Cubitus varus is the most frequent complication following the treatment of supracondylar humeral fractures in children. We investigated data from publications reporting on the surgical management of cubitus varus found in electronic searches of Ovid/MEDLINE and Cochrane Library databases. In 894 children from 40 included studies, the mean age at initial injury was 5.7 years (3 to 8.6) and 9.8 years (4 to 15.7) at the time of secondary correction. The four osteotomy techniques were classified as lateral closing wedge, dome, complex (multiplanar) and distraction osteogenesis. A mean angular correction of 27.6º (18.5° to 37.0°) was achieved across all classes of osteotomy. The meta-analytical summary estimate for overall rate of good to excellent results was 87.8% (95% CI 84.4 to 91.2). No technique was shown to significantly affect the surgical outcome, and the risk of complications across all osteotomy classes was 14.5% (95% CI 10.6 to 18.5). Nerve palsies occurred in 2.53% of cases (95% CI 1.4 to 3.6), although 78.4% were transient. No one technique was found to be statistically safer or more effective than any other.
Cite this article: Bone Joint J 2014;96-B:691–700.
- Cubitus varus; Supracondylar osteotomy; Elbow deformity; Systematic review; Surgical outcomes
We thank J. Feeken, J. Neville and M. Whittenbeer for their exceptional support in the production of this study.
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
This article was primary edited by D. Rowley and first proof edited by G. Scott.
Supplementary material. A table summarising baseline characteristics, an example of a data-extraction form and further information is available alongside the electronic version of this article on our website www.bjj.boneandjoint.org.uk
- Received May 2, 2013.
- Accepted January 29, 2014.
- ©2014 The British Editorial Society of Bone & Joint Surgery