Efficacy Analysis of External Fixator Combined with Kirschner Wire Fixation in the Treatment of Cubitus Varus Deformity in Children

Efficacy Analysis of External Fixator Combined with Kirschner Wire Fixation in the Treatment of Cubitus Varus Deformity in Children | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Efficacy Analysis of External Fixator Combined with Kirschner Wire Fixation in the Treatment of Cubitus Varus Deformity in Children Kang Xie, Ziwen Hu, Yapeng Zhang, Xiangjun Chu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8156290/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To analyze the efficacy and surgical techniques of distal humeral wedge osteotomy combined with external fixator and Kirschner wire fixation in the treatment of cubitus varus in children. Methods A retrospective analysis was performed on 25 children with cubitus varus deformity secondary to supracondylar humeral fracture who underwent distal humeral wedge osteotomy combined with external fixator and Kirschner wire fixation in our department from July 2021 to July 2023. General data such as gender, age, fracture time, and affected side of the children were collected. The carrying angle, elbow range of motion, and Lateral Condylar Prominence Index (LCPI) before and after surgery were compared. The fracture healing time, postoperative complications, and elbow function at the last follow-up were evaluated using the Oppenheim functional score. Results There were statistically significant differences in the carrying angle and LCPI before and after surgery in children with cubitus varus deformity treated by distal humeral wedge osteotomy combined with external fixator and Kirschner wire fixation (P < 0.05). The excellent and good rate of Oppenheim functional score of the elbow at the last follow-up was 96%, and the incidence of postoperative complications was 4%. Conclusion The combination of external fixator and Kirschner wire in the treatment of cubitus varus deformity in children can achieve satisfactory results in elbow function and correction of cubitus varus angle, and reduce the occurrence of postoperative lateral humeral condyle prominence. Cubitus varus Osteotomy External fixator Kirschner wire Children Figures Figure 1 Figure 2 Background Cubitus varus deformity is a common late complication of supracondylar humeral fractures in children [ 1 ][ 2 ]. Although children's bones can continuously reshape during development, this remodeling capacity for deformities is limited and hardly improves over time. Long-term complications of cubitus varus include lateral humeral condyle fracture, chronic pain, ulnar nerve palsy, posterolateral rotational instability, etc. Meanwhile, the potential psychological harm caused by long-term deformities to children should be considered, and cubitus varus in children should not be simply regarded as an appearance abnormality [ 3 ] [ 4 ]. Supracondylar osteotomy is currently the most commonly used treatment for correcting cubitus varus deformity [ 5 ]. Early correction of cubitus varus can reduce the incidence of complications. In order to reduce the incidence of complications after cubitus varus osteotomy, scholars have continuously improved the surgical methods [ 6 ][ 7 ]. However, most new osteotomy methods and fixation methods are complex and difficult to popularize. In this study, the combination of external fixator and Kirschner wire for treating cubitus varus in children can achieve three-dimensional orthopedics while centralizing the osteotomy site, reduce the occurrence of lateral humeral condyle prominence, with simple operation, short learning curve, and few current reports. This study retrospectively analyzed the efficacy of distal lateral humeral wedge osteotomy combined with external fixator and Kirschner wire fixation in the treatment of cubitus varus in children. Materials and Methods General Data Inclusion criteria for this study: (1) Cubitus varus secondary to supracondylar humeral fracture; (2) Age ≥ 5 years; (3) Cubitus varus angle ≥ 20°; (4) Follow-up time ≥ 12 months; (5) Complete follow-up data. Exclusion criteria: (1) Pathological fracture; (2) Bilateral cubitus varus deformity; (3) Complicated with vascular and nerve injury. The study was approved by the Ethics Committee of Anhui Provincial Children's Hospital (Approval No.:20190021) and the legal guardians of the children gave informed consent. The carrying angle of both sides and the flexion-extension function of both elbows were determined by standard full-length anteroposterior and lateral X-rays of both upper limbs. The location of the osteotomy line and related angles were determined on preoperative imaging data, and the osteotomy correction angle = affected side cubitus varus angle + contralateral carrying angle. Surgical Methods The surgery was performed in supine position without tourniquet under general anesthesia. First, two Schanz pins (Carefix, Shanghai, China) with a diameter of 2.5 or 3.0 mm were inserted. Among them, the distal Schanz pin was placed on the lateral side of the distal end of the humeral osteotomy, parallel to the area above the epiphyseal line of the lateral humeral condyle. The proximal Schanz pin, perpendicular to the longitudinal axis of the humeral shaft, was fixed to the lateral side of the humerus approximately 2–4 cm above the osteotomy site.A lateral approach to the distal humerus was adopted. The lateral periosteum of the humerus was incised while the medial periosteum was preserved. A distal humeral wedge osteotomy was performed, and the medial cortical bone of the humerus was transected simultaneously. The two Schanz pins were manipulated to assist in correcting cubitus varus, rotational deformity, and humeral condylar-shaft angle deformity, and to translate the distal end of the osteotomy toward the ulnar side for centralization, followed by fixation of the external fixator. Finally, a 2.0 mm-diameter Kirschner wire was inserted retrogradely from the lateral humeral condyle to increase anti-rotational stability( Fig. 1 ). A drainage tube was placed in the incision after the operation and removed 2 days later. The main observation indicators included operation time, osteotomy healing time, cubitus varus angle before and after surgery, and postoperative complications. Postoperative review of anteroposterior and lateral X-rays of the elbow was performed to evaluate the correction effect of cubitus varus deformity at different time points during follow-up. The removal of the external fixator was determined according to the healing of the osteotomy site. Elbow function was evaluated according to the Oppenheim criteria [ 8 ], which was divided into excellent, good, and poor. LCPI was evaluated based on the anteroposterior X-ray of the elbow, with LCPI = (AB - BC)/AC% [ 9 ]( Fig. 1 a). Statistical Analysis SPSS 22.0 statistical software was used for data collation and analysis. Measurement data such as age, operation time, LCPI before and after surgery, carrying angle, and fracture healing time were expressed as mean ± standard deviation (± s). The comparison of enumeration data such as LCPI, elbow range of motion, and carrying angle before and after surgery was performed using the chi-square test. P < 0.05 was considered statistically significant. Results All 25 children were followed up, with an average follow-up time of 24.32 months (ranging from 14 to 39 months). Among them, 22 were boys and 3 were girls, aged 5–15 years, with an average age of (9.33 ± 2.58) years. There were 16 cases of left cubitus varus deformity and 9 cases of right cubitus varus deformity. The time from fracture to surgery was 1–12 years, with an average of (3.47 ± 2.74) years. One case had postoperative complications, which was pin tract infection. The operation time was (1.21 ± 0.16) hours, and the fracture healing time was (44.24 ± 5.06) days. The excellent and good rate of Oppenheim elbow function score at the last follow-up was 96%. The carrying angle of the healthy side was (7.40 ± 1.71)°, the preoperative carrying angle of the affected side was − (25.36 ± 4.15)°, and the postoperative carrying angle was (7.16 ± 1.75)°. There was a statistically significant difference in the carrying angle between before and after surgery (P = 0.000). The difference in LCPI between before surgery (1.44 ± 5.50)% and after surgery (-0.98 ± 5.46)% was statistically significant (P < 0.001)( Table 1 ). A typical case is shown in Fig. 2 . Table 1 Comparison of affected side carrying angle, elbow range of motion, and LCPI before and after surgery in children Category Preoperative Postoperative Statistical value P value Affected side carrying angle (°) − (25.36 ± 4.15) 7.16 ± 1.75 t = -37.293 0.000 Elbow flexion-extension range of motion (°) 127.76 ± 3.84 126.80 ± 2.94 t = 1.509 0.144 Lateral Condylar Prominence Index (%) 1.44 ± 5.50 -0.98 ± 5.46 t = 4.529 < 0.001 Discussion At present, the main treatment for cubitus varus deformity in children is supracondylar humeral osteotomy, including lateral closing wedge osteotomy, stepped osteotomy, dome osteotomy, three-dimensional osteotomy, etc. There are various fixation methods after osteotomy, including internal fixation such as plates, screws, Kirschner wires, and external fixation such as Ilizarov frame and Taylor frame, each with its own advantages and disadvantages, which have been demonstrated in the literature [ 10 – 14 ]. There are also reports of using "8"-shaped plate for distal humeral hemiepiphysiodesis in the treatment of cubitus varus [ 15 ], but it is mainly aimed at mild to moderate cubitus varus, and its efficacy is not yet accurate and reliable. However, there are few reports on the combination of external fixator and Kirschner wire in the treatment of cubitus varus in this study. Levine et al [ 16 ]first reported 5 children with cubitus varus treated by distal humeral osteotomy and external fixator fixation in 1996, all achieving good expected results. Theddy Slongo[ 17 ] reported the surgical technique of radial external fixator in the treatment of cubitus varus deformity in 2015, which described that the external fixator combined with Kirschner wire fixation was first applied in the treatment of complex supracondylar humeral fractures. Tang Xin et al [ 18 ] reported 16 cases of children with cubitus varus deformity treated by external fixator combined with Kirschner wire, all achieving satisfactory correction results. Compared with children with cubitus varus treated by plate internal fixation, external fixator treatment has lower surgical cost, shorter operation time, smaller scar, and shorter postoperative plaster fixation time. Shi Qiang et al [ 19 ] reported 19 cases of children with cubitus varus treated by external fixator combined with Kirschner wire fixation after osteotomy, with an excellent and good rate of elbow function reaching 94.7%, which was higher than 85.7% of that with Kirschner wire combined with postoperative plaster fixation. In this study, the excellent and good rate of elbow function at the last follow-up was as high as 96% in 25 children treated by external fixator combined with Kirschner wire, which is due to the early activity of the elbow joint enabled by external fixator combined with Kirschner wire fixation. For children, especially those in school age, early activity of the affected limb allows them to participate in school and social activities as normally as possible. The risk of complications in children with cubitus varus deformity treated by traditional lateral humeral wedge osteotomy is as high as 24%-34% [ 8 ][ 20 ], which may include overcorrection or undercorrection, persistent lateral condyle prominence, nonunion of osteotomy, motor dysfunction, nerve injury, growth arrest, and osteomyelitis. In this study, no nerve injury complications occurred. The preoperative LCPI was smaller than the postoperative LCPI in children treated by external fixator combined with Kirschner wire fixation (P < 0.05). On the one hand, in traditional distal humeral wedge osteotomy, the ulnar cortex of the osteotomy is connected, and the distal osteotomy site of the humerus shifts to the radial side relative to the proximal osteotomy site, making the lateral condyle more prominent and LCPI increased [ 9 ]. Although dome and stepped translation osteotomy methods were invented to reduce the prominent lateral condyle[ 1 ][ 21 ], these two osteotomy methods are complex and difficult to operate. However, when the medial cortical bone of the humeral osteotomy is transected in external fixator combined with Kirschner wire fixation, the Schanz pin fixing the distal humeral osteotomy site can be operated to shift the distal humeral osteotomy block to the ulnar side in the coronal plane relative to the proximal humeral osteotomy site, thereby reducing the lateral humeral condyle index and the occurrence of lateral humeral condyle prominence [ 22 ][ 23 ]. Surgical key points and advantages of external fixator combined with Kirschner wire fixation in the treatment of cubitus varus:Technical key points: (1) Due to the small operation area for inserting Schanz pins in the distal humerus of children and considering the safe area of the lateral radial nerve of the humerus, 2 Schanz pins are selected. One Schanz pin is placed at the distal humeral osteotomy site, parallel to the upper part of the epiphyseal line of the lateral humeral condyle to avoid damaging the epiphysis, and should not completely penetrate the medial cortex of the humerus to avoid damaging the ulnar nerve; the other is perpendicular to the longitudinal axis of the proximal humerus, located below the radial nerve passing through the humerus, about 2–4 cm above the osteotomy. Meanwhile, when inserting the Schanz pin, an electric drill sleeve can be used to fit perpendicular to the lateral humeral bone surface, and the Schanz pin is screwed in under the protection of the sleeve to avoid involving the radial nerve. (2) One Kirschner wire is inserted retrogradely from the lateral humeral condyle to increase fixation stability. (3) The Schanz pin of the external fixator can be used as a joystick to moderately shift the distal humeral osteotomy block to the ulnar side in the coronal plane relative to the proximal humeral osteotomy site, reducing the lateral humeral condyle index. Conclusions In summary,external fixator combined with Kirschner wire fixation in the treatment of cubitus varus can achieve good functional and orthopedic results, allow early activity of children after surgery, with convenient operation, and reduce the occurrence of lateral condyle prominence. However, this study has limitations: first, it is a retrospective case analysis with a small sample size, and multi-center controlled studies are needed in the later stage. Second, the postoperative follow-up time did not reach the skeletal maturity of the children, and further follow-up results are required. Abbreviations LCPI Lateral Condylar Prominence Index Declarations Authors’ contributions KX contributed to the study design and the drafting of the article. YPZ contributed to the implementation. KX and ZWH collected data . KX and XJC contributed to all procedures. Funding This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate The study was reviewed and approved by the Ethics Committee of Anhui Provincial Children's Hospital (Approval No.:20190021) and all procedures performed in studies involving human participants were in accordance with the principles of the World Medical Association Declaration of Helsinki (2013 revision) for medical research involving human subjects.And the legal guardians of the children gave informed consent. Consent for publication All participants in this study are younger than 16 years (age range:5–15years), and written informed consent for publication of clinical details and clinical images was obtained from the patient’s legal guardian.The consent process included a detailed explanation of the study purpose, procedures, potential risks, and benefits, and all guardians voluntarily signed the consent form. Competing interests The authors declare that they have no competing interests. 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08:25:17","extension":"xml","order_by":23,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":58330,"visible":true,"origin":"","legend":"","description":"","filename":"91664f13473a4a198bd789be654e9c3e1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8156290/v1/7d5891f3b91089ab4c7cd7ff.xml"},{"id":97126740,"identity":"4293a799-1868-4865-9264-840b402b1f32","added_by":"auto","created_at":"2025-12-01 08:25:17","extension":"html","order_by":24,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":62489,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8156290/v1/c9a23d3dd394a6436fce1b85.html"},{"id":97141992,"identity":"9229a9af-d11c-43d2-9bb7-71cb9089c1e9","added_by":"auto","created_at":"2025-12-01 10:07:16","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":178194,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic diagrams of the surgical method for cubitus varus deformity\u003cbr\u003e\na. Anteroposterior X-ray schematic diagram of cubitus varus deformity, where point A is the prominent point of the lateral epicondyle of the humerus, point C is the prominent point of the medial epicondyle of the humerus; point B is the intersection of the line connecting A and C and the anatomical axis of the humerus. LCPI = (AB - BC)/AC%;\u003cbr\u003e\nb. Intraoperative lateral wedge osteotomy of the supracondylar humerus;\u003cbr\u003e\nc. External fixator combined with 1 Kirschner wire fixation\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8156290/v1/76c4b05e40c00e0f1104267d.png"},{"id":97126762,"identity":"996c4272-4ac8-4fab-b863-9b37544071b2","added_by":"auto","created_at":"2025-12-01 08:25:21","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":489959,"visible":true,"origin":"","legend":"\u003cp\u003eAn 8-year-old boy with cubitus varus deformity secondary to left supracondylar humeral fracture for 2 years and 2 months\u003cbr\u003e\na, b. Anteroposterior and lateral X-rays of the elbow 7 weeks after left supracondylar humeral fracture;\u003cbr\u003e\nc. Anteroposterior X-ray of the left elbow 2 years and 2 months after fracture;\u003cbr\u003e\nd. Anteroposterior X-ray of the right elbow 2 years and 2 months after fracture;\u003cbr\u003e\ne, f.Anteroposterior and lateral X-rays after surgery: the distal humeral bone block is shifted to the ulnar side after osteotomy, fixed with an external fixator and 1 Kirschner wire from the lateral humeral condyle;\u003cbr\u003e\ng,h. Anteroposterior and lateral X-rays of the elbow 7 weeks after surgery: the osteotomy is healed;\u003cbr\u003e\ni,j. Anteroposterior and lateral X-rays of the elbow rechecked 14 months after surgery: the osteotomy is healed, and the cubitus varus deformity is satisfactorily corrected.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8156290/v1/fb7cc4333091ab021daa0fcb.png"},{"id":103277715,"identity":"0ffaace1-1641-44e8-9b13-3cf1c3d6c163","added_by":"auto","created_at":"2026-02-24 02:10:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1300045,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8156290/v1/e0f66bbb-44f7-4edf-960e-b8f647e1a857.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Efficacy Analysis of External Fixator Combined with Kirschner Wire Fixation in the Treatment of Cubitus Varus Deformity in Children","fulltext":[{"header":"Background","content":"\u003cp\u003eCubitus varus deformity is a common late complication of supracondylar humeral fractures in children [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e][\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Although children's bones can continuously reshape during development, this remodeling capacity for deformities is limited and hardly improves over time. Long-term complications of cubitus varus include lateral humeral condyle fracture, chronic pain, ulnar nerve palsy, posterolateral rotational instability, etc. Meanwhile, the potential psychological harm caused by long-term deformities to children should be considered, and cubitus varus in children should not be simply regarded as an appearance abnormality [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Supracondylar osteotomy is currently the most commonly used treatment for correcting cubitus varus deformity [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Early correction of cubitus varus can reduce the incidence of complications. In order to reduce the incidence of complications after cubitus varus osteotomy, scholars have continuously improved the surgical methods [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e][\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, most new osteotomy methods and fixation methods are complex and difficult to popularize. In this study, the combination of external fixator and Kirschner wire for treating cubitus varus in children can achieve three-dimensional orthopedics while centralizing the osteotomy site, reduce the occurrence of lateral humeral condyle prominence, with simple operation, short learning curve, and few current reports. This study retrospectively analyzed the efficacy of distal lateral humeral wedge osteotomy combined with external fixator and Kirschner wire fixation in the treatment of cubitus varus in children.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eGeneral Data\u003c/h2\u003e\n \u003cp\u003eInclusion criteria for this study: (1) Cubitus varus secondary to supracondylar humeral fracture; (2) Age\u0026thinsp;\u0026ge;\u0026thinsp;5 years; (3) Cubitus varus angle\u0026thinsp;\u0026ge;\u0026thinsp;20\u0026deg;; (4) Follow-up time\u0026thinsp;\u0026ge;\u0026thinsp;12 months; (5) Complete follow-up data. Exclusion criteria: (1) Pathological fracture; (2) Bilateral cubitus varus deformity; (3) Complicated with vascular and nerve injury. The study was approved by the Ethics Committee of Anhui Provincial Children\u0026apos;s Hospital (Approval No.:20190021) and the legal guardians of the children gave informed consent.\u003c/p\u003e\n \u003cp\u003eThe carrying angle of both sides and the flexion-extension function of both elbows were determined by standard full-length anteroposterior and lateral X-rays of both upper limbs. The location of the osteotomy line and related angles were determined on preoperative imaging data, and the osteotomy correction angle\u0026thinsp;=\u0026thinsp;affected side cubitus varus angle\u0026thinsp;+\u0026thinsp;contralateral carrying angle.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eSurgical Methods\u003c/h3\u003e\n\u003cp\u003eThe surgery was performed in supine position without tourniquet under general anesthesia. First, two Schanz pins (Carefix, Shanghai, China) with a diameter of 2.5 or 3.0 mm were inserted. Among them, the distal Schanz pin was placed on the lateral side of the distal end of the humeral osteotomy, parallel to the area above the epiphyseal line of the lateral humeral condyle. The proximal Schanz pin, perpendicular to the longitudinal axis of the humeral shaft, was fixed to the lateral side of the humerus approximately 2\u0026ndash;4 cm above the osteotomy site.A lateral approach to the distal humerus was adopted. The lateral periosteum of the humerus was incised while the medial periosteum was preserved. A distal humeral wedge osteotomy was performed, and the medial cortical bone of the humerus was transected simultaneously. The two Schanz pins were manipulated to assist in correcting cubitus varus, rotational deformity, and humeral condylar-shaft angle deformity, and to translate the distal end of the osteotomy toward the ulnar side for centralization, followed by fixation of the external fixator. Finally, a 2.0 mm-diameter Kirschner wire was inserted retrogradely from the lateral humeral condyle to increase anti-rotational stability( Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). A drainage tube was placed in the incision after the operation and removed 2 days later.\u003c/p\u003e\n\u003cp\u003eThe main observation indicators included operation time, osteotomy healing time, cubitus varus angle before and after surgery, and postoperative complications. Postoperative review of anteroposterior and lateral X-rays of the elbow was performed to evaluate the correction effect of cubitus varus deformity at different time points during follow-up. The removal of the external fixator was determined according to the healing of the osteotomy site. Elbow function was evaluated according to the Oppenheim criteria [\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e], which was divided into excellent, good, and poor. LCPI was evaluated based on the anteroposterior X-ray of the elbow, with LCPI = (AB - BC)/AC% [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e]( Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003ea).\u003c/p\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical Analysis\u003c/h2\u003e\n \u003cp\u003eSPSS 22.0 statistical software was used for data collation and analysis. Measurement data such as age, operation time, LCPI before and after surgery, carrying angle, and fracture healing time were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (\u0026plusmn;\u0026thinsp;s). The comparison of enumeration data such as LCPI, elbow range of motion, and carrying angle before and after surgery was performed using the chi-square test. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAll 25 children were followed up, with an average follow-up time of 24.32 months (ranging from 14 to 39 months). Among them, 22 were boys and 3 were girls, aged 5\u0026ndash;15 years, with an average age of (9.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.58) years. There were 16 cases of left cubitus varus deformity and 9 cases of right cubitus varus deformity. The time from fracture to surgery was 1\u0026ndash;12 years, with an average of (3.47\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74) years.\u003c/p\u003e\n\u003cp\u003eOne case had postoperative complications, which was pin tract infection. The operation time was (1.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16) hours, and the fracture healing time was (44.24\u0026thinsp;\u0026plusmn;\u0026thinsp;5.06) days. The excellent and good rate of Oppenheim elbow function score at the last follow-up was 96%. The carrying angle of the healthy side was (7.40\u0026thinsp;\u0026plusmn;\u0026thinsp;1.71)\u0026deg;, the preoperative carrying angle of the affected side was \u0026minus;\u0026thinsp;(25.36\u0026thinsp;\u0026plusmn;\u0026thinsp;4.15)\u0026deg;, and the postoperative carrying angle was (7.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.75)\u0026deg;. There was a statistically significant difference in the carrying angle between before and after surgery (P\u0026thinsp;=\u0026thinsp;0.000). The difference in LCPI between before surgery (1.44\u0026thinsp;\u0026plusmn;\u0026thinsp;5.50)% and after surgery (-0.98\u0026thinsp;\u0026plusmn;\u0026thinsp;5.46)% was statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001)( Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). A typical case is shown in Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of affected side carrying angle, elbow range of motion, and LCPI before and after surgery in children\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePostoperative\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStatistical value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAffected side carrying angle (\u0026deg;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;(25.36\u0026thinsp;\u0026plusmn;\u0026thinsp;4.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003et = -37.293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eElbow flexion-extension range of motion (\u0026deg;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e127.76\u0026thinsp;\u0026plusmn;\u0026thinsp;3.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e126.80\u0026thinsp;\u0026plusmn;\u0026thinsp;2.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003et\u0026thinsp;=\u0026thinsp;1.509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLateral Condylar Prominence Index (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.44\u0026thinsp;\u0026plusmn;\u0026thinsp;5.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.98\u0026thinsp;\u0026plusmn;\u0026thinsp;5.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003et\u0026thinsp;=\u0026thinsp;4.529\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAt present, the main treatment for cubitus varus deformity in children is supracondylar humeral osteotomy, including lateral closing wedge osteotomy, stepped osteotomy, dome osteotomy, three-dimensional osteotomy, etc. There are various fixation methods after osteotomy, including internal fixation such as plates, screws, Kirschner wires, and external fixation such as Ilizarov frame and Taylor frame, each with its own advantages and disadvantages, which have been demonstrated in the literature [\u003cspan additionalcitationids=\"CR11 CR12 CR13\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. There are also reports of using \"8\"-shaped plate for distal humeral hemiepiphysiodesis in the treatment of cubitus varus [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], but it is mainly aimed at mild to moderate cubitus varus, and its efficacy is not yet accurate and reliable. However, there are few reports on the combination of external fixator and Kirschner wire in the treatment of cubitus varus in this study. Levine et al [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]first reported 5 children with cubitus varus treated by distal humeral osteotomy and external fixator fixation in 1996, all achieving good expected results. Theddy Slongo[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] reported the surgical technique of radial external fixator in the treatment of cubitus varus deformity in 2015, which described that the external fixator combined with Kirschner wire fixation was first applied in the treatment of complex supracondylar humeral fractures. Tang Xin et al [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] reported 16 cases of children with cubitus varus deformity treated by external fixator combined with Kirschner wire, all achieving satisfactory correction results. Compared with children with cubitus varus treated by plate internal fixation, external fixator treatment has lower surgical cost, shorter operation time, smaller scar, and shorter postoperative plaster fixation time. Shi Qiang et al [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] reported 19 cases of children with cubitus varus treated by external fixator combined with Kirschner wire fixation after osteotomy, with an excellent and good rate of elbow function reaching 94.7%, which was higher than 85.7% of that with Kirschner wire combined with postoperative plaster fixation. In this study, the excellent and good rate of elbow function at the last follow-up was as high as 96% in 25 children treated by external fixator combined with Kirschner wire, which is due to the early activity of the elbow joint enabled by external fixator combined with Kirschner wire fixation. For children, especially those in school age, early activity of the affected limb allows them to participate in school and social activities as normally as possible.\u003c/p\u003e\u003cp\u003eThe risk of complications in children with cubitus varus deformity treated by traditional lateral humeral wedge osteotomy is as high as 24%-34% [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e][\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], which may include overcorrection or undercorrection, persistent lateral condyle prominence, nonunion of osteotomy, motor dysfunction, nerve injury, growth arrest, and osteomyelitis. In this study, no nerve injury complications occurred. The preoperative LCPI was smaller than the postoperative LCPI in children treated by external fixator combined with Kirschner wire fixation (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). On the one hand, in traditional distal humeral wedge osteotomy, the ulnar cortex of the osteotomy is connected, and the distal osteotomy site of the humerus shifts to the radial side relative to the proximal osteotomy site, making the lateral condyle more prominent and LCPI increased [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Although dome and stepped translation osteotomy methods were invented to reduce the prominent lateral condyle[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e][\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], these two osteotomy methods are complex and difficult to operate. However, when the medial cortical bone of the humeral osteotomy is transected in external fixator combined with Kirschner wire fixation, the Schanz pin fixing the distal humeral osteotomy site can be operated to shift the distal humeral osteotomy block to the ulnar side in the coronal plane relative to the proximal humeral osteotomy site, thereby reducing the lateral humeral condyle index and the occurrence of lateral humeral condyle prominence [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e][\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSurgical key points and advantages of external fixator combined with Kirschner wire fixation in the treatment of cubitus varus:Technical key points: (1) Due to the small operation area for inserting Schanz pins in the distal humerus of children and considering the safe area of the lateral radial nerve of the humerus, 2 Schanz pins are selected. One Schanz pin is placed at the distal humeral osteotomy site, parallel to the upper part of the epiphyseal line of the lateral humeral condyle to avoid damaging the epiphysis, and should not completely penetrate the medial cortex of the humerus to avoid damaging the ulnar nerve; the other is perpendicular to the longitudinal axis of the proximal humerus, located below the radial nerve passing through the humerus, about 2\u0026ndash;4 cm above the osteotomy. Meanwhile, when inserting the Schanz pin, an electric drill sleeve can be used to fit perpendicular to the lateral humeral bone surface, and the Schanz pin is screwed in under the protection of the sleeve to avoid involving the radial nerve. (2) One Kirschner wire is inserted retrogradely from the lateral humeral condyle to increase fixation stability. (3) The Schanz pin of the external fixator can be used as a joystick to moderately shift the distal humeral osteotomy block to the ulnar side in the coronal plane relative to the proximal humeral osteotomy site, reducing the lateral humeral condyle index.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn summary,external fixator combined with Kirschner wire fixation in the treatment of cubitus varus can achieve good functional and orthopedic results, allow early activity of children after surgery, with convenient operation, and reduce the occurrence of lateral condyle prominence. However, this study has limitations: first, it is a retrospective case analysis with a small sample size, and multi-center controlled studies are needed in the later stage. Second, the postoperative follow-up time did not reach the skeletal maturity of the children, and further follow-up results are required.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLCPI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLateral Condylar Prominence Index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKX contributed to the study design and the drafting of the article. YPZ\u003c/p\u003e\n\u003cp\u003econtributed to the implementation. KX and ZWH collected data . KX and XJC contributed to all procedures.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from any funding agency in\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ethe public, commercial, or not-for-profit sector.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available\u0026nbsp;\u003c/p\u003e\n\u003cp\u003efrom the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was reviewed and approved by the Ethics Committee of Anhui Provincial Children's Hospital (Approval No.:20190021) and all procedures performed in studies involving human participants were in accordance with the principles of the World Medical Association Declaration of Helsinki (2013 revision) for medical research involving human subjects.And the legal guardians of the children gave informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants in this study are younger than 16 years (age range:5–15years), and written informed consent for publication of clinical details and clinical images was obtained from the patient’s legal guardian.The consent process included a detailed explanation of the study purpose, procedures, potential risks, and benefits, and all guardians voluntarily signed the consent form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKumar R, Rangasamy K, Raj Gopinathan N, Sudesh P, Goni VG. Is modified reverse step-cut osteotomy better than Yun's reverse V osteotomy in paediatric cubitus varus deformity correction? A prospective, double-blinded, randomized controlled trial. Int Orthop. 2022;46(9):2041\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu X, Liu K, Yang J. A Modified Reverse Right-angled Triangle Osteotomy Using the Lateral Approach for the Treatment of Posttraumatic Cubitus Varus Deformity in Children. J Pediatr Orthop. 2023;43(6):355\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSu Y, Nan G. Lateral closing isosceles triangular osteotomy for the treatment of a post-traumatic cubitus varus deformity in children. Bone Joint J. 2016;98\u0026ndash;B(11):1521\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHo CA. Cubitus Varus-It's More Than Just a Crooked Arm! J Pediatr Orthop. 2017;37(Suppl 2):S37\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBauer AS, Pham B, Lattanza LL. Surgical Correction of Cubitus Varus. J Hand Surg Am. 2016;41(3):447\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKlahs KJ, Polmear MM, Transtrum B, Rodriguez E, Abdelgawad A, Thabet AM. Correction of Cubitus Varus Using Computer-Assisted Hexapod Multiplanar External Fixators: A Report of 3 Cases. JBJS Case Connect. 2023;13(1):e2200284.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHu X, Zhong M, Lou Y, et al. Clinical application of individualized 3D-printed navigation template to children with cubitus varus deformity. J Orthop Surg Res. 2020;15(1):111.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOppenheim WL, Clader TJ, Smith C, Bayer M. Supracondylar humeral osteotomy for traumatic childhood cubitus varus deformity. Clin Orthop Relat Res. 1984;(188):34\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWong HK, Lee EH, Balasubramaniam P. The lateral condylar prominence. A complication of supracondylar osteotomy for cubitus varus. J Bone Joint Surg Br. 1990;72:859\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSolfelt DA, Hill BW, Anderson CP, Cole PA. Supracondylar osteotomy for the treatment of cubitus varus in children: a systematic review. Bone Joint J. 2014;96\u0026ndash;B(5):691\u0026ndash;700.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBelthur MV, Iobst CA, Bor N, et al. Correction of Cubitus Varus After Pediatric Supracondylar Elbow Fracture: Alternative Method Using the Taylor Spatial Frame. J Pediatr Orthop. 2016;36(6):608\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi J, Wang J, Rai S, et al. 3D-printed model and osteotomy template technique compared with conventional closing-wedge osteotomy in cubitus varus deformity. Sci Rep. 2022;12(1):6762.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAgrawal R, Agrawal RA, Kaul R, Akhoon N, Bollabathini R. Post-traumatic cubitus varus: long-term follow-up of corrective osteotomy using the Ilizarov method of compression distraction osteogenesis. J Pediatr Orthop B. 2022;31(1):31\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSingh P, Krishna A, Arora S, Mehta R, Gupta V, Kumar V. Shortening dome osteotomy for correction of severe cubitus varus secondary to malunited supracondylar fractures in children. Arch Orthop Trauma Surg. 2023;143(3):1371\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMart\u0026iacute;nez-\u0026Aacute;lvarez S, Gal\u0026aacute;n-Olleros M, Alonso-Hern\u0026aacute;ndez J, Vara-Patudo I, Miranda-Gorozarri C, Palaz\u0026oacute;n-Quevedo \u0026Aacute;. Guided Growth for the Treatment of Cubitus Varus in Children: Medium- to Long-Term Results. J Clin Med. 2023;12(7):2632. Published 2023 Mar 31.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLevine MJ, Horn BD, Pizzutillo PD. Treatment of posttraumatic cubitus varus in the pediatric population with humeral osteotomy and external fixation. J Pediatr Orthop. 1996;16(5):597\u0026ndash;601.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSlongo T. Treatment of posttraumatic cubitus varus in children and adolescents. Supracondylar humeral osteotomy using radial external fixation. Oper Orthop Traumatol. 2015;27(3):194\u0026ndash;209.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTang X, Wang J, Slongo T, et al. Comparison of internal fixation vs. external fixation after corrective osteotomy in children with cubitus varus. J Shoulder Elb Surg. 2020;29(4):845\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShi Q, Yan H, Yang M, Chen S, Lu B. Comparative evaluation of pinning and cast fixation vs. external fixation after lateral closing-wedge osteotomy for cubitus varus in children. J Shoulder Elb Surg. 2022;31(3):481\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRaney EM, Thielen Z, Gregory S, Sobralske M. Complications of supracondylar osteotomies for cubitus varus. J Pediatr Orthop. 2012;32(3):232\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGurung YP, Pokharel S, Bhusal R, Rajbhandari T, Banskota AK, Banskota B. Effectiveness of supracondylar dome osteotomy in reducing lateral condylar prominence and enhancing functional outcomes in pediatric cubitus varus: a retrospective study. BMC Musculoskelet Disord. 2025;26(1):128.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePankaj A, Dua A, Malhotra R, Bhan S. Dome osteotomy for posttraumatic cubitus varus: a surgical technique to avoid lateral condylar prominence. J Pediatr Orthop. 2006;26(1):61\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePersiani P, Noia G, de Cristo C, Graci J, Gurz\u0026igrave; MD, Villani C. Lateral wedge osteotomy for pediatric post-traumatic cubitus varus: Kirschner-wires or locking angular plate? J Pediatr Orthop B. 2017;26(5):405\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cubitus varus, Osteotomy, External fixator, Kirschner wire, Children","lastPublishedDoi":"10.21203/rs.3.rs-8156290/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8156290/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo analyze the efficacy and surgical techniques of distal humeral wedge osteotomy combined with external fixator and Kirschner wire fixation in the treatment of cubitus varus in children.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective analysis was performed on 25 children with cubitus varus deformity secondary to supracondylar humeral fracture who underwent distal humeral wedge osteotomy combined with external fixator and Kirschner wire fixation in our department from July 2021 to July 2023. General data such as gender, age, fracture time, and affected side of the children were collected. The carrying angle, elbow range of motion, and Lateral Condylar Prominence Index (LCPI) before and after surgery were compared. The fracture healing time, postoperative complications, and elbow function at the last follow-up were evaluated using the Oppenheim functional score.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThere were statistically significant differences in the carrying angle and LCPI before and after surgery in children with cubitus varus deformity treated by distal humeral wedge osteotomy combined with external fixator and Kirschner wire fixation (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The excellent and good rate of Oppenheim functional score of the elbow at the last follow-up was 96%, and the incidence of postoperative complications was 4%.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe combination of external fixator and Kirschner wire in the treatment of cubitus varus deformity in children can achieve satisfactory results in elbow function and correction of cubitus varus angle, and reduce the occurrence of postoperative lateral humeral condyle prominence.\u003c/p\u003e","manuscriptTitle":"Efficacy Analysis of External Fixator Combined with Kirschner Wire Fixation in the Treatment of Cubitus Varus Deformity in Children","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-01 08:24:36","doi":"10.21203/rs.3.rs-8156290/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"10fb0934-5294-4f72-b508-d5aa9e8069c4","owner":[],"postedDate":"December 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-24T02:09:30+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-01 08:24:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8156290","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8156290","identity":"rs-8156290","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}