Surgical technique: Spike translation: a new modification in step-cut osteotomy for cubitus varus deformity.
BACKGROUND
Various methods of osteotomy have been proposed for the treatment of cubitus varus. We designed a modification of the step-cut osteotomy to achieve more correction of the deformity. We describe this new technique called spike translation step-cut osteotomy and report the clinical and radiographic outcomes (deformity correction, ROM, function, osteotomy healing, complications) in a series of patients treated for cubitus varus using this technique.


METHODS
The technique involves a kind of closing-wedge osteotomy with a lateral spike to correct cubitus varus. To avoid lateral epicondyle prominence, the spike is translated medially and embedded in the proximal segment.


METHODS
We treated 13 patients with cubitus varus using the new technique between 2005 and 2010. We compared preoperative and postoperative clinical and radiographic parameters (humerus-elbow-wrist angle, lateral prominence index, arc of elbow motion, DASH score) for all patients. Time to union was recorded. Postoperative evaluation was performed according to the modified criteria of Oppenheim et al. Minimum followup was 16 months (average, 27 months; range, 16-43 months).


RESULTS
The average humerus-elbow-wrist angle improved from -26° to 11°. The mean lateral prominence index did not differ after correction of deformity compared with the normal side. By using our rehabilitation protocol, all patients regained preoperative arcs of elbow motion in a mean of 2.5 months (range, 1.50-3.50 months) postoperatively, and the mean union time was 1.65 months. According to the criteria of Oppenheim et al., there were 11 excellent and two good results.


CONCLUSIONS
Our spike translation step-cut osteotomy with a larger contact surface of cancellous bone can be a reasonable alternative for correction of a cubitus varus deformity, with satisfactory deformity correction, reliable healing of osteotomy, and low complication rates.
Orthopedic & Trauma Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Ahmad-Abad Street, Mashhad, 91799-9199, Iran.
Ali
A
Moradi
Ehsan
E
Vahedi
Mohammad H
MH
Ebrahimzadeh
D000293:Adolescent; D000328:Adult; D001696:Biomechanical Phenomena; D002648:Child; D004185:Disability Evaluation; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects*; D017759:Fractures, Malunited / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D016916:Joint Deformities, Acquired / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult