, Volume 471, Issue 5, pp 1564-1571
Date: 25 Jan 2013

Surgical Technique: Spike Translation: A New Modification in Step-cut Osteotomy for Cubitus Varus Deformity

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Topic
Elbow

Abstract

Background

Various methods of osteotomy have been proposed for the treatment of cubitus varus. We designed a modification of the step-cut osteotomy to achieve more correction of the deformity. We describe this new technique called spike translation step-cut osteotomy and report the clinical and radiographic outcomes (deformity correction, ROM, function, osteotomy healing, complications) in a series of patients treated for cubitus varus using this technique.

Description of Technique

The technique involves a kind of closing-wedge osteotomy with a lateral spike to correct cubitus varus. To avoid lateral epicondyle prominence, the spike is translated medially and embedded in the proximal segment.

Methods

We treated 13 patients with cubitus varus using the new technique between 2005 and 2010. We compared preoperative and postoperative clinical and radiographic parameters (humerus-elbow-wrist angle, lateral prominence index, arc of elbow motion, DASH score) for all patients. Time to union was recorded. Postoperative evaluation was performed according to the modified criteria of Oppenheim et al. Minimum followup was 16 months (average, 27 months; range, 16–43 months).

Results

The average humerus-elbow-wrist angle improved from −26° to 11°. The mean lateral prominence index did not differ after correction of deformity compared with the normal side. By using our rehabilitation protocol, all patients regained preoperative arcs of elbow motion in a mean of 2.5 months (range, 1.50–3.50 months) postoperatively, and the mean union time was 1.65 months. According to the criteria of Oppenheim et al., there were 11 excellent and two good results.

Conclusions

Our spike translation step-cut osteotomy with a larger contact surface of cancellous bone can be a reasonable alternative for correction of a cubitus varus deformity, with satisfactory deformity correction, reliable healing of osteotomy, and low complication rates.

Level of Evidence

Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his or her institution approved the human protocol for this investigation that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.