Results of supracondylar osteotomy and bone fixation with the Ilizarov apparatus for cubitus varus and valgus deformities

Introduction Cubitus varus denotes the inward deviation of the supinated forearm on the extended elbow. In cubitus valgus, the forearm is angled away from the body with the arm fully extended. Both deformities manifest clinically as an abnormal carrying angle, along with a cosmetically unsightly appearance, with or without restricted range of motion (ROM).
The aim of the study is to evaluate the results of one-stage supracondylar corrective osteotomy and bone fixation using the Ilizarov apparatus in varus and valgus deformities of the elbow joint, using the angulation‑translation principle (osteotomy rule 2); to determine the effect of this method on the humerus-elbow-wrist angle (HEW), ODD and lateral prominence index (LPI).
Materials and Methods A total of 12 patients, age ranging from 7–24 years, who presented with cubitus varus of ≥ 10° (n = 9) and cubitus valgus (n = 3) of ≥ 20°, were included in the study. All patients underwent acute correction using a mini-incision, supracondylar osteotomy and fixation with the Ilizarov frame.
Results The mean time to union was 14.2 weeks (range, 11–18 weeks). The average duration of follow-up was 24 months. Functional outcome was graded as excellent in 9 cases (75 %), good in 2 (17 %) cases and poor in 1 case (8 %) using the grading system of Oppenheim. For cubitus varus, the mean HEW angle improved significantly, from (–15.5 ± 4.2) pre-operatively to (8.2 ± 1.5) post-operatively. For cubitus valgus, the mean HEW angle was (28.3 ± 5.3) pre-operatively, which improved to (14.1 ± 3.1) post-operatively, which was statistically significant. Complications encountered included superficial pin-tract infection in 1 case, lateral condylar prominence in 1 case and complete radial nerve palsy in 1 case.
Discussion Conventional methods of treatment of cubitus varus or valgus include various corrective osteotomies, typically stabilized with internal fixation. Despite being successful, a substantial number of distressing complications have been reported with the use of internal fixation. The mandatory requirement of post-operative immobilization, resulting in stiffness and disuse atrophy, is a deterrent to the use of internal hardware, which can be easily circumvented by the versatility of the Ilizarov apparatus.
Conclusion External fixation with the Ilizarov apparatus is a versatile means of correction of cubitus varus and valgus. It precisely achieves the desired carrying angle and cosmetic appearance of the elbow. It facilitates residual adjustments in under/over-corrected scenarios. The stability is indisputable. Early joint mobilization leads to an improved functional outcome.

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