A Modified Reverse Right-angled Triangle Osteotomy Using the Lateral Approach for the Treatment of Posttraumatic Cubitus Varus Deformity in Children

Abstract

Background: Cubitus varus deformity is a complex 3-dimensional deformity. Various osteotomies have been introduced to correct this deformity, however, there is no consensus on the best procedure to correct the deformity while avoiding complications. In this retrospective study, we used a modified inverse right-angled triangle osteotomy to treat 22 children with posttraumatic cubitus varus deformity. The primary objective was to evaluate this technique by presenting its clinical and radiologic results. Methods: Twenty-two consecutive patients with a cubitus varus deformity underwent a modified reverse right-angled triangle osteotomy between October 2017 and May 2020 and were then followed for a minimum of 24 months. We evaluated its clinical and radiologic results. Functional outcomes were assessed using Oppenheim criteria. Results: The average follow-up period was 34.6 months (range, 24.0 to 58.1 months). The mean range of motion was 4.32 degrees (range, 0 degrees to 15 degrees)/122.73 degrees (range, 115 degrees to 130 degrees) (hyperextension/flexion) before surgery and 2.05 degrees (range, 0 degrees to 10 degrees)/127.27 degrees (range, 120 degrees to 145 degrees) at the final follow-up. There were significant (P < 0.05) differences between the flexion and hyperextension angles before surgery and at the final follow-up. Based on Oppenheim criteria, results were excellent for 20, good for 2, and none of the patients had poor results. The mean humerus-elbow-wrist angle improved from 18.23 degrees (range, 10 degrees to 25 degrees) varus preoperatively to 8.45 degrees (range, 5 degrees to 15 degrees) valgus postoperatively (P < 0.05). The mean of the preoperative lateral condylar prominence index was 3.52 (range, 2.5 to 5.2) and the average postoperative lateral condylar prominence index was −3.28 (range, −1.3 to −6.0). All patients were pleased with the overall appearance of their elbows. Conclusions: The modified reverse right-angled triangle osteotomy can precisely and stably correct the deformity in the coronal and sagittal planes, we recommend this technique as a simple, safe, and reliable correction of cubitus varus deformity. Level of Evidence: Level IV; case series; therapeutic studies—investigating the results of treatment.