Modified Double Dome Osteotomy For Treatment Of Paediatric Cubitus Varus Deformity: A Case Series
Swapnil Singh, MBBS, MS(orthopaedics)1; Tahir Ansari, MBBS, MS(orthopaedics), MRCS, FRCS(Ortho)2; Abhinav Agarwal, MBBS, MS(orthopaedics)2
1AIIMS, New Delhi, New Delhi, India, India, 2AIIMS, New Delhi, New Delhi, NH, India
Purpose: In this case series of 21 paediatric patients with cubitus varus, we are reporting the results and advantages of a modified double osteotomy technique. This is the first such case series reporting the results of modified double dome osteotomy for paediatric cubitus varus.
Material and methods: 21 patients (13 males, 8 females) with cubitus varus and a mean age of 8.6 years underwent deformity correction for various indications using a modified double dome osteotomy technique between Feb 2014 to Feb 2016 and the results were analyzed retrospectively. The osteotomy site was fixed with three 2mm. K wires (1 medial and 2 lateral) in patients less than 10 years of age and a Y plate was used for fixation of the osteotomy site in patients beyond that age group. Preoperative data including the clinical symptoms, range of motion, carrying angle etc. were obtained from patient records and postoperatively this data was obtained from patient follow-ups. Ulno-humeral angles were calculated from the full length radiographs and were compared preoperatively and postoperatively. The mean follow-up duration was 20.4 months.
Results: All patients underwent successful correction of the deformity with a mean postoperative ulnohumeral angle of 6.2 degrees of valgus as compared to the preoperative varus angle of 20.1 degrees. The mean time to union was 6 weeks and no patient showed evidence of delayed union or nonunion. Mean Range of postoperative flexion-extension arc was 132.3 degrees while pronation – supination was 85.7 degrees. Mean lateral prominence index was -0.87. No major complications were noted and only 1 patient had superficial infection and wound dehiscence which was successfully treated with debridment and secondary closure. There were no transient or permanent nerve injuries seen in this group of patients.
Conclusions: Modified double dome osteotomy is technically simple to perform and provides excellent correction of the paediatric cubitus varus deformity with good union rates and minimal complications.
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