Internal and external fixation after closing wedge osteotomy yielded reliable outcomes
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Published results showed either internal or external fixation after lateral closing-wedge corrective osteotomy yielded reliable outcomes with a low rate of complications and satisfactory functional results in pediatric patients with cubitus varus.
Researchers categorized 35 pediatric patients with cubitus varus deformities secondary to supracondylar fractures into groups based on whether they underwent external fixation (n=16) or internal fixation with plates (n=19) after corrective osteotomy through a limited lateral approach. Researchers used the Mayo Elbow Performance Score and Flynn criteria to evaluate functional outcome.
Results showed external fixation yielded significantly lower costs, a shorter operation, smaller scars and a shorter time for plaster cast use postoperatively. However, researchers found no nonunion or failure of fixation, as well as no significant difference in postoperative elbow range of motion or Mayo Elbow Performance score between the external and internal fixation groups. Researchers also noted satisfactory functional and cosmetic results were achieved in both groups.
“Cubitus varus in children after [supracondylar humeral fractures] SHFs remains a treatment challenge. Both lateral external fixation and single-plate internal fixation after corrective lateral closing wedge osteotomy meet the basic requirements of treatment management, which entails anatomic elbow carrying angle reconstruction, stable fixation avoiding delayed healing and early immobilization,” the authors wrote. “Neither external nor internal fixation in this series was associated with an increased rate of perioperative complications or unsatisfactory functional results.” – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Abigail K. Allen, MD
Cubitus varus is a known and common complication after pediatric supracondylar humerus fractures that we all know too well. The authors point out that it is primarily a cosmetic deformity, but it is worth noting that is also carries with it an increased incidence of lateral condyle fractures, posterolateral rotatory instability and tardy ulnar nerve palsy.
It is encouraging to see that both groups in this study achieved satisfactory cosmetic and functional results. In reality, there are obviously more ways to address cubitus varus than the two methods addressed in this article. When there are many different ways to address one problem, it usually means one of two things: that either nothing works well or that everything works well. In this particular case, I believe the latter to be the case. The bottom line is that most patients will be happy and do well with this correction, regardless of the method of treatment.
If I could add a “public service announcement” to this perspective, it would be to do one’s best to avoid having to address cubitus varus in the first place. If there is ever a type 2 supracondylar humerus fracture in your ED and you are not quite sure if it needs to be fixed, simply fix it. As you can see from this study, most of the cubitus varus patients had not had surgery before their corrective osteotomy. It makes one ponder had they only had a simple surgery in the first place, perhaps they would have avoided this larger surgery.
Mount Sinai
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