Review Question - QID 3651

Cubitus varus is one of the most common complications of a supracondylar fracture in a child. Malreduction leads to progressive varus deformity which is cosmetic displeasing, though functional use of the limb is usually not impacted.

Figure A demonstrates a cubitus varus deformity in a skeletally immature child who had a supracondylar fracture treated in a cast . While lateral closing-wedge osteotomy is the most commonly described procedure for correction of cubitus varus, it does not allow for medialization of the distal fragment. This corrects the radiographic deformity but may leave a lateral condylar prominence. (The lateral prominence can be minimized by making an oblique osteotomy with cuts of similar size). Due to the risk of of lateral prominence, other techniques are described.

Pankaj et al. performed dome osteotomy in 12 children for correction of cubitus varus. There were 7 excellent and 5 good outcomes and no child had prominence of the lateral condyle. The average carrying angle was corrected from 21.5 degrees of varus to 10.8 degrees of valgus with no loss or gain in range of motion.

Yun et. al. describe a reverse V osteotomy for correction of cubitus varus. 20 of 22 children treated had excellent outcomes and no child was found to have a lateral prominence. They noted the advantages of "better inherent stability, the avoidance of a prominent lateral condyle after correction and firm fixation allowing early movement."

Moradi et al. describe a step cut osteotomy and describe their experience with 13 patients, achieving 11 excellent and 2 good results.

Koch et al. describe an opening wedge osteotomy used in 4 patients to achieve a mean valgus correction of 21.75 degrees.

Illustration A (Pankaj et al.) shows the inherent problem with lateral closing wedge osteotomy (lateral condylar prominence) as compared to dome osteotomy. Illustration B (Pankaj et al.) shows a planned cubitus varus correction using dome osteotomy. Illustration C (Yun et al.) shows a schematic for planning a cubitus varus correction using a reverse V osteotomy. Illustration D (Moradi et al.) shows a schematic for planning a step cut osteotomy. Illustration E (Koch et al.) shows a diagram of an opening wedge osteotomy.

Incorrect Answers:
Answers 1-4 allow for medialization of the distal fragment to prevent the lateral condylar prominence that may contribute to residual deformity.