Cubitus Varus Osteotomy



Cubitus Varus Osteotomy


Peter M. Waters



Operative Indications



  • Malunion of distal humerus supracondylar fracture, usually Baumann angle >90° (Figure 14.1)


Surgical Technical Options



  • Closing wedge osteotomy (Figure 14.2)


  • Dome osteotomy (Figure 14.3)


  • Step cut osteotomy


  • Internal fixation with smooth wires or plates and screws


  • External fixation


  • Growth modulation NOT an option (Figure 14.4)

Closing Wedge Step Osteotomy (Figure 14.5)




Positioning



  • Supine with arm extended on fluoroscopic table


Surgical Approach



  • Straight lateral approach to distal humerus



    • Extend from distal lateral condylar prominence proximally to diaphysis


    • Be aware of radial nerve crossing proximally


  • Subperiosteal anterior and posterior exposure


  • Anteriorly stay subperiosteally to protect median nerve and brachial artery



    • This is especially important if there is marked extension malunion in which neurovascular bundle (NVB) can be anteromedial to exostosis (median nerve has been iatrogenically injured in corrective osteotomy)


  • Posteriorly expose olecranon fossa completely to be certain osteotomy cuts stay above fossa later in case


  • Medially stay subperiosteally to protect ulnar nerve throughout case


  • Protect radial nerve anteriolaterally at the proximal edge of incision. Large Hohmann retractors are placed anteriorly all the way across to anteriomedial distal humerus to expose malunion and protect anteriomedial brachial artery and median nerve. The NVB can get stuck as it drapes over malunion, and this protective subperiosteal elevation is very important for safe surgical care


  • This retractor enables full visualization of anterior cortex during pin placement and osteotomy cuts to prevent error. Similar large Hohmann retractor is placed posteriorly all the way across to posteriomedial distal humerus. This protects ulnar nerve throughout operation


  • Enables full visualization of olecranon fossa during pin placement and osteotomy cuts to prevent error

Jun 9, 2022 | Posted by in Reconstructive surgery | Comments Off on Cubitus Varus Osteotomy
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