Abstract
BACKGROUND: Cubitus varus, a common complication of pediatric supracondylar humerus fractures, presents with internal rotation, extension, and varus angulation. While primarily considered a cosmetic concern, it can lead to significant complications, including chronic pain, ulnar nerve palsy, and posterolateral elbow instability. This study evaluates the effectiveness of supracondylar dome osteotomy in decreasing lateral condylar prominence and improving functional outcomes in patients with cubitus varus. METHODS: This retrospective cohort study analyzed 65 patients under 18 who underwent dome-shaped corrective osteotomy between 2017 and 2022 at the Hospital and Rehabilitation Center for Disabled Children, Nepal. Inclusion criteria comprised patients with cubitus varus deformity greater than 10 degrees and at least six months post-trauma. Outcomes were assessed using the Mayo Elbow Performance Score (MEPS), Lateral Condylar Prominence Index (LPI), and radiological measurements of carrying angle (CA). RESULTS: The mean age at surgery was 11.77 years (± 3.76), with an average time since injury of 54.15 months (± 31.76). Post-operatively, the radiological carrying angle improved from 23.90° (± 8.84) varus to 5.14° (± 7.64) valgus. The LPI changed from 0.58 (± 16.68) preoperatively to -3.18 (± 16.39) post-operatively. MEPS improved from 89.54 (± 6.66) to 95.23 (± 5.26). Significant improvements in LPI were observed in patients older than 12 years (p = 0.00) and patients with radiological CA less than 20° (p = 0.02) and with a clinical CA less than 20°(p = 0.04). CONCLUSIONS: Supracondylar dome osteotomy effectively reduces lateral condylar prominence in cubitus varus, particularly in post-pubertal patients and cases with radiological carrying angles less than 20 degrees. The procedure demonstrates good functional outcomes with acceptable complication rates, making it a viable surgical option for treating cubitus varus deformity.