Abstract：
The results of conventional corrective procedures remain suboptimal for severe cubitus varus deformities (> 30°) in children. We present the results of shortening dome osteotomy for the correction of such deformities.
METHODS: We present retrospective review of prospectively collected data of 18 patients (11 boys and 7 girls) who underwent shortening dome osteotomy between January 2011 and December 2019 for severe cubitus varus deformities (> 30°) secondary to malunited supracondylar fracture. The procedure involved the removal of convexo-concave bone (5-8 mm wide) between the two domes. Humero-ulnar angles, lateral condylar prominence index (LCPI), and elbow range of movements were recorded preoperatively and postoperatively.
RESULTS: Mean age was 7.5 years (range 5 years-11 years). Indication for surgery was poor cosmesis in all the patients and tardy ulnar nerve symptoms in three patients. Mean preoperative humero-ulnar angle was 26.1° varus (range 22°-34°), while it was 7.1° valgus (range 0°-12°) for contralateral normal elbow. They were followed for a mean duration of 2.2 years (range 12 months-5.8 years). The mean postoperative valgus angle achieved was 7.3° (range 2°-12°) as total angular correction achieved was 34.4° (range 30°-44°) (p < 0.001). Radiological healing was observed in all the patients at mean duration of 7.1 weeks (range 5 weeks-9 weeks). Mean preoperative and postoperative LCPI were - 2.4 (range +4.7 to - 10.5) and - 1.7 (range +4.5 to - 5.1), respectively (p = 0.595). Three patients had pin tract infections and two of them responded to aseptic dressings and oral antibiotics, while another required early pin removal and additional protection in splint. All patients regained preoperative arc of motion within 6 months after the procedure.
CONCLUSIONS: Shortening dome osteotomy is a safe and effective method for correcting severe cubitus varus deformities (> 30°) secondary to malunited supracondylar fracture in children.
METHODS: We present retrospective review of prospectively collected data of 18 patients (11 boys and 7 girls) who underwent shortening dome osteotomy between January 2011 and December 2019 for severe cubitus varus deformities (> 30°) secondary to malunited supracondylar fracture. The procedure involved the removal of convexo-concave bone (5-8 mm wide) between the two domes. Humero-ulnar angles, lateral condylar prominence index (LCPI), and elbow range of movements were recorded preoperatively and postoperatively.
RESULTS: Mean age was 7.5 years (range 5 years-11 years). Indication for surgery was poor cosmesis in all the patients and tardy ulnar nerve symptoms in three patients. Mean preoperative humero-ulnar angle was 26.1° varus (range 22°-34°), while it was 7.1° valgus (range 0°-12°) for contralateral normal elbow. They were followed for a mean duration of 2.2 years (range 12 months-5.8 years). The mean postoperative valgus angle achieved was 7.3° (range 2°-12°) as total angular correction achieved was 34.4° (range 30°-44°) (p < 0.001). Radiological healing was observed in all the patients at mean duration of 7.1 weeks (range 5 weeks-9 weeks). Mean preoperative and postoperative LCPI were - 2.4 (range +4.7 to - 10.5) and - 1.7 (range +4.5 to - 5.1), respectively (p = 0.595). Three patients had pin tract infections and two of them responded to aseptic dressings and oral antibiotics, while another required early pin removal and additional protection in splint. All patients regained preoperative arc of motion within 6 months after the procedure.
CONCLUSIONS: Shortening dome osteotomy is a safe and effective method for correcting severe cubitus varus deformities (> 30°) secondary to malunited supracondylar fracture in children.
摘要：
对于儿童严重的肘内翻畸形（>30°），常规矫正程序的结果仍然欠佳。我们介绍了缩短圆顶截骨术以矫正此类畸形的结果。
方法：我们对2011年1月至2019年12月期间接受缩短穹顶截骨术治疗的18例患者（11名男孩和7名女孩）的前瞻性数据进行了回顾性回顾，这些患者均为严重的肘内翻畸形（>30°）继发于畸形的髁上骨折。该过程涉及移除两个圆顶之间的凸凹骨(5-8mm宽)。Humero-尺骨角度，外侧髁突突出指数(LCPI)，术前和术后记录肘关节运动范围。
结果：平均年龄为7.5岁（范围5-11岁）。所有患者的手术指征均为外观差，3例尺神经症状迟缓。术前肱骨尺骨平均内翻角度为26.1°(范围22°-34°),对侧正常肘部为7.1°外翻(范围0°-12°)。随访时间平均为2.2年（12个月-5.8年）。术后平均外翻角度为7.3°（范围2°-12°），总角度矫正为34.4°（范围30°-44°）（p<0.001）。在所有患者中观察到放射学愈合，平均持续时间为7.1周（范围5周-9周）。术前和术后平均LCPI分别为-2.4（范围+4.7至-10.5）和-1.7（范围+4.5至-5.1），分别(p=0.595)。三名患者有针道感染，其中两名患者对无菌敷料和口服抗生素有反应，而另一个需要早期的引脚移除和额外的保护夹板。所有患者在术后6个月内恢复了术前运动弧。
结论：缩短穹顶截骨术是一种安全有效的方法，用于矫正儿童髁上骨折合并严重肘内翻畸形(>30°)。
方法：我们对2011年1月至2019年12月期间接受缩短穹顶截骨术治疗的18例患者（11名男孩和7名女孩）的前瞻性数据进行了回顾性回顾，这些患者均为严重的肘内翻畸形（>30°）继发于畸形的髁上骨折。
结果：平均年龄为7.5岁（范围5-11岁）。
结论：缩短穹顶截骨术是一种安全有效的方法，用于矫正儿童髁上骨折合并严重肘内翻畸形(>30°)。
