Supracondylar Osteotomy for the Treatment of Post-Traumatic Cubitus Varus in Children: Long-Term Results and Comparison of Two Different Fixation Methods
Keywords:
Blount staple, carrying angle, cubitus varus, elbow supracondylar valgus osteotomy, K-wire, 8 plateAbstract
Cubitus varus is the most common complication of supracondylar fractures in children. The purpose of this study was to analyze the long-term results of valgus osteotomy for the treatment of this condition and to compare two different fixation methods of the osteotomy site. A retrospective, IRB approved review was conducted on 48 children who underwent supracondylar osteotomy for posttraumatic cubitus varus. Two groups with different internal fixation methods were compared: Group A: isolated K-wire construct, and Group B: augmented construct using k-wires with either a Blount staple or an 8-plate. Clinical and radiological parameters were measured and compared between both groups and complications were included. Statistical analysis was done using Chi-square test, ANCOVA test, Mann-Whitney U test and Friedman test. Age at surgery was 4±1.8 years, with a mean follow up of 10±4.5 years. Patients showed a significant post-operative increase in active flexion compared to preoperative values (140° vs 122°, p < 0.0001). Clinical carrying angle was 5° of valgus postoperatively vs 18° of varus preoperatively (p < 0.0001). Radiological carrying angle was 7° of valgus postoperatively vs 18° of varus preoperatively (p < 0.0001). A mean clinical and radiological carrying angle correction of 22° and 25°, respectively, was achieved. No statistically significant differences were found between the K-wire and augmented construct groups concerning flexion, extension, carrying angle, gain of flexion, gain of extension, and gain of carrying angle, and total incidence of complications; hypertrophic scar events were however more present in group A. Both groups yielded comparable excellent, good and poor results, yet patient satisfaction was better in Group B. Implementing an augmented construct in older patients was thought to counteract the varus moment and provide a more stable osteotomy. However, correction was comparable between both groups. Furthermore, no benefit was found in reducing complication rates, increasing range of motion and overall clinical results. We find it therefore difficult to recommend a rigid construct systematically in all patients. Supracondylar lateral closing wedge osteotomy yielded overall excellent/good long-term outcomes. Major complications were rare. No benefit concerning range of motion and carrying angles was procured in augmenting a K-wire construct with an 8-plate or Blount staple. However, K-wire + 8-plate/staple constructs displayed less hypertrophic scar events and more overall satisfaction. Complication rates and clinical results were comparable no matter the montage employed.
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