Focal dome osteotomy for correction of varus deformity at elbow in children.

BACKGROUND: Cubitus varus is the most common complication of un-treated or mal-treated supracondylar fracture of humerus at elbow. Various osteotomies have been described to correct this deformity but each is associated with its own complications. In this study, focal dome osteotomy for correction of cubitus varus was performed to determine its functional and radiological outcome.

MATERIALS AND METHOD: In this study, 35 children with cubitus varus deformity were admitted from Jan 2009- Jan 2013. Clinical assessment was done before the procedure by measuring the carrying angle at elbow joint. Radiographic assessment of deformity was done by anteroposterior (AP) radiographs of the elbow by measuring the humeral-ulnar angle (HUA) and metaphyseal-diaphyseal angle (MDA). Through anterolateral approach, supracondylar region of humerus was exposed and focal dome osteotomy was done at the center of rotation of angulation (CORA). Final assessment was done clinically for carrying angle and radiologically for HUA and MDA at 8 weeks to evaluate the functional and radiological outcome as good or poor.

RESULTS: The mean age of 35 children at the time of surgery was (mean ± SD 8.03 ± 2.35) with range from 5 - 12 years, Male to female ratio was 1.50:1. The mean duration of injury was (170.26 ± 41.78) days. The functional outcome for carrying angle improved from 1.49 ± 5.95 to 14.46 ±1.44 with p value <0.05. Radiological outcome for humeral-ulnar and metaphyseal-diaphyseal angle improved from 27.71 ± 4.31 to 17.77 ± 1.23 and 103.66 ± 4.76 to 90.49 ± 1.96 with p value <0.05 respectively. The final Functional and Radiological outcome was good in 32 patients (91%) and poor in 3 patients (9%).

CONCLUSIONS: Focal dome osteotomy is safe and stable method of correction of cubitus varus which avoids prominence of lateral condyle and is cosmetically acceptable.