Ostéotomie en marche d’escalier modifiée dans le traitement du cubitus varus post-traumatique : notre expérience chez 14 enfants

BackgroundLateral closing wedge osteotomy is a commonly described procedure for correcting cosmetically unacceptable posttraumatic cubitus varus deformity in children. However complications like residual deformity, lateral prominence, loss of fixation and ulnar nerve palsies commonly contribute to poor outcomes with such an osteotomy.MethodsFourteen children (11 boys and three girls) presenting a malunited extension type supracondylar fracture of the humerus with an average age of 9.07 years (6 to 14 years) were operated around 3.6 years (1.5 to 7 years) after the injury using a modified step cut osteotomy. The average follow-up period was 2.1 years (1 to 4 years). Objective assessment included measurement of preoperative and postoperative lateral prominence index, carrying angle and range of elbow motion. Results were graded excellent, good or poor as per the Oppenheim criteria.ResultsThere were eight excellent, five good and one poor result. A residual varus of more than 10 degrees was seen in the single patient with poor result. None of the patients showed a prominent lateral humeral condyle or formation of hypertrophic scar. Our results were comparable to the published results of the classical lateral closing-wedge osteotomy in terms of elbow motion and correction of deformity.ConclusionA modified step cut osteotomy is a safe and simple procedure which prevents lateral prominence and leads to good or excellent outcomes in most of the patients. The step cut osteotomy procedure, mentioned here, might be beneficial over the conventional lateral closing wedge osteotomy in certain aspects like the lateral humeral condyle prominence, scar acceptibility and cosmesis. However, the apparent aforementioned advantages of this osteotomy over the conventional lateral closing wedge osteotomy need to be further evaluated and confirmed on the basis of large, prospective randomized controlled trials.Level of evidenceLevel IV. Retrospective study.