Corrective dome osteotomy using the paratricipital (triceps-sparing) approach for cubitus varus deformity in children.

BACKGROUND: Dome osteotomy has been described extensively in literature to correct posttraumatic cubitus varus deformity in children. Most case series on dome osteotomy using the posterior triceps-splitting approach report a decreased postoperative range of motion (ROM). We prospectively analyzed the results of dome osteotomy using the soft-tissue preserving paratricipital, (triceps-sparing) approach with respect to correction of deformity and preservation of elbow ROM. METHODS: During 2006 to 2009, 24 children with cubitus varus deformity after supracondylar humerus fracture were treated with a dome osteotomy using the triceps-sparing approach. The follow-up period varied between 22 and 36 months (average, 27.6 mo). The average interval between injury to surgery was 26.7 months. The average age of the patients was 9.2 years. RESULTS: The average preoperative carrying angle (humerus-elbow-wrist angle, HEW) was -17.1 degrees (range, -8 to -30 degrees), whereas the average postoperative carrying (humerus-elbow-wrist) angle was +11.7 degrees (range, -12 to +16 degrees) with a mean correction of 28.8 degrees. The average preoperative ROM in the flexion/extension arc was 126.8 degrees and the average postoperative ROM was 132.1 degrees (range, 110 to 140 degrees). The lateral condylar prominence index changed from an average of -9.5% preoperatively to an average of -15.2% postoperatively. Excellent results were seen in 14 patients, whereas 9 had a good outcome. CONCLUSIONS: Supracondylar humeral dome osteotomy using the paratricipital approach for cubitus varus deformity allows correction of deformity, prevents lateral condylar prominence and avoids loss of elbow motion. LEVEL OF EVIDENCE: IV.

Composite treatment for primary long-bone hydatidosis.

Hydatid disease is a parasitic tapeworm infection caused by the Echinococcus species. Involvement of the long tubular bones is rare in hydatid bone disease. Patients are initially asymptomatic and usually present at a later stage of the disease when the bony lesions are extensive. Diagnosing bone hydatid disease is challenging, even in endemic regions, and a high index of suspicion is required because the radiologic findings often mimic other bone pathologies. Recurrence following treatment can occur after a long period of quiescence.This article describes a case of hydatid disease in a 62-year-old woman with extensive diaphyseal tibial involvement. She was treated with initial chemotherapy followed by extended curettage, polymethylmethacrylate cementation, and intramedullary fixation. Functional outcome was excellent, with no recurrence at 60-month follow-up. She was fully weight bearing with no pain or discomfort and had full hip, knee, and ankle range of motion.This case was important due to its rarity, the diagnostic challenge it presented, and the composite nature of the treatment used to avoid recurrence. Diaphyseal bone hydatidosis can be initially treated like a low-grade malignant tumor with curettage and high-speed burring, followed by filling the defect with polymethylmethacrylate cement. The composite treatment of chemotherapy with the surgical protocol described offers a reasonable chance of long-term disease suppression. Recurrent disease can be treated with repeat curettage and cementation. Wide excision with reconstruction of the resulting defect should only be considered for recalcitrant diaphyseal hydatid disease.