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Scientific Articles   |    
Supracondylar Osteotomy of the Humerus to Correct Cubitus Varus: Do Both Internal Rotation and Extension Deformities Need to Be Corrected?*
Takehiko Takagi, MD1; Shinichiro Takayama, MD, PhD2; Toshiyasu Nakamura, MD, PhD1; Yukio Horiuchi, MD, PhD3; Yoshiaki Toyama, MD, PhD1; Hiroyasu Ikegami, MD, PhD1
1 Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. E-mail address for T. Takagi: ttkg7@me.com
2 Department of Orthopaedic Surgery, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
3 Department of Orthopaedic Surgery, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kawasaki, Kanagawa 210-0013, Japan
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, and Department of Orthopaedic Surgery, National Center for Child Health and Development, Tokyo, Japan
This article is based on and reanalyzes a study first reported by Takagi T, Takayama S, Ikegami H, Nakamura T, Kusakabe H, Morisawa Y, Nishiwaki T, Eguchi Y, Uchikawa S, Horiuchi Y, Toyama Y. [Corrective osteotomy for cubitus varus deformity]. J Jpn Pediatr Orthop Assoc. 2007;16:260-4. Japanese.

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Jul 07;92(7):1619-1626. doi: 10.2106/JBJS.I.00796
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Abstract

Background: 

A variety of osteotomies has been proposed to correct posttraumatic cubitus varus deformity as well as any associated hyperextension and/or rotational deformities. However, lateral closing-wedge osteotomy and step-cut osteotomy, both of which have been used extensively with satisfactory outcomes, correct only in the coronal plane. To date, no direct comparison has been made between three-dimensional and simple coronal plane osteotomies.

Methods: 

Between 1983 and 2007, we treated eighty-six elbows with a posttraumatic varus deformity. We classified patients who underwent three-dimensional osteotomies as Group I and those who underwent simple coronal plane osteotomies as Group II, and we compared the outcomes between the groups. Clinical evaluation included an assessment of the carrying angle and measurement of the passive range of motion before surgery and at the time of the final follow-up. To evaluate the remodeling capacity of the bone to recover elbow flexion in Group II, we assessed the range of motion before surgery and at the time of the final follow-up in patients who were less than ten years old and those who were more than ten years old.

Results: 

There was no significant difference between the groups with regard to the carrying angle or the elbow range of motion, either before surgery or at the time of the final follow-up. However, Group I had more significant loss of correction (p = 0.018). In Group II, elbow motion reached the physiological range by the time of the final follow-up in patients who were less than ten years old.

Conclusions: 

For osteotomies to correct cubitus varus deformity, correction of internal rotation is not needed. With a three-dimensional osteotomy, it is difficult to maintain correction and to acquire the planned carrying angle because of the small area of bone contact. It is necessary to correct hyperextension in patients older than ten years of age, as after that age bone remodeling is not expected to increase elbow flexion.

Level of Evidence: 

Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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