Preferred treatment for Cubitus varus is
Cubitus valgus -medial closing wedge osteotomy, lateral opening wedge osteotomy * Milch devised two osteotomies * Milch type I fractures (Salter-Harris type IV) -- Little lateral displacement when the nonunion is seen relatively early. -- Cubitus valgus usually is not as marked. -- Types * Closing wedge medial osteotomy (Speed) * Opening wedge lateral osteotomy (Milch) -- Combine the osteotomy with an autogenous bone graft and smooth pin fixation to the epiphysis. Cubitus varus -lateral closing wedge osteotomy, medial opening wedge osteotomy Lateral closing wedge osteotmy * Easiest, the safest, and the most stable osteotomy. * Lateral closing wedge osteotomy with a medial hinge will correct the varus deformity, with some minor correction of hyperextension * Types -- Lateral closing wedge osteotomy (Voss et al) -- French osteotomy -- Modified french osteotomy * Different methods of fixation -- Two screws and a wire attached between them -- Plate fixation -- Crossed Kirschner wires -- Staples french osteotomy : * Posterior approach * Detach the lateral half of the triceps from its inseion * Coex is broken * Medial periosteum left intact * Approximate the cut surfaces, and correct the rotation deformity by rotating the distal fragment externally until the distal screw is directly distal to the proximal screw. * Approximate the wedge till the 2 screws are parallel * Two parallel screws that are attached by a single figure-of-eight wire that is tightened for fixation. * Danger of damaging the physis is minimized Medial Opening Wedge Osteotomy with bone grafting (King & Secor) : * Requires bone grafting * Disadvantages -- Gains length -- Creates a ceain amount of inherent instability. -- Stretches and damages the ulnar nerve (due to lengthening) Refer : maheswari 9th ed
Medial closing wedge osteotomy
Lateral closing wedge osteotomy
Medial opening wedge osteotomy
Lateral opening wedge osteotomy
Elbow injuries