Various Corrective Osteotomy Techniques for Cubitus Varus in Children: Systematic Review
Bibliographic record
Abstract
BACKGROUND: Supracondylar humerus fractures are common in children, often leading to malunion and cubitus varus. Corrective osteotomy techniques for cubitus varus include lateral closing-wedge, step-cut, dome, distraction osteogenesis, and computer-assisted multiplanar 3D osteotomies. This study seeks to determine the most effective corrective osteotomy technique for pediatric malunion of the supracondylar humerus through a systematic review, as there is currently no up-to-date review on this topic. METHODS: A literature search was conducted across the PubMed, EMBASE, ProQuest, Scopus, and Cochrane Library databases on April 2, 2023, following the PRISMA guidelines. Selected articles underwent a review process by 2 independent reviewers to reassess their eligibility based on predefined inclusion criteria. The quality and potential biases of each article were assessed utilizing the Newcastle-Ottawa Scale (NOS) for nonrandomized studies and the Cochrane Risk of Bias Tool for randomized studies. RESULTS: This systematic review included 39 out of 754 articles, involving 863 patients who underwent various osteotomies. The patients were followed up for an average of 27.3 months, and data on range of motion, angle correction, and clinical outcomes were collected. Different assessment criteria were used for functional outcomes. Complications included infections, nerve injuries, reoperations, residual deformity, and absence of lateral condyle prominence. The systematic review revealed a shortage of randomized controlled trials (RCTs) due to challenges in randomization, surgical technique variations, and ethical considerations. CONCLUSIONS: Various osteotomy techniques can be used to achieve favourable outcomes in cases of pediatric supracondylar malunion. These techniques include lateral closing wedge osteotomy, step-cut osteotomy, dome osteotomy, distraction osteogenesis, and multiplanar 3D osteotomy. Each osteotomy technique has its own advantages and disadvantages for specific outcomes. Lateral closing wedge osteotomy is recommended for patients with preoperative range of motion deficits. Step-cut osteotomy excels in correcting the humerus-elbow-wrist angle. A meta-analysis favoured the lateral closing wedge over the dome osteotomy for satisfactory outcomes. LEVEL OF EVIDENCE: Level III.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".