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Evaluating Outcomes of Step-Cut Osteotomy for Pediatric Cubitus Deformities.

J Orthop Case Rep

January 2025

Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.

Introduction: Supracondylar fractures in children often result in malunion and subsequent cubitus varus or valgus deformity. While often considered cosmetic, these deformities can lead to pain, functional impairment, and other complications. Corrective osteotomy is a common treatment option, with step-cut osteotomy being a preferred method due to its effectiveness and relative simplicity.

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Purpose Of Review: This review aims to provide a comprehensive analysis of the nonoperative management of Gartland Type II fractures in pediatric patients.

Recent Findings: Supracondylar humeral fractures (SCF) are one of the most common traumatic fractures in pediatric populations, characterized as transverse fractures at the distal humerus between the medial and lateral columns. Early studies strongly opposed closed reduction and casting as an acceptable treatment modality for Gartland type II fractures as an early case series showed high rates of complications; however, more recent studies have suggested better outcomes.

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The plantaris muscle is spindle-shaped in the posterior compartment of the leg. It is distinguished for its small muscle belly and an exceptionally long tendon. It presents with great variability in its origin and insertion when present.

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The standard treatment for displaced pediatric supracondylar fracture of humer us (PSCFH) is closed reduction and percutaneous pinning under image intensifier guidance. This technical note describes Kapandji intrafocal pinning technique (KIPT) for achieving optimal fracture reduction and stable fixation in Gartland Type III or IV extension type PSCFH. In KIPT, a K wire was introduced into the fracture site from the posterior aspect, fracture manipulation was done by levering with wire reducing the posterior displacement of the distal fragment and the wire was fixed to the anterior cortex of the proximal fragment.

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Background: Pediatric supracondylar humeral fractures present considerable surgical challenges due to the difficulty of achieving proper fracture alignment and stable fixation while avoiding injury to the ulnar nerve. This study assesses the biomechanical performance of a novel Kirschner wire (K-wire) fixation device (KFD), designed to enhance stability and reduce complications linked to traditional K-wire configurations.

Methods: Using finite element analysis (FEA), we evaluated four fixation strategies for treatment of pediatric supracondylar humeral simple transverse fractures: crossed pin fixation, crossed pin fixation with KFD, two lateral pin fixation, and two lateral pin fixation with KFD, under various mechanical loads.

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