Distal humeral osteotomy for cubitus varus in children compared to adolescents

Abstract

Background: While pediatric cubitus varus has often been considered merely a cosmetic deformity, long-standing cubitus varus can lead to symptomatic pain and elbow instability in adults and may present as early as adolescence. The purpose of this study was to compare patient and radiographic characteristics, surgical factors, and symptom resolution after distal humeral osteotomy for cubitus varus in pediatric versus adolescent patients. Methods: This is a retrospective single-institution review of 17 patients (12 patients 10.0 years (group Adol)) were treated for cubitus varus with distal humeral osteotomy from 2003 to 2019. Peds had a median age of 6.3 years (range, 2.7-7.8 years) at the time of osteotomy, and Adol had a median age of 14.1 years (range, 13.5-16.7 years). A Fisher’s exact test was used to compare categorical variables between Peds and Adol, and continuous variables were compared using Mann-Whitney or Student’s t-test depending on normality results using the Shapiro-Wilk test. Statistical significance was set at P<.05. Results: Preoperative pain was present in 17% (2/12) of Pediatric patients (Peds) but 100% (5/5) of Adolescent patients (Adols). Mechanical symptoms were present in 17% (2/12) of Peds and 80% (4/5) in Adol. Radiographic correction and final range of motion did not significantly differ between the 2 groups. The mean tourniquet time was 83 minutes in Peds and 117 minutes in Adol. Pin fixation was used in 100% (12/12) of Peds; 80% (4/5) of Adol had plates. At the final follow-up, all Peds had resolution of symptoms, but 60% (3/5) Adol had continued pain and mechanical symptoms. Conclusions: Although both pediatric and adolescent patients have similar radiographic correction and range of motion after distal humeral osteotomy to correct cubitus varus, the surgery may be more technically difficult in adolescent patients, with longer tourniquet times and the use of plate instead of pin fixation. Adolescents should be counseled that, like adults, their symptoms may not completely resolve after correction of radiographic and clinical deformity. The authors recommend that cubitus varus be corrected in childhood prior to the development of symptoms in adolescence. Key Concepts: 1) Cubitus varus following pediatric distal humerus fracture may present with pain and mechanical symptoms as early as adolescence. 2) Although pediatric and adolescent patients may have similar radiographic correction and range of motion after distal humeral osteotomy, the surgery is technically more difficult in adolescent patients. 3) Adolescents should be counseled that pre-operative symptoms may not completely resolve after correction of radiographic and clinical limb deformity. 4) It is the authors’ opinion that cubitus varus should be surgically corrected before a child reaches adolescence, when it is technically less demanding and before mechanical symptoms and pain develop. Level of Evidence: Level III – Retrospective Cohort Study

Keywords

• Cubitus varus
• Distal humerus
• Osteotomy
• Adolescents