Translation Step-Cut Osteotomy Versus Pentagonal Osteotomy for Pediatric Cubitus Varus Deformity: Does Dual-Triangle Geometry Improve Cosmetic Outcomes?

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Abstract
Background: Post-traumatic cubitus varus is a 3-dimensional deformity that may result in cosmetic dissatisfaction and, in a minority of patients, functional impairment. Translation step-cut osteotomy (TSCO) provides stable correction but may be associated with residual lateral condylar prominence. A modified spike translation step-cut configuration, referred to as the pentagonal osteotomy, has been proposed to enhance medial translation and improve cosmetic contour. This study prospectively compares the clinical, radiologic, and cosmetic outcomes of TSCO and pentagonal osteotomy in pediatric cubitus varus deformity. Methods: This prospective comparative study included 24 children (P =0.603). Radiologic parameters, including the Baumann and HEW angles, improved significantly in both groups, with no significant intergroup differences. LPI improved in both cohorts, with a more negative mean value in the pentagonal group (−9.53±2.44 vs. −5.86±8.71), although this difference was not statistically significant ( P =0.174). A statistically significant difference in postoperative extension deficit of 4 degrees was observed in favor of the TSCO group ( P =0.046), while flexion and rotational correction were comparable. Excellent cosmetic satisfaction was reported by 83.3% of TSCO patients and 91.7% of patients undergoing pentagonal osteotomy ( P =0.592). Conclusion: Both translation step-cut osteotomy (TSCO) and pentagonal osteotomy are safe and effective techniques for the correction of pediatric cubitus varus deformity, with comparable clinical, radiologic, and cosmetic outcomes. Further studies with larger cohorts and longer follow-up are required to determine the long-term advantages of the pentagonal osteotomy, if any. Level of Evidence: Level II—prospective comparative study.

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