study introduces a method for accurate 3D osteotomy of cubitus varus deformity using a limited lateral incision.

Five patients (2 males and 3 females) with cubitus varus deformity following supracondylar fracture underwent 3D corrective osteotomy using 3D-printed, patient-specific osteotomy templates, along with custom location and reduction guides, between August 2022 and January 2025. These cases were evaluated retrospectively. Clinical outcomes assessed included pre- and postoperative carrying angles, operative time, elbow joint function, intraoperative blood loss, degree of osteotomy, time to bone union, and postoperative complications.

The mean carrying angle on the affected side improved significantly from -15.74° ± 6.58° (varus) preoperatively to 7.77° ± 3.94° (valgus) postoperatively. The mean tilting angle improved from 54.8° ± 7.40° to 51.4° ± 2.33°. Elbow range of motion normalized in all patients, with a mean increase in flexion angle of 24° ± 8° (range: 15°-35°). Hyperextension of the elbow and internal rotation of the shoulder were also corrected. Bone union was achieved at a mean of 2.6 ± 0.49 months (range: 2-3 months). The average operative time was 139.6 ± 22.26 min (range: 116-175 min), and mean intraoperative blood loss was 42 ± 31.87 mL (range: 10-100 mL). The mean correction angle achieved through osteotomy was 23.51° ± 8.79° (range: 12.43°-33.43°). According to the Mayo Elbow Performance Index (MEPI), all five patients achieved excellent outcomes at the final follow-up (mean: 21.6 ± 4.8 months), with no reports of poor results, recurrence of varus deformity, or wound-related complications. One patient exhibited transient ulnar nerve symptoms postoperatively. No patients reported prominence of the lateral humerus.

The use of a 3D-printed, patient-specific osteotomy guide combined with custom location and reduction templates enables safe, accurate, and reproducible 3D correction of cubitus varus deformity through a small lateral incision. This surgical technique, grounded in 3D computer simulation, reduces variability between surgeons and may represent a viable therapeutic option for the correction of cubitus varus deformity.