Application of picture archiving and communication systems in lateral wedge osteotomy for cubitus varus deformity in teenagers_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WU Jianqun ¹ , TAO Rui ² , WEI Kuanhai ³ , YU Bin ³ ,  LI Jianwei ³

1. Department of Bone and Joint, the First Affiliated Hospital (Shenzhen People’s Hospital), School of Medicine, Southern University of Science and Technology, Shenzhen Guangdong, 518055, P.R.China;
2. Department of Orthopedics and Traumatology, Zengcheng Branch of Nanfang Hospital, Southern Medical University, Guangzhou Guangdong, 511325, P.R.China;
3. Department of Orthopedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou Guangdong, 510515, P.R.China;

Corresponding author：

LI Jianwei, Email: ljwoven1979@163.com

Keywords：

Supracondylar fracture of humerus; cubitus varus deformity; picture archiving and communication system; lateral wedge osteotomy; teenager

DOI：

10.7507/1002-1892.202101059

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Objective To investigate effectiveness of picture archiving and communication systems (PACS) in lateral wedge osteotomy for cubitus varus deformity in teenagers.Methods A clinical data of 16 teenagers with cubitus varus deformity between July 2014 and July 2016 was retrospectively analyzed. All patients were treated with lateral wedge osteotomy and fixed with plate. Before operation, the osteotomy design (the osteotomy angle and length) was done in the PACS, including the carrying angle of healthy limb and the varus angle of affected side. There were 10 males and 6 females, with an average age of 11.4 years (range, 10-17 years). The disease duration ranged from 2 to 10 years (mean, 5.6 years). The preoperative X-ray film showed that the supracondylar fractures of the humerus had all healed, and 9 cases had internal rotation deformity; the varus angle of the affected side was 19.5°-33.5°. After operation, the fracture healing and cubitus varus deformity correction were observed by X-ray films, the elbow function was evaluated by Mayo scoring, and the elbow range of motion was detected.Results There was no significant difference between the actual intraoperative osteotomy angle and length and the preoperative design (P>0.05). The hospital stay was 2-8 days, with an average of 4.5 days. No complication such as incision infection or ulnar nerve injury occurred. All 16 cases were followed up 12-18 months, with an average of 14 months. X-ray films showed that the osteotomy healed at 2-7 months after operation, with an average of 2.5 months. The internal fixators were removed within 8-14 months after operation (mean, 12.0 months). X-ray films measurement showed that the carrying angle of the affected side recovered to (10.3±2.0)° at 1 day after operation, which was not significantly different from that of the healthy side [(10.6±1.5)°] before operation (t=0.480, P=0.637). The carrying angle of the affected side was (9.8±2.6)° at 1 year after operation, which was not significantly different from that of the healthy side [(10.4±1.6)°] at the same time point (t=0.789, P=0.438). At 1 year after operation, the ranges of flexion and extension of affected side were (131.6±8.4)° and (6.4±2.6)°, respectively; and the ranges of flexion and extension of healthy side were (134.2±6.3)° and (5.9±2.2)°, respectively. There was no significant difference between the healthy and affected sides (t=1.143, P=0.262; t=0.587, P=0.561). The elbow joint function at 1 year after operation evaluated by Mayo scoring standard rated as excellent in 9 cases, good in 6 cases, and fair in 1 case, and the excellent and good rate was 93.7%.Conclusion Before lateral wedge osteotomy, the PACS is used to design the osteotomy angle and length, which can guide the operation and make the osteotomy more accurate and simple.

Citation： WU Jianqun, TAO Rui, WEI Kuanhai, YU Bin, LI Jianwei. Application of picture archiving and communication systems in lateral wedge osteotomy for cubitus varus deformity in teenagers. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(7): 836-840. doi: 10.7507/1002-1892.202101059 Copy

1.	Kumar V, Singh A. Fracture supracondylar humerus: a review. J Clin Diagn Res, 2016, 10(12): RE01-RE06.
2.	Kumar K, Sharma VK, Sharma R, et al. Correction of cubitus varus by French or dome osteotomy: a comparative study. J Trauma, 2000, 49(4): 717-721.
3.	Ho CA. Cubitus varus-it’s more than just a crooked arm! J Pediatr Orthop, 2017, 37 Suppl 2: S37-S41.
4.	Bauer AS, Pham B, Lattanza LL. Surgical correction of cubitus varus. J Hand Surg (Am), 2016, 41(3): 447-452.
5.	Solfelt DA, Hill BW, Anderson CP, et al. Supracondylar osteotomy for the treatment of cubitus varus in children: a systematic review. J Bone Joint Surg (Br), 2014, 96(5): 691-700.
6.	王儒法, 楼跃, 唐凯, 等. 改良肱骨髁上阶梯截骨技术治疗儿童肘内翻畸形. 中华实用儿科临床杂志, 2018, 33(23): 1788-1791.
7.	余希临, 沈先涛, 于立松, 等. 儿童肘内翻截骨角度的设计与应用. 中国矫形外科杂志, 2005, 13(8): 637-638.
8.	Takeyasu Y, Oka K, Miyake J, et al. Preoperative, computer simulation-based, three-dimensional corrective osteotomy for cubitus varus deformity with use of a custom-designed surgical device. J Bone Joint Surg (Am), 2013, 95(22): e173. doi: 10.2106/JBJS.L.01622.
9.	Zhang YZ, Lu S, Chen B, et al. Application of computer-aided design osteotomy template for treatment of cubitus varus deformity in teenagers: a pilot study. J Shoulder Elbow Surg, 2011, 20(1): 51-56.
10.	Takagi T, Takayama S, Nakamura T, et al. Supracondylar osteotomy of the humerus to correct cubitus varus: do both internal rotation and extension deformities need to be corrected? J Bone Joint Surg (Am), 2010, 92(7): 1619-1626.
11.	范磊, 何斌, 刘军, 等. 微信平台结合PACS影像系统在骨科临床见习中的应用. 中国高等医学教育, 2019, (2): 85-86.
12.	王华松, 王庆伟, 黄继锋, 等. PACS系统在改良等腰三角形截骨治疗肘内翻中的辅助应用. 中国矫形外科杂志, 2017, 25(19): 1817-1819.
13.	任少君. 不同手术时机对儿童肱骨髁上骨折后肘内翻畸形矫正的影响. 临床骨科杂志, 2013, 16(2): 194-195, 199.
14.	Lee SC, Shim JS, Sul EJ, et al. Remodeling after lateral closing-wedge osteotomy in children with cubitus varus. Orthopedics, 2012, 35(6): e823-828.
15.	王庆伟, 王华松, 黄继锋, 等. 设计并应用改良肱骨髁上等腰三角形截骨矫形治疗肘内翻畸形. 中华创伤骨科杂志, 2018, 20(1): 16-21.
16.	Hu X, Zhong M, Lou Y, et al. Clinical application of individualized 3D-printed navigation template to children with cubitus varus deformity. J Orthop Surg Res, 2020, 15(1): 111. doi: 10.1186/s13018-020-01615-8.
17.	Su Y, Nan G. Lateral closing isosceles triangular osteotomy for the treatment of a post-traumatic cubitus varus deformity in children. Bone Joint J, 2016, 98-B(11): 1521-1525.
18.	Vashisht S, Sudesh P, Gopinathan NR, et al. Results of the modified reverse step-cut osteotomy in paediatric cubitus varus. Int Orthop, 2020, 44(7): 1417-1426.
19.	Takeyasu Y, Murase T, Miyake J, et al. Three-dimensional analysis of cubitus varus deformity after supracondylar fractures of the humerus. J Shoulder Elbow Surg, 2011, 20(3): 440-448.

1. Kumar V, Singh A. Fracture supracondylar humerus: a review. J Clin Diagn Res, 2016, 10(12): RE01-RE06.
2. Kumar K, Sharma VK, Sharma R, et al. Correction of cubitus varus by French or dome osteotomy: a comparative study. J Trauma, 2000, 49(4): 717-721.
3. Ho CA. Cubitus varus-it’s more than just a crooked arm! J Pediatr Orthop, 2017, 37 Suppl 2: S37-S41.
4. Bauer AS, Pham B, Lattanza LL. Surgical correction of cubitus varus. J Hand Surg (Am), 2016, 41(3): 447-452.
5. Solfelt DA, Hill BW, Anderson CP, et al. Supracondylar osteotomy for the treatment of cubitus varus in children: a systematic review. J Bone Joint Surg (Br), 2014, 96(5): 691-700.
6. 王儒法, 楼跃, 唐凯, 等. 改良肱骨髁上阶梯截骨技术治疗儿童肘内翻畸形. 中华实用儿科临床杂志, 2018, 33(23): 1788-1791.
7. 余希临, 沈先涛, 于立松, 等. 儿童肘内翻截骨角度的设计与应用. 中国矫形外科杂志, 2005, 13(8): 637-638.
8. Takeyasu Y, Oka K, Miyake J, et al. Preoperative, computer simulation-based, three-dimensional corrective osteotomy for cubitus varus deformity with use of a custom-designed surgical device. J Bone Joint Surg (Am), 2013, 95(22): e173. doi: 10.2106/JBJS.L.01622.
9. Zhang YZ, Lu S, Chen B, et al. Application of computer-aided design osteotomy template for treatment of cubitus varus deformity in teenagers: a pilot study. J Shoulder Elbow Surg, 2011, 20(1): 51-56.
10. Takagi T, Takayama S, Nakamura T, et al. Supracondylar osteotomy of the humerus to correct cubitus varus: do both internal rotation and extension deformities need to be corrected? J Bone Joint Surg (Am), 2010, 92(7): 1619-1626.
11. 范磊, 何斌, 刘军, 等. 微信平台结合PACS影像系统在骨科临床见习中的应用. 中国高等医学教育, 2019, (2): 85-86.
12. 王华松, 王庆伟, 黄继锋, 等. PACS系统在改良等腰三角形截骨治疗肘内翻中的辅助应用. 中国矫形外科杂志, 2017, 25(19): 1817-1819.
13. 任少君. 不同手术时机对儿童肱骨髁上骨折后肘内翻畸形矫正的影响. 临床骨科杂志, 2013, 16(2): 194-195, 199.
14. Lee SC, Shim JS, Sul EJ, et al. Remodeling after lateral closing-wedge osteotomy in children with cubitus varus. Orthopedics, 2012, 35(6): e823-828.
15. 王庆伟, 王华松, 黄继锋, 等. 设计并应用改良肱骨髁上等腰三角形截骨矫形治疗肘内翻畸形. 中华创伤骨科杂志, 2018, 20(1): 16-21.
16. Hu X, Zhong M, Lou Y, et al. Clinical application of individualized 3D-printed navigation template to children with cubitus varus deformity. J Orthop Surg Res, 2020, 15(1): 111. doi: 10.1186/s13018-020-01615-8.
17. Su Y, Nan G. Lateral closing isosceles triangular osteotomy for the treatment of a post-traumatic cubitus varus deformity in children. Bone Joint J, 2016, 98-B(11): 1521-1525.
18. Vashisht S, Sudesh P, Gopinathan NR, et al. Results of the modified reverse step-cut osteotomy in paediatric cubitus varus. Int Orthop, 2020, 44(7): 1417-1426.
19. Takeyasu Y, Murase T, Miyake J, et al. Three-dimensional analysis of cubitus varus deformity after supracondylar fractures of the humerus. J Shoulder Elbow Surg, 2011, 20(3): 440-448.

Chinese Journal of Reparative and Reconstructive Surgery

Application of picture archiving and communication systems in lateral wedge osteotomy for cubitus varus deformity in teenagers

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