A Simple Dual-Planar Osteotomy to Correct Cubitus Varus Deformity in Children

Objectives:To report the outcomes when performing a dual-planar osteotomy of the distal humerus via a posterior approach for gunstock deformity in children. Design:A retrospective review.Setting:Penn State Hershey Pediatric Bone and Joint Institute. Patients/Participants:Sixteen patients were reviewed. The average patient age was 8 years (range, 5-13 years). Intervention:A complete dual-planar closing wedge osteotomy was performed with the patient in the prone position via a posterior triceps-splitting approach. Fixation with buried smooth K wires was utilized. Main Outcome Measurements:Valgus correction obtained, final elbow range of motion, radiographic and clinical correction of the deformity, the patient's satisfaction, and elbow function were evaluated. Results:Preoperative radiographs showed the average humeral-ulnar angle (HUA) was 17 degrees of varus (range, 10-26 degrees varus). The average wedge removed wallow-up clinical exam demonstrated that the carrying angle was in valgus in 15 cases and neutral in 1 case. The average carrying angle was 5 degrees of valgus (range, 0-11 degrees valgus). The average hyperextenss 25 degrees (range, 20-40 degrees). Duration of follow-up averaged 51 months (range, 12-126 months). Final foion deformity improved from 9 degrees preoperatively to 1 degree postoperatively. Outcomes were classified by the grading scale described by Oppenheim: 14 cases had excellent results and 2 cases had good results. Conclusions:This method provides clear visualization and excellent correction of the deformities. The posterior scar is cosmetically acceptable. We recommend this technique for the treatment of gunstock deformity in children.