RETROSPECTIVE COMPARISON OF PARATRICIPITAL APPROACH AND TRICEPS SPLITTING APPROACH FOR THE MANAGEMENT OF CUBITUS VARUS BY CORRECTIVE OSTEOTOMY

Abstract

Corrective osteotomy for cubitus varus deformity can be approached both via triceps splitting approach as well as paratricipital approach. The aim of our study was to compare the functional outcome after triceps splitting and paratricepetal approach for corrective osteotomy in cubitus Varus deformities. None of the previous studies have compared the approaches head to head when dealing with osteotomy for cubitus varus deformities. This is a retrospective study done on cases operated between January 2001 and December 2015. A total of 40 patients presented with cubitus varus deformity. Exclusion criteria removed 10 patients from the study. Of the 40 patients, 22 patients had been operated with a triceps splitting approach while 18 patients had been operated with a paratricepetal approach. In all the cases stabilization was done using internal fixation. Postoperative immobilization consisted of above elbow slabs or cast for a duration of three weeks. The length of duration for which follow up was available for all the cases was two years. Retrospectively data was extracted. Morrey’s system of functional assessment of outcome had been primarily used by the surgeons to assess the outcomes. Other than this, an osteotomy that corrected the humeral – ulnar angle to less than 10 degrees of the contralateral side was considered a good result. Our final data consisted of 40 cases. All the twenty-two cases in group A were fully satisfied with cosmetic results, but one case in group B had complaints related to cosmetic appearance due to excessive lateral condylar prominence. In group A, there was no pain in seventeen, mild pain in three, moderate pain in two cases and none had severe pain. In group B, there was no pain in fifteen, mild pain in two, moderate pain in one case and none had severe pain. No case had instability in the coronal plane. Till date, neither triceps-splitting nor paratricepetal approach is considered superior to the other approach. Mostly, the experience of the surgeon and the type of fracture determine the preferred incision to be employed. As compared to triceps splitting approach, paratricepetal approach results in better functional outcomes, triceps strength, elbow ROM and less extension contracture in the final follow up.

Keywords

• triceps splitting,paratricepetal approach,functional outcomes,cubitus varus deformity,closed wedge osteotomy