Once the osteotomy is complete, the 2 guidewires are removed. The surgeon flexes and pronates the elbow through the osteotomy. A satisfying crack is usually heard as the maneuver fractures the intact bridge. With the elbow flexed and pronated, the correction is confirmed under anteroposterior and lateral fluoroscopy. The 2 wires are then driven across the osteotomy site into the proximal cortex (Fig. 8). If needed, a third lateral wire can be placed for added stability.
A long arm splint with a sidewall is placed, and the child is admitted for 23 hours of observation for swelling and pain. Postoperatively, repeat radiographs in the splint are taken at 7 to 10 days to confirm maintenance of the correction, and the splint is overwrapped to a cast. Typically, there is enough callus at 4 weeks to pull the pins in clinic and start early motion.
In short, correction of cubitus varus in the pediatric population is technically easier than in adolescents and adults, and can prevent long-term sequelae such as PLRI, ulnar neuritis, and chronic elbow pain. Pediatric orthopaedists should reconsider the long-held belief that cubitus varus is merely a cosmetic deformity.
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