Is modified reverse step-cut osteotomy better than Yun's reverse V osteotomy in paediatric cubitus varus deformity correction? A prospective, double-blinded, randomized controlled trial. 2022

Ramesh Kumar, and Karthick Rangasamy, and Nirmal Raj Gopinathan, and Pebam Sudesh, and Vijay G Goni
Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Various corrective osteotomy techniques have been described in the literature for correcting paediatric cubitus varus. But we are still in search of the perfect technique that gives maximum possible deformity correction and cosmetic appearance that satisfies parents with minimal complications. We compared the outcomes of two technically sound osteotomy techniques having minimal postoperative lateral condyle prominence described in the literature. Is modified reverse step-cut osteotomy (MRSO) better in terms of clinical, radiological, and cosmetic outcomes than Yun's reverse V osteotomy (RVO) in pediatric cubitus varus deformity correction? In total, 20 children with unilateral cubitus varus resulting from malunited supracondylar humerus fractures were included. Randomization was done by computer-generated random slips. A total of ten cases each were operated by MRSO and RVO techniques, respectively. Clinical, radiological, and cosmetic appearance assessments were done at the final two year follow-up and compared between the two groups. The mean age of children in the MRSO and RVO groups is 9.9 years (3-16) and 8.6 years (3-16), respectively. The mean pre-operative carrying angle in the deformed elbow of MRSO and RVO group was - 20.5° and - 19.5°, respectively, and the mean pos-toperative carrying angle in the corrected elbow of MRSO and RVO group was + 6.8° and + 6.5°, respectively. Regarding the lateral prominence index (LPI), a positive correlation was noted between pre-operative and post-operative periods with a value of 0.855 and 0.844 (p value: 0.001 and 0.03, respectively) in both MRSO and RVO groups, respectively. However, the change was statistically not significant when compared between the two groups (p = 0.63). There was no statistically significant difference (p > 0.05) when the clinical, radiological, and cosmetic outcomes were compared between the groups at final follow-up. The surgeon can choose either one of these techniques based on their expertise since the results of both the techniques are comparable in terms of clinical, radiological, and cosmetic outcomes.

UI MeSH Term Description Entries
D009140 Musculoskeletal Diseases Diseases of the muscles and their associated ligaments and other connective tissue and of the bones and cartilage viewed collectively. Orthopedic Disorders,Musculoskeletal Disease,Orthopedic Disorder
D010027 Osteotomy The surgical cutting of a bone. (Dorland, 28th ed) Osteotomies
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D002675 Child, Preschool A child between the ages of 2 and 5. Children, Preschool,Preschool Child,Preschool Children
D004551 Elbow Joint A hinge joint connecting the FOREARM to the ARM. Elbow Joints,Joint, Elbow,Joints, Elbow
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D006810 Humeral Fractures Fractures of the HUMERUS. Humeri Fractures,Humerus Fractures,Fracture, Humeral,Fracture, Humeri,Fracture, Humerus,Humeral Fracture,Humeri Fracture,Humerus Fracture
D006811 Humerus Bone in humans and primates extending from the SHOULDER JOINT to the ELBOW JOINT. Humeri,Greater Tubercle,Humeral Greater Tuberosity,Humeral Lesser Tuberosity,Lesser Tubercle,Olecranon Fossa,Olecranon Fossi,Greater Tubercles,Greater Tuberosities, Humeral,Greater Tuberosity, Humeral,Humeral Greater Tuberosities,Humeral Lesser Tuberosities,Lesser Tubercles,Lesser Tuberosities, Humeral,Lesser Tuberosity, Humeral,Tubercle, Greater,Tubercles, Greater
D000293 Adolescent A person 13 to 18 years of age. Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths

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