Comparative study of external fixator combined with Kirschner wire fixation and Kirschner wires fixation in treatment of cubitus varus deformity in children_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIE Kang , HU Ziwen , ZHANG Sicheng , JIA Guoqiang , JIN Bin , CHU Xiangjun ,  SUN Jun

Department of Orthopedics, Anhui Medical University Children’s Medical Center, Anhui Provincial Children’s Hospital, Hefei Anhui, 230051, P. R. China;

Corresponding?author：

SUN Jun, Email: Sunjun500@aliyun.com

Keywords：

Cubitus varus deformity; osteotomy; external fixator; Kirschner wire; children

DOI：

10.7507/1002-1892.202312045

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Objective To analyze the effectiveness comparison of external fixator combined with Kirschner wire fixation and Kirschner wire fixation in the treatment of cubitus varus deformity in children. Methods A retrospective case-control study was conducted to collect 36 children of postoperative supracondylar humerus fracture complicating cubitus varus deformity between January 2018 and July 2022. Among them, 17 cases were treated with distal humeral wedge osteotomy external fixation combined with Kirschner wire fixation (observation group), and 19 cases were treated with distal humeral wedge osteotomy and Kirschner wire fixation (control group). The baseline data including age, gender, deformity side, time from fracture to operation, carrying angle of the healthy side and preoperative carrying angle of the affected side, elbow flexion and extension range of motion, and lateral condylar prominence index (LCPI) showed no significant difference between the two groups (P>0.05). The operation time, hospitalization cost, healing time of osteotomy, postoperative complications, and the carrying angle, LCPI, and elbow flexion and extention range of motion were recorded and compared between the two groups. The elbow function was assessed by Oppenheim score at 3 months after operation and at last follow-up. Results The children in both groups were followed up 13-48 months, with an average of 26.7 months. There was 1 case of needle tract infection in the observation group and 2 cases in the control group, and no nerve injury occurred, the difference in the incidence of complication (5.88% vs 10.53%) between the two groups was not significant (χ²=0.502, P=0.593). There was no significant difference in the operation time and fracture healing time between the two groups (P>0.05); the hospitalization cost of the observation group was significantly higher than that of the control group (P<0.05). The Oppenheim score of the observation group was significantly better than that of the control group at 3 months after operation (P<0.05), but there was no significant difference in the Oppenheim score between the two groups at last follow-up (P>0.05). At last follow-up, the carrying angle of affected side significantly improved in both groups when compared with preoperative ones (P<0.05); the differences of the pre- and post-operative carrying angle of affected side and elbow flexion and extension range of motion showed no significant differences between the two groups (P>0.05), but the difference in pre- and post-operative LCPI of the observation group was significantly better than that of the control group (P<0.05). Conclusion External fixator combined with Kirschner wire fixation and Kirschner wire fixation both can achieve satisfactory correction of cubitus varus deformity in children, and the former can achieve better short-term functional recovery of elbow joint and reduce the incidence of humeral lateral condyle protrusion.

Citation： XIE Kang, HU Ziwen, ZHANG Sicheng, JIA Guoqiang, JIN Bin, CHU Xiangjun, SUN Jun. Comparative study of external fixator combined with Kirschner wire fixation and Kirschner wires fixation in treatment of cubitus varus deformity in children. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(3): 284-289. doi: 10.7507/1002-1892.202312045 Copy

1.	Kumar R, Rangasamy K, Raj Gopinathan N, et al. 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. Int Orthop, 2022, 46(9): 2041-2053.
2.	李傳峰, 郭敬喜, 梁磊, 等. 肱骨外側截骨外固定支架與鋼板治療兒童肘內翻的對比研究. 中華手外科雜志, 2022, 38(3): 238-240.
3.	陳榆林, 謝亞娟, 潘志見, 等. 改良外側楔形截骨術治療肘內翻畸形. 廣東醫學, 2023, 44(4): 467-472.
4.	朱立寧, 夏天, 周敏, 等. 等分線法肱骨髁上截骨治療兒童肘內翻畸形的臨床研究. 臨床小兒外科雜志, 2023, 22(5): 460-464.
5.	吳建群, 陶銳, 魏寬海, 等. 影像存儲傳輸系統在青少年肘內翻畸形肱骨外側楔形截骨矯形術中的應用. 中國修復重建外科雜志, 2021, 35(7): 836-840.
6.	Wong HK, Lee EH, Balasubramaniam P. The lateral condylar prominence. A complication of supracondylar osteotomy for cubitus varus. J Bone Joint Surg (Br), 1990, 72(5): 859-861.
7.	Oppenheim WL, Clader TJ, Smith C, et al. Supracondylar humeral osteotomy for traumatic childhood cubitus varus deformity. Clin Orthop Relat Res, 1984(188): 34-39.
8.	趙國強, 趙旭飛, 馮婷婷. 肱骨遠端截骨Ilizarov矯形與單純楔形截骨克氏針固定矯治術治療兒童肘內翻的對比研究. 臨床小兒外科雜志, 2019, 18(8): 675-680, 685.
9.	Klahs KJ, Polmear MM, Transtrum B, et al. Correction of cubitus varus using computer-assisted hexapod multiplanar external fixators: A report of 3 cases. JBJS Case Connect, 2023, 13(1).
10.	Li J, Wang J, Rai S, et al. 3D-printed model and osteotomy template technique compared with conventional closing-wedge osteotomy in cubitus varus deformity. Sci Rep, 2022, 12(1): 6762.
11.	Agrawal R, Agrawal RA, Kaul R, et al. Post-traumatic cubitus varus: long-term follow-up of corrective osteotomy using the Ilizarov method of compression distraction osteogenesis. J Pediatr Orthop B, 2022, 31(1): 31-42.
12.	Slongo T. Treatment of posttraumatic cubitus varus in children and adolescents. Supracondylar humeral osteotomy using radial external fixation. Oper Orthop Traumatol, 2015, 27(3): 194-209.
13.	Tang X, Wang J, Slongo T, et al. Comparison of internal fixation vs external fixation after corrective osteotomy in children with cubitus varus. J Shoulder Elbow Surg, 2020, 29(4): 845-852.
14.	Shi Q, Yan H, Yang M, et al. Comparative evaluation of pinning and cast fixation vs external fixation after lateral closing-wedge osteotomy for cubitus varus in children. J Shoulder Elbow Surg, 2022, 31(3): 481-487.
15.	Masquijo J, Artigas C, Hernández Bueno JC, et al. Surgical correction of cubitus varus in children with a lateral closing-wedge osteotomy: a comparison between two different techniques. J Pediatr Orthop B, 2024, 33(2): 167-173.
16.	Raney EM, Thielen Z, Gregory S, et al. Complications of supracondylar osteotomies for cubitus varus. J Pediatr Orthop, 2012, 32(3): 232-240.
17.	Stoffel C, de Lima E, Salles MJ. Hydroxyapatite-coated compared with stainless steel external fixation pins did not show impact in the rate of pin track infection: a multicenter prospective study. Int Orthop, 2023, 47(5): 1163-1169.
18.	Pankaj A, Dua A, Malhotra R, et al. Dome osteotomy for posttraumatic cubitus varus: a surgical technique to avoid lateral condylar prominence. J Pediatr Orthop, 2006, 26(1): 61-66.
19.	Persiani P, Noia G, de Cristo C, et al. Lateral wedge osteotomy for pediatric post-traumatic cubitus varus: Kirschner-wires or locking angular plate? J Pediatr Orthop B, 2017, 26(5): 405-411.
20.	譚為, 朱嘉文, 孫永建, 等. 兒童肘內翻髁上截骨矯正外固定與內固定比較. 中國矯形外科雜志, 2021, 29(22): 2017-2021.

1. Kumar R, Rangasamy K, Raj Gopinathan N, et al. 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. Int Orthop, 2022, 46(9): 2041-2053.
2. 李傳峰, 郭敬喜, 梁磊, 等. 肱骨外側截骨外固定支架與鋼板治療兒童肘內翻的對比研究. 中華手外科雜志, 2022, 38(3): 238-240.
3. 陳榆林, 謝亞娟, 潘志見, 等. 改良外側楔形截骨術治療肘內翻畸形. 廣東醫學, 2023, 44(4): 467-472.
4. 朱立寧, 夏天, 周敏, 等. 等分線法肱骨髁上截骨治療兒童肘內翻畸形的臨床研究. 臨床小兒外科雜志, 2023, 22(5): 460-464.
5. 吳建群, 陶銳, 魏寬海, 等. 影像存儲傳輸系統在青少年肘內翻畸形肱骨外側楔形截骨矯形術中的應用. 中國修復重建外科雜志, 2021, 35(7): 836-840.
6. Wong HK, Lee EH, Balasubramaniam P. The lateral condylar prominence. A complication of supracondylar osteotomy for cubitus varus. J Bone Joint Surg (Br), 1990, 72(5): 859-861.
7. Oppenheim WL, Clader TJ, Smith C, et al. Supracondylar humeral osteotomy for traumatic childhood cubitus varus deformity. Clin Orthop Relat Res, 1984(188): 34-39.
8. 趙國強, 趙旭飛, 馮婷婷. 肱骨遠端截骨Ilizarov矯形與單純楔形截骨克氏針固定矯治術治療兒童肘內翻的對比研究. 臨床小兒外科雜志, 2019, 18(8): 675-680, 685.
9. Klahs KJ, Polmear MM, Transtrum B, et al. Correction of cubitus varus using computer-assisted hexapod multiplanar external fixators: A report of 3 cases. JBJS Case Connect, 2023, 13(1).
10. Li J, Wang J, Rai S, et al. 3D-printed model and osteotomy template technique compared with conventional closing-wedge osteotomy in cubitus varus deformity. Sci Rep, 2022, 12(1): 6762.
11. Agrawal R, Agrawal RA, Kaul R, et al. Post-traumatic cubitus varus: long-term follow-up of corrective osteotomy using the Ilizarov method of compression distraction osteogenesis. J Pediatr Orthop B, 2022, 31(1): 31-42.
12. Slongo T. Treatment of posttraumatic cubitus varus in children and adolescents. Supracondylar humeral osteotomy using radial external fixation. Oper Orthop Traumatol, 2015, 27(3): 194-209.
13. Tang X, Wang J, Slongo T, et al. Comparison of internal fixation vs external fixation after corrective osteotomy in children with cubitus varus. J Shoulder Elbow Surg, 2020, 29(4): 845-852.
14. Shi Q, Yan H, Yang M, et al. Comparative evaluation of pinning and cast fixation vs external fixation after lateral closing-wedge osteotomy for cubitus varus in children. J Shoulder Elbow Surg, 2022, 31(3): 481-487.
15. Masquijo J, Artigas C, Hernández Bueno JC, et al. Surgical correction of cubitus varus in children with a lateral closing-wedge osteotomy: a comparison between two different techniques. J Pediatr Orthop B, 2024, 33(2): 167-173.
16. Raney EM, Thielen Z, Gregory S, et al. Complications of supracondylar osteotomies for cubitus varus. J Pediatr Orthop, 2012, 32(3): 232-240.
17. Stoffel C, de Lima E, Salles MJ. Hydroxyapatite-coated compared with stainless steel external fixation pins did not show impact in the rate of pin track infection: a multicenter prospective study. Int Orthop, 2023, 47(5): 1163-1169.
18. Pankaj A, Dua A, Malhotra R, et al. Dome osteotomy for posttraumatic cubitus varus: a surgical technique to avoid lateral condylar prominence. J Pediatr Orthop, 2006, 26(1): 61-66.
19. Persiani P, Noia G, de Cristo C, et al. Lateral wedge osteotomy for pediatric post-traumatic cubitus varus: Kirschner-wires or locking angular plate? J Pediatr Orthop B, 2017, 26(5): 405-411.
20. 譚為, 朱嘉文, 孫永建, 等. 兒童肘內翻髁上截骨矯正外固定與內固定比較. 中國矯形外科雜志, 2021, 29(22): 2017-2021.

Chinese Journal of Reparative and Reconstructive Surgery

Comparative study of external fixator combined with Kirschner wire fixation and Kirschner wires fixation in treatment of cubitus varus deformity in children

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