Journal of Clinical and Diagnostic Research. 2023 Jul, Vol-17(7): RC01-RC04 1 1 DOI: 10.7860/JCDR/2023/63239.18112 Original Article Orthopaedics Section Functional Outcome Analysis of Cubitus Varus Deformity Treatment in Children undergoing Modified French Osteotomy with Technical Modification: A Retrospective Cohort Study INTRODUCTION Cubitus varus is the most common delayed malunion of supracondylar humerus fractures in children in developing countries [1,2]. The cubitus varus is a three-dimensional deformity with coronal, sagittal, and rotational components [3]. The most accepted treatment for varus malunion is corrective osteotomy using various techniques. The lateral closing wedge osteotomy by modified French technique, where a figure of eight wiring with two 3.5 mm cortical screws has been used, is a standard fixation technique [4]. Lateral closing wedge corrective osteotomy corrects coronal plane deformity (varus) and some sagittal plane deformity (extension) by taking more anterior wedge. Distal anterior and proximal posterior screw placement at osteotomies corrects the rotational deformity. The drastically reduced contact area between the osteotomy site and the SS wire during the final tightening always results in either angulation or loss of correction [5,6]. This loss of reduction intraoperatively or postoperatively has not been considered in recent literature. The novelty of present study was to concentrate on the prevention of intraopertive angulation and more stable postoperative fixation. The patients who had undergone two surgical technical modifications with additional K-wires in a conventional modified French lateral closing wedge were analysed. First, four wires were used for precise osteotomy, followed by guided compression over the additional K-wire at osteotomy. However, it has not been patented. This study aimed to retrospectively analyse the functional outcome of cubitus varus deformity treatment with the technical modification done in Modified French Osteotomy by additional K-wires. MATERIALS AND METHODS The present study was a retrospective cohort study conducted at the Department of Orthopaedics, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, a tertiary care 1,100 bedded multispecialty teaching hospital. The study period was from April 2019 to April 2022. The Institute’s Ethics Committee (IEC) approved the study (IEC No.-66/22). Inclusion criteria: All cubitus varus deformity patients; Age: 3-12 years; Restricted Range Of Motion (ROM) patients were also MADHUSUDAN MISHRA 1 , SWAGAT MAHAPATRA 2 , VINEET KUMAR 3 , PANKAJ AGGARWAL 4 , SACHIN AVASTHI 5 , MOHD AMMAR ASLAM 6 , PRABHAT KUMAR 7 Keywords: Elbow deformity, Lateral closing wedge osteotomy, Paediatric ABSTRACT Introduction: Lateral closing wedge osteotomy is an accepted correction method for cubitus varus deformity. The techniques used to fix the osteotomy mostly lead to either angulation or loss of correction during the final tightening of the Stainless Steel (SS) wire at the osteotomy site. The records for patients undergoing two modifications in a conventional modified French Osteotomy were analysed. Four wires, two proximal and two distal to the osteotomy site for precision and guided compression over the other additional Kirschner wire (K-wire) at the osteotomy site, were the two modifications in these patients. Aim: To analyse the functional outcome of cubitus varus deformity in children treated with technical modifications of modified French osteotomy. Materials and Methods: This was a retrospective cohort study done at the Department of Orthopaedics, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. The study duration was three years (from April 2019 to April 2022). A total of 34 cubitus varus deformity patients were included in this study who were operated with lateral closing wedge-modified French osteotomy with technical modification by K-wires. The patients were followed-up for a minimum of six months. The results were analysed using Quick Disabilities of the Arm, Shoulder and Hand (DASH) and Flynn’s criteria. Statistical Package for the Social Sciences (SPSS) version 21.0 was used and p-value<0.05 was considered statistically significant. Results: Twenty-three (67.65%) cases were male, and 11 (32.35%) were female. Twenty-eight (82.4%) patients were children aged 5 to 10 years, 20 (58.8%) cases involved a right- sided deformity, while the remaining 14 (41.2%) had left-side involvement. The mean age was 7.58±2.49 years (ranging from 3 to 12 years). The mean time since they had initial trauma was 2.42±1.28 years. The preoperative mean cubitus varus angle was 11.73±2.39°, the mean hyperextension was 13.27±2.69°, and the mean internal rotation was 36.48±5.01°. Postoperative six months’ corrective mean carrying angle (valgus) was 5.79±2.46°, corrective hyperextension was 2.18±1.06°, and corrective internal rotation was 5.39±2.74°. Out of 34 cases, all had excellent results as analysed by Quick DASH and Flynn’s criteria. Conclusion: The technical modifications by K-wires in conventional modified French osteotomy provided guided compression over the osteotomy site, ensured perfect implant placement without cutting out the screw, and improved 3D (Dimensional) correction of cubitus varus deformity. 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