Correction of cubitus varus with lateral closed wedge osteotomy and cross k-wire fixation: results of a prospective series of 19 patients

Abstract

Background: Cubitus varus is the most common late complication of displaced supracondylar fractures of the humerus in children and may lead to long-term problems such as increased chances of lateral humeral condyle fractures, posterolateral instability of the elbow, and tardy ulnar nerve palsy. Various complex corrective osteotomies have been described in literature with no consensus. We conducted this study to evaluate whether a simple lateral closed wedge osteotomy can give predictably good results in these patients. Materials and Methods: Nineteen children with malunited supracondylar fracture humerus leading to cubitus varus deformity underwent lateral closed wedge osteotomy, which was fixed with cross K-wires. Patients were evaluated for carrying angle, elbow range of motion, complications if any, and radiological correction of humeroulnar angle. Results: Osteotomy healed in all patients by 8 weeks (range 4–8 weeks, mean of 5.5 weeks). Excellent correction was achieved in 18 patients, whereas one patient had inadequate correction. Preoperative varus ranging from 10° to 30° (average – 17°) improved to 0°–12° valgus (average-8°). Two patients had minor complications in the form of pin tract infections which resolved with local care and antibiotics. There was no loss of correction or pin loosening. Sixteen patients had excellent result, whereas three patients had fair result as per Bellemore s criteria. Conclusion: Complex three-dimensional osteotomy is not always necessary for cubitus varus correction and a simple lateral closed wedge osteotomy fixed using cross K-wires can give good results with proper planning and execution.