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Preoperative, Computer Simulation-Based, Three-Dimensional Corrective Osteotomy for Cubitus Varus Deformity with Use of a Custom-Designed Surgical Device
Yukari Takeyasu, MD, PhD1; Kunihiro Oka, MD, PhD2; Junichi Miyake, MD1; Toshiyuki Kataoka, MD1; Hisao Moritomo, MD, PhD3; Tsuyoshi Murase, MD, PhD1
1 Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. E-mail address for T. Murase: tmurase-osk@umin.ac.jp
2 Department of Orthopaedic Surgery, Bell Land General Hospital, 500-3 Higashiyama, Naka-ku, Sakai 599-8247, Japan
3 Department of Physical Therapy, Osaka Yukioka College of Health Science, Sojiji 1-1-41, Ibaragi-shi, Osaka 567-0801, Japan
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Investigation performed at Osaka University Graduate School of Medicine, Osaka, Japan



Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Nov 20;95(22):e173 1-9. doi: 10.2106/JBJS.L.01622
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Abstract

Background: 

Cubitus varus deformity after a supracondylar fracture classically includes varus, extension, and internal rotation components. However, to our knowledge, no reliable surgical method for three-dimensional corrective osteotomy has been established. We developed an intraoperative guide system involving a custom-made surgical template designed on the basis of a three-dimensional computer simulation incorporating computed tomography (CT) data. We aimed to investigate the feasibility of this novel technique for correcting cubitus varus deformity.

Methods: 

Thirty consecutive patients (twenty-three males and seven females) with a cubitus varus deformity resulting from the malunion of a distal humeral supracondylar fracture were included in this study. Between October 2003 and May 2011, the patients underwent a three-dimensional corrective osteotomy with use of a custom-made surgical template. The patients were then followed for a minimum of twelve months. We evaluated radiographic parameters, including the humerus-elbow-wrist angle and tilting angle, as well as the ranges of motion of the elbow and shoulder at the time of the most recent follow-up. An overall clinical evaluation was performed.

Results: 

Bone union was achieved at a mean of four months after surgery. The mean humerus-elbow-wrist angle and tilting angle on the affected side improved significantly from 18.2° (varus) and 25.0°, respectively, before surgery, to 5.8° (valgus) and 38.0°, respectively, after surgery. Hyperextension of the elbow and internal rotation of the shoulder were normalized in all patients. Early plate breakage was observed in one patient. One patient had mild recurrence of varus deformity. Twenty-seven patients had an excellent result, three had a good result, and none had a poor result.

Conclusions: 

Three-dimensional corrective osteotomy with the use of a custom-made surgical template that is designed and produced on the basis of computer simulation is a feasible and useful treatment option for cubitus varus deformity.

Level of Evidence: 

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

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    Video 1 Video illustrating the computer simulation of the correction.

    Running Time: 0:18

    Video 2 Video showing the surgical procedure with use of the custom-made template.

    Running Time: 1:07

    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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