Management of Cubitus Varus Deformity in Children by Closed Dome Osteotomy

Introduction: Supracondylar fractures are the most common elbow injuries in skeletally immature children between 5-10 years of age and cubitus varus deformity is the most common late complication. Cubitus varus or bow elbow or gunstock deformity is the result of malunion occurring as a complication of supracondylar fracture of the humerus. Various type of corrective osteotomies are used of which lateral closed wedge French osteotomy is commomly used which has its own complications like lateral condylar prominence, unsightful scar and limitation of movement. Closed dome osteotomy is a technique which overcomes these complications. This surgery is done with simple readily available instruments in the orthopaedic operation theatre with no special requirements for instrumentation. Aim: This study was done to study the results of closed dome osteotomy for correction of cubitus varus deformity, after malunited supracondylar fracture of humerus in children. Materials and Methods: This study included 25 children of either sex with malunited supracondylar fracture of distal humerus having cubitus varus deformity admitted in orthopaedics department. After appropriate pre operative assessment, closed dome osteotomy was done and post operatively X-ray of patients was taken and carrying angle and Lateral Condylar Prominence Index (LCPI) were calculated. Patients were re-assessed at complete union and results were calculated as per Mitchell and Adams criteria. Results: In our study of 25 patients, 68% were males, 32% were females. Majority (84%) of patients were in the age group of 5-10 years. Carrying angle post operatively was 0-10° valgus in 64% of patients while 36% had 10-20° valgus. LCPI changed post operatively ranging from +5.0% to -10.7%, average -2.75%. Decrease in LCPI had better cosmetic appearance. Range of motion post operatively increased or remained same as previous full motion in 84% of the patients. Union occurred in all patients by eight weeks. Few complications were seen. Results according to Mitchell and Adams criteria were excellent in 88% and good in 12%; while no poor results were recorded. Conclusion: The results obtained in our study concluded that closed dome osteotomy is safe and effective treatment for the correction of cubitus varus deformity with few minor complications.