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Journal Club

March 2010

Reverse V osteotomy of the distal humerus the correction of cubitus varus

Yun YH, Shin SJ, Moon JG.

Department of Orthopaedic Surgery, Ewha Womans University, Mok-dong Hospital, 911-1, Mok-dong, Yangcheon-gu, Seoul 158-710, Korea.

J Bone Joint Surg Br. 2007 Apr;89(4):527-31

Abstract link

Introduction

• Case series/technical note

Methodology

• Pre-operative planning
  • Full length XR both arms
    • Humeral-elbow-wrist angle both arms
    • Valgus +, varus –
    • Amount of correction required based on contralateral arm
  • Osteotomy planned
  • Correction of lateral/medial prominence
• Procedure
  • Tourniquet, lateral, elbow 90° flexion
  • Posterolateral approach
  • Goniometer
  • ABC resected
  • Lateral rotation of distal segment
  • Lateral crossed K-wire and wiring

• 90° slab for 2/52 then active ROM
• Evaluation
  • Radiologically
    • Correction of deformity based on humeral-elbow-wrist angle
    • Lateral prominence (X-Y)
  • Clinically
    • ROM
    • Complications
  • Rated as excellent/good/poor according to Oppenheim

Results

• 22 children with cubitus varus
  • 19 boys, 3 girls
  • Mean age 9.5
  • 17 supracondylar, 2 lateral condylar, 2 medial condylar, 1 physeal seperation
  • All children had good elbow function and full ROM
  • Indication was cosmetic deformity
• 20 excellent, 2 good (at mean follow up 16/12)
• All osteotomies united at 10 weeks
• Mean pre-operative deformity
  • -16.9 (-25 to +9)
• Post-operatively
  • +7.3 (-2 to +14)
• Mean correction 24.1 degrees
• 2 with lateral prominence (mild < 5mm)
• 1 intra-operative fracture
• 1 ulna nerve palsy

Discussion

• Many approaches/osteotomies/fixation described
• Perceived advantages of reverse V
  • High. Providing better fixation. Particularly in adult.
  • Inherently stable
  • Easy and precise assessment/correction of lateral prominence through pre-op plan
• Fixation
  • Lateral crossed K-wires with supplemental wiring
  • Reduced chance of iatrogenic nerve injury
  • Stable enabling active ROM to begin at 2 weeks

Pros of Study

• Well described Case series/technical note