The effect of rotational deformity on patellofemoral parameters following the treatment of femoral shaft fracture.

OBJECTIVE: The purpose of this study was to investigate the effect of rotational deformities on patellofemoral alignment using the dynamic magnetic resonance imaging method on patients whose femur fractures were treated with intramedullary locking nails. METHODS: The dynamic patellofemoral magnetic resonance imaging results of 33 patients (5 females and 28 males) were reviewed. The mean age of the patients was 36.3 (range 19-61) years. The mean follow-up was 30.2 months (range 24-38). All the patients were given Kujala patellofemoral clinical evaluation scores at the latest follow-up. Those with less than 10° of rotational deformity in either direction were classified as Group A, those with more than a 10° of internal rotation deformity as Group B and more than a 10° of external rotation deformity as Group C. The three groups were then compared regarding to clinical scores. Patellofemoral parameters of operated and contralateral side were also compared in each group. RESULTS: There were 14 (42.4 %) patients in Group A, 12 (36.4 %) patients in Group B and 7 (21.2 %) patients in Group C. The mean patella score in Group C (74 ± 7.02) was significantly lower when compared with Group B (87.6 ± 9.9) and group A (90.6 ± 6.1) (p < 0.05). In Group C patients, medial patellar tilt was detected when compared with the intact side. There were no significant changes in patellofemoral position in either Group A or Group B. CONCLUSION: The results of this study revealed that more than 10° of external rotation deformity could cause a detoriation in the patellofemoral scores. Anatomic reduction of the fracture site should be performed as soon as possible and external rotational deformities should especially be avoided in order to prevent patellofemoral malalignment.

Short-term clinical and radiologic results of the scarf osteotomy: what factors contribute to recurrence?

The present retrospective investigation aimed to determine the factors associated with recurrence of hallux valgus deformity after scarf osteotomy in 50 feet in 43 consecutive patients. We hypothesized that hallux abductovalgus after scarf osteotomy recurs because of the presence of preoperative joint incongruity. The clinical and radiographic findings, including the weightbearing radiographic hallux valgus angle, first intermetatarsal angle, distal metatarsal articular angle, first metatarsophalangeal joint congruence, American Orthopaedic Foot and Ankle Society scores, and pain measured on a visual analog scale, and logistic regression analysis were used to analyze the association of the independent variables with the recurrence of deformity. The mean age of the patients was 47.7 (range 21 to 65) years, and the mean follow-up duration was 26.2 (range 18 to 36) months. The mean American Orthopaedic Foot and Ankle Society scores improved from 50.7 ± 4.9 to 88.7 ± 7.9, and the visual analog scale pain scores improved from 7.5 ± 1.1 to 2.4 ± 1.0 (p < .05). The changes in the radiographic measurements were also statistically significant. Of the 50 feet, 5 (10%) developed recurrent hallux abductovalgus, each of which occurred in feet that had displayed a first metatarsophalangeal joint incongruity on preoperative radiographs. The incongruity was observed to be a statistically significant risk factor for recurrence according to the regression models. From our experience with the patients analyzed in the present report, we believe that first metatarsophalangeal joint congruity should be given particular attention when surgical correction of hallux abductovalgus is undertaken.

Factors affecting the closed reduction of diaphyseal fractures of the femur.

INTRODUCTION: This level II prospective study investigates patient and fracture-related factors likely to affect closed reduction time in the surgical treatment of femur fractures, and the effect these factors have on closed reduction time. PATIENTS AND METHODS: Seventy-nine diaphyseal femur fractures of 75 patients were included in the present study. All fractures were treated with indirect closed reduction by manual traction using antegrade nailing and static, locked, reamed intramedullary nails. The three variables considered to influence the duration of closed reduction, that is, the type of fracture, BMI, and the preoperative period (time from injury to surgery), were evaluated either separately or in a combination of two or three of the variables. Their influence on the closed reduction time was analyzed and evaluated. RESULTS: In this study according to the outcomes, a preoperative period ≤24 h had a significant effect in shortening the reduction time. The reduction time was not significantly affected by the type of fracture. The reduction time was prolonged in overweight patients, but the difference was not significant. When the three variables BMI, preoperative period, and fracture types were evaluated together, the common effect of these three variables was not significant. CONCLUSION: In conclusion, based on these results, we think that closed reduction should certainly be aimed for in femur fractures in which intramedullary nailing is planned. Also, early surgical intervention appears to have a beneficial effect on the success of closed reduction.

Unexpected injury of the orthopaedic surgeon: a case report of a hammer splinter.

Sharps injuries have become one of the most important occupational injuries and they are common during surgery, with rates between 1.7 and 6.9% of all surgical procedures. This case report, however, revealed an extremely rare and unexpected condition, which could not be prevented by the reasonable safety precautions against injury. Closed reduction and closed intramedullary fixation was planned for the patient with humeral shaft fracture. While advancing the nail by hammering a piece of metal detached. A short time following the commencement of the procedure, the surgeon who was performing the operation felt a sudden severe pain in the neck. A radio-opaque intensity in the cervical region was detected on X-rays. There was a piece of metal from the hammer. The risk encountered in the present case comprises a condition, the prevention of which is probably impossible with the frequently utilized preventive measures against injuries. For this reason, the operating room team and in particular, the surgeon, should be careful about possible expected injuries, as well as the unexpected ones. Sharps injuries continue to be a serious concern for all healthcare workers. In some studies however, reporting of sharps injuries by healthcare workers remains a problem with reporting levels cited as low as 15% and as high as 90% (Kerr H-L, Stewart N Ann R Coll Surg Engl 91:430-432, [6]). Guo et al. pointed out the most recent sharps injuries at work, and syringe needles was by far the most important items causing injuries, followed by glass products, suture needles, and intravenous catheters.

Rate of conversion of reports presented at the Turkish Society of Sports Traumatology, Arthroscopy and Knee Surgery Congress into publication.

OBJECTIVE: The aim of this study was to evaluate the conversion rate of oral and poster presentations into publications presented at four consecutive congresses held by the Turkish Society of Sports Injuries and Arthroscopy between 2008 and 2014 and to determine the publication pattern. METHODS: The manuscripts published in peer-reviewed journals were identified using the Web of Knowledge, PubMed, Google Scholar databases, ULAKBIM, and Endnote citation management software (X7.7.1). The identified manuscripts were classified according to the level of evidence, number of citations, subject, publication journals, time period until publication, and citation index of the journal. RESULTS: Between 2008 and 2014, a total of 561 presentations were made, comprising 278 posters and 283 oral presentations. Of these presentations, 164 (29.2%) were published as a manuscript. Of the published articles, 114 were originated from oral presentations (40.2% of total) and 50 from poster presentations (18% of total). A significantly higher number of oral presentations compared to poster presentations were converted into publications (p < 0.05). However, no significant difference was determined between the conversion rates of oral and poster presentations in 2014. The mean time from presentation at the congress to publication was 15.4 months (range: -144 months to +62 months). The mean impact factor of the journals at the time of publication increased for each congress. Evidence level of presented articles was significantly higher in the 2014 congress when compared to previous congresses. CONCLUSION: The rate of conversion into publication was higher for oral presentations, which can be attributed to the fact that studies with a higher level of evidence are more likely to have been presented as oral presentations. Based on these study results, authors of oral presentations at congresses should be encouraged to increase the rate of conversion into publication.

Assessment of quality of life in children after successful treatment of hip dysplasia as compared with normal controls.

OBJECTIVE: To document the quality of life of children who have been treated for developmental dysplasia of the hip (DDH) within the first 3 years of life successfully after a minimum follow-up period of 2 years, and compare their results with healthy age-matched children. METHODS: Thirty patients with DDH treated between 1998 and 2002 in Ankara Numune Education and Research Hospital, Ankara, Turkey and 19 age-matched healthy controls were included in this study with the approval of the ethical committee. The mean follow up period was 56.1 months. Each child's parents answered the Child Health Questionnaire-Parent Form 50 (CHQ-PF50) after giving informed consent. The answers were evaluated, and scores were calculated and results were analyzed. RESULTS: There were no significant differences in 14 health-related quality of life concepts, according to the CHQ instrument's outcomes, between the healthy controls and the patients with DDH who were successfully treated within the first 3 years of life. Only the physical functioning concept was found to be lower for the DDH patients (Mann Whitney U test, p=0.036). CONCLUSION: Although children who were successfully treated for DDH may have impairment in physical functioning after a certain period of follow-up, there was no significant impairment in physical and psychosocial summary scores, in comparison with their age-matched controls.

[Selection of treatment modalities in children with chronic osteomyelitis]. / Kronik osteomiyelitli çocuklarda cerrahi tedavi yöntemlerinin seçimi.

OBJECTIVES: We evaluated clinical and follow-up findings and treatment methods of pediatric patients with chronic osteomyelitis. METHODS: The study included 22 children (14 boys, 8 girls; mean age 8+/-7 years) who were treated for chronic osteomyelitis. Infection sites were the femur, tibia, ulna, and radius in 11, 8, 1, and 2 patients, respectively. Sixteen patients had a history of trauma. Fourteen patients had fractures, nine of which were associated with segmentary bone defects. All the patients underwent at least one debridement and received antibiotic treatment for at least six weeks. When necessary, medications were modified according to the antibiogram results. Cast immobilization was applied, but external fixation was used when bone instability existed. The mean follow-up period was 54 months. RESULTS: Clinical improvement was achieved in 13 patients following surgical debridement procedures, antibiotic treatment for six weeks, secondary grafting (5 patients), and cast immobilization. Of nine patients with segmentary bone losses, seven patients needed bone reconstruction procedures. Spontaneous shaft regeneration was observed in one patient with ulnar osteomyelitis. CONCLUSION: The results of surgical debridement and antibiotic treatment are satisfactory in more than half of the pediatric patients with chronic osteomyelitis. However, those developing segmentary bone defects after surgical debridement require bone reconstruction procedures.

Histopathologic effects of a low molecular weight heparin on bone healing in rats: a promising adjuvant in dacryocystorhinostomy.

AIM: To investigate the effect of short-term prophylactic dose of a low molecular weight heparin (LMWH) drug on the bone healing process in an animal model simulating the osteotomy obtained in dacryocystorhinostomy. METHODS: Forty male Wistar albino rats were divided into 2 groups. Subcutaneous injections of enoxaparin 1 mg/kg (enoxaparin-treated group) and saline solution (control group) were performed once daily for 4d, beginning on the first preoperative day. The osteotomy was created at the femoral diaphysis in all animals by using a Kirschner wire. Each group was further divided into 2 subgroups depending on the timing of the second operation, 14 or 21d following initial osteotomy. Patent osteotomy area on the second and the third weeks in each group were calculated by using a computer software on digital micrographs. RESULTS: The patent osteotomy areas at the second and the third weeks were significantly larger in the enoxaparin-treated group than those of the control group (P<0.001 for each time-period). In the control group, the patent osteotomy area at the third week of healing was significantly smaller than that of the second week (P=0.003), whereas there was no significant difference between these two measurements in the enoxaparin-treated group (P=0.185). CONCLUSION: Short-term administration of enoxaparin resultes in a significant alteration in bone healing at 14 and 21d after injury. LMWHs can be regarded as promising alternative adjuvants in dacryocystorhinostomy after being evaluated with further clinical and animal studies.

An Overlooked Deformity in Patients with Hallux Valgus Tailor's Bunion.

BACKGROUND: Tailor's bunion is a deformity of the fifth toe, and its concomitance with hallux valgus (HV) is defined as splayfoot deformity. Treatment is focused on the HV deformity in splayfoot, and the tailor's bunion deformity can be overlooked. The frequency of HV concomitant with tailor's bunion in splayfoot has not been reported in the literature. METHODS: A retrospective evaluation was performed to detect the existence of tailor's bunion deformity in 203 patients (376 feet) treated for HV. Standing anteroposterior and lateral radiographs were used in the radiologic evaluation. Fallat's classification was used to grade tailor's bunion. Surgery for HV was applied to 86 patients (136 feet), and conservative treatment was applied to 117 patients (240 feet). Mean follow-up was 28.3 months (range, 18-42 months). Clinical evaluation was by American Orthopaedic Foot and Ankle Society (AOFAS) score. RESULTS: Of the 376 feet with HV, 28 (7.4%) had tailor's bunion, of which 17 (60.7%) were overlooked according to the surgery criteria for tailor's bunion. In the HV surgery group, there were no differences in preoperative mean AOFAS scores according to concurrence with tailor's bunion, but postoperative AOFAS scores were low in patients with accompanying tailor's bunion (P < .001). In the conservative group, no differences were determined in mean AOFAS scores according to tailor's bunion. CONCLUSIONS: Tailor's bunion deformity sometimes goes undiagnosed in patients with treated HV. This deformity must be kept in mind for patients with HV to improve clinical results.

Finite element analysis of the stability of transverse acetabular fractures in standing and sitting positions by different fixation options.

BACKGROUND: Treatment of a transverse acetabular fracture type is possible from an anterior approach, a posterior approach or both. Different fixation methods have been described but whether one is superior to the other is still under debate. The aim of the current study was to test the different fixation alternatives of stabilization of transverse acetabular fractures under two basic physiological loading conditions: standing and sitting utilizing a finite element model. MATERIAL AND METHODS: A transtectal transverse fracture model was fixed in five different alternatives: an anterior column plate; a posterior column plate; an anterior column plate combined with a posterior column screw; a posterior column plate combined with an anterior column screw; and a posterior column plate and an anterior column plate. In these models, a load of 400N was applied at standing and sitting positions and the displacements were analyzed by using three-dimensional finite element stress analysis method. RESULTS: In the model simulating standing human position, overall motion at the posterior column was minimum when two columns were plated (0.071mm). The second best fixation was posterior column plate with an anterior column screw (0.077mm). Overall motion at the anterior column was minimum by posterior column plate with an anterior column screw (0.0326mm). The plating of two columns was associated with motion of (0.0333mm). In the model that simulates sitting position, the motion at the posterior column was minimum when two columns were plated (0.0478mm), and (0.0517mm) when a posterior column plate with an anterior column screw was used. Overall motion in the anterior column was minimum when posterior column plate with an anterior column screw (0.0198mm) was used, whereas the motion was (0.0203mm) when plating of both columns was examined. CONCLUSION: Posterior column plating combined with an anterior column screw has quite comparable results to a both column plating in transverse fractures, suggesting that two column fixations might be unnecessary. This method is also very superior to anterior column plating combined with a posterior column screw in that type of fractures.

An Unusual Disengagement of the Humeral Head Component after Hemiarthroplasty: A Case Report Presentation.

INTRODUCTION: Proximal humeral fractures account for 4% to 5% of all fractures. Complex proximal humeral fractures with displaced three- and four-part fragments, humeral head splits and fracture-dislocations are more difficult to treat. In older patients, because of poor bone quality, hemiarthroplasty is often the indicated treatment. CASE REPORT: One such case of a 73-year-old woman is presented here. The patient presented with a four-part fracture of the proximal humerus, with displacement of the humeral head. Hemiarthroplasty was done in the right shoulder. At postoperative 20 days, during physical therapy, the humeral head component of the prosthesis disengaged and a second operation was necessary. A deltopectoral approach was repeated using the previous incision. The humeral stem was seen to be well-fixed into the bone so the humeral head was changed for a new one of the same size. At two years, the dominant right side had active, painless ROM. CONCLUSION: The management and two-year follow-up of this case is reported here, which was the first to occur at our institution.

Avoiding iatrogenic radial nerve injury during humeral fracture surgery: a modified approach to the distal humerus.

OBJECTIVE: Our aim was to assess the results of posterior retraction technique to prevent iatrogenic radial nerve injury during humeral fracture surgery. METHODS: Seventy-two patients who underwent surgery for a distal humerus fracture between 1996 and 2002 were reviewed. These 72 patients comprised Group 1. Following a cadaveric study on the vascularization of the radial nerve, a modified surgical approach was undertaken starting in 2002. Sixty-one patients who underwent this new surgical approach were included in Group 2. The rates of radial nerve deficit of the groups were compared using the Pearson chi-square test. RESULTS: In Group 1, 19 iatrogenic nerve deficits occurred. After defining the blood circulation of the nerve, the lateral approach was modified. The anterolateral side of the nerve was released and the nerve was left attached to the triceps muscle. In Group 2, one patient developed postoperative transient nerve deficit. CONCLUSION: The radial nerve is supplied by the branches of the deep brachial artery in close relation with the triceps muscle. Anterior dissection and posterior retraction of the radial nerve during lateral approach may preserve its blood supply and reduces the risk of iatrogenic injury.

Short or long fusion after thoracolumbar burst fractures does not alter selected gait parameters: a preliminary study.

We evaluated the gait characteristics of patients who had short or long-segment fusion after thoracolumbar burst fractures. The study included 12 patients (5 male, 7 female) who had vertebral fusion after traumatic thoracolumbar region (T12-L2) burst fractures. Patients were divided into two groups based on fixation type (short or long segment). Twelve healthy age and sex-matched subjects (seven male, five female) served as controls. Quantitative gait data, including all time-distance (walking velocity, cadence, step time, step length, double support time), kinematic (joint rotation angles of pelvis, hip, knee, and ankle), and kinetic data (moments of hip in sagittal and coronal plane) were collected. Three patients had a T12, six patients an L1, and three patients had an L2 lesion. Patients in the two groups were similar in terms of age, sex, and time since operation. No significant differences were found in the time-distance, kinematic, and kinetic gait characteristics between the two groups. This preliminary study reveals that the gait characteristics of patients with short and long-segment fusion after thoracolumbar burst fractures were similar to those of healthy subjects and did not differ from each other. However, the present results should be interpreted with caution due to the small sample size. Future studies with larger groups are needed to provide additional data to validate these findings.

Performance of modified anatomic plates is comparable to proximal femoral nail, dynamic hip screw and anatomic plates: finite element and biomechanical testing.

AIM: To establish whether the modified anatomic plate (MAP) performs as well as the anatomic plate (AP), dynamic hip screw (DHS) and proximal femoral nail (PFN) from a biomechanical perspective. MATERIALS AND METHODS: The, AP, MAP, DHS and PFN were assessed using finite element (FE) methods and biomechanical tests. A solid model was created based on the fracture lines and results were assessed using analyses of variance. MAIN OUTCOME MEASUREMENTS: Independent variables were the implants (n=4) and axial loads: 0-1000 Newton (N) in 100 N increments. Dependent variables were loads at the intertrochanteric fracture line as measured by load cells. RESULTS: Axial loads ≤400 N generated significantly (p<0.05) greater stress at the fracture line in both the FE model and biomechanical settings: the PFN generated the highest forces at the fracture line followed by the AP, MAP and DHS. For axial loads ≥400 N, the AP and DHS generated nonsignificant (p>0.5) lower forces (almost 50% less) compared with the MAP and PFN. At 1000 N, the DHS generated the highest (p<0.05) load at the fracture line. CONCLUSION: The biomechanical features of the MAP were similar to those of the PFN. The MAP generated optimal loads at both the fracture site and the proximal femur. FE methods and biomechanical tests revealed that the MAP is associated with both intra- and extra-medullary fixation features, even though the load was applied as an extramedullary stimulus.

Gait symmetry in patients with unilateral partial hip arthroplasty.

OBJECTIVES: In this study gait deviations symmetry and asymmetry in patients with unilateral partial hip arthroplasty was determined. PATIENTS AND METHODS: Gait characteristics and time since operation (11.9+/-6.1; range 7 to 29 months) of 16 patients (9 females, 7 males; mean age 61.5+/-16.5 years; range 27 to 86 years) with unilateral partial hip arthroplasty were evaluated. Ten healthy volunteers (3 females, 7 males; mean age 54.1+/-11.9 years; range 35 to 65 years) were included in the study as control group. Quantitative gait data was collected with the Vicon 370 System (Oxford Metrics, Oxford, UK). Spatio-temporal (walking velocity, cadence, step time, step length, double support time) and kinematic (joint rotation angles of pelvis and hip in sagittal plane) data were processed by using Vicon Clinical Manager software package. Spatio-temporal and kinematic gait symmetry indices of both groups were calculated. RESULTS: Spatio-temporal and kinematic gait characteristics, but not the symmetry indices, of patients with unilateral partial hip arthroplasty were different from the control group (p>0.05). CONCLUSION: Findings of this study reveal that patients with unilateral partial hip arthroplasty had various gait deviations compared to healthy subjects, but that symmetry was preserved.

Timing of surgical treatment for type III supracondylar humerus fractures in pediatric patients.

BACKGROUND: Type III supracondylar humeral fracture is a common cause of emergency hospitalization among children requiring surgical treatment. The configuration of the internal fixation material, surgical technique, and optimal timing of surgery (TS) have always been popular topics of debate. The TS in uncomplicated cases is usually determined by surgeons. METHODS: In this study, we prospectively followed children with type III supracondylar fractures. We aimed to clarify the effects of injury side, gender, and post-injury delay on switching to open surgery and the ease of the reduction. RESULTS: Based on our results, the probability of switching to open surgery increased by a factor of 4 every 5 h beginning 15 h after injury. Open surgery was necessary after 32 h. CONCLUSION: Reduction became technically more difficult as TS increased.

The effect of prophylactic dose of a low molecular weight heparin on skin wound healing of rats.

PURPOSE: To investigate the effect of prophylactic dose of a low molecular weight heparin, enoxaparin, on skin wound healing of rats. METHODS: Forty rats were used for the study. Rats were randomly assigned to two equal groups. Experimental group received prophylactic dose of enoxaparin. Physiologic saline was administered to the control group. Parameters of wound healing of experimental and control groups were compared. For comparison of the groups in terms of fibrosis, vascularization, inflammation, epithelization, and tensile strength test (Newton). Mann-Whitney-U test was used because variables were categorical data (fibrosis, vascularization, inflammation and epithelization). Differences between groups were analyzed with independent samples t-test (tensile strength). Significance was set at p<0.05. RESULTS: Skin wound of the experimental group presented tensile strength significantly decreased (p<0.001), histopathologic examination revealed a significant (p<0.001) delayed epithelization and decreased in fibrosis, vascularization, inflammation (p<0.001) in the experimental group. CONCLUSION: Enoxaparin delay wound healing by decreased inflammatory cells, fibroblast contents and their products (growth factors), and by promoted hemorrhage.

Blood loss evaluation in children under the age of 11 with femoral shaft fractures patients with isolated versus multiple injuries.

BACKGROUND: Blood loss from non-cavitary hemorrhages is a significant source of hypovolemic shock in trauma patients. It has been reported that pediatric femoral fractures do not cause excess blood loss if there is no additional injury or trauma. The purpose of this study was to define the magnitude of blood loss resulting from pediatric femoral fractures and the factors influencing the loss. METHODS: Twenty children under the age of 11 with femoral shaft fractures were included in this study. The patients' data were collected prospectively for 2 years. Hemoglobin concentrations, hematocrit levels, emergency room records, and clinical findings were evaluated and additional injuries were considered. RESULTS AND CONCLUSION: The patients with additional trauma showed significant decreases in both hemoglobin concentrations and hematocrit levels, comparison with the patients who had only isolated femoral fractures. If there is an obvious decrease in hematocrit and/or hemoglobin concentration in a child with a femoral fracture, the possibility of additional injuries should be investigated.

Which one is at risk in intraoperative fluoroscopy? Assistant surgeon or orthopaedic surgeon?

BACKGROUND: Orthopaedic surgeons use intraoperative portable fluoroscopy and roentgenography. The present study was an attempt to find out if there is a difference between the occupational radiation exposure to the orthopaedic surgeon and assistant surgeon in the operating room while using intraoperative fluoroscopy or radiographic control and to measure it. METHODS: During a 3-month period, 107 consecutive operations were monitored for radiation exposure. At monthly intervals, the radiation doses were measured in millirem and recorded. The distance of the orthopaedic surgeon and the assistant surgeon from the X-ray source were noted in every fluoroscopic check. The orthopaedic surgeon was always at a safe distance (more than 90 cm), but the assistant surgeon always stood nearby (10 cm) the X-ray source for positioning of the patient. RESULTS: The radiation exposure according to the badge on the shoulder was consecutively 3, 4, 3 mrem for the orthopaedic surgeon and 20, 19, 22 mrem for the assistant surgeon. The radiation exposure according to the badges on the anaesthetic machine, in the room and under the apron of the orthopaedic surgeon were all zero, whereas the readings of the badge under the apron of the assistant surgeon were 7, 6, 5 mrem consecutively. CONCLUSION: Our findings show that although the radiation exposure during orthopaedic operations is below the recommendations of the European Committee on Radiation Protection, there is a higher risk of exposure for the assistant surgeon. It has to be kept in mind that there could be morphological and functional damage in cells exposed to radiation. Therefore, we should continue to use appropriate shielding precautions in view of the unknown long-term risks.

Posterior instability of the shoulder after supracondylar fractures recovered with cubitus varus deformity.

Cubitus varus is a common complication after supracondylar fractures of the humerus, and there have been several discussions about the timing of correction of deformity. Although surgery is performed mainly for cosmetic purposes, the authors in this article show the relationship between cubitus varus and dislocation of the ulnar nerve and posterior instability of the ipsilateral shoulder with a Bankart lesion in three children. A special type of osteotomy to obtain three-dimensional correction was made. All shoulders were found to be clinically stable at follow-up with full pain-free range of motion. Corrective osteotomy of the distal humerus itself corrected the varus angulation and dislocation of the medial portion of the triceps in two patients and prevented the ulnar nerve from dislocating. The authors' experience illustrates the importance of biomechanics in understanding the pathoanatomy of cubitus varus; this deformity should not be regarded as a cosmetic deformity and should be treated early.