Comparison of Outcome between Modified French Osteotomy and Three-Dimensional Osteotomy for the Management of Gunstock Deformity

Author(s): Dr. Debashish Dey, Prof. Dr. Krishna Priya Das, Dr. Md. Nazrul Islam, Dr. Md. Golam Shaikh Ferdous, Dr. Aminur Rasul, Dr. Sabrina Khan

Background: Gunstock deformity is a triplanar deformity around the elbow. Modified French osteotomy is profoundly used for the correction of deformity. However, as it doesn’t correct all three deformity components, hence, Three-Dimensional (3D) osteotomy was developed. Still, debate persists about the superiority of this technique.

Aim of the study: To compare the clinical outcomes between modified French osteotomy and three-dimensional osteotomy for management of gunstock deformity.

Methods: This prospective comparative study was conducted in the Department of Orthopaedics, BSMMU, Dhaka and New Life Hospital, Dhaka from October 2022 to September 2024 where 40 patients were allocated into two groups. Three-Dimensional osteotomy (Group A) and Modified French osteotomy (Group B). Assessments were done preoperatively and at one, three, six, and twelve months postoperatively. Clinical outcome was evaluated by assessing Carrying Angle, Range of Motion of Elbow, Mayo Elbow Performance Score (MEPS) and Radiological union. Data analysis was done by using ‘Statistical Package for Social Science’ version 26 and for all analyses p-value <0.05 was considered significant.

Result: The mean age of our study population was 11.28± 2.44 years with male predominance (65%). 55% of the cases had the involvement of left limb. 92.5% and 7.5% of the patients had a previous history of supracondylar and lateral condyle fracture of the humerus. The mean duration of initial injury to the surgery was 43.80 ±17.99 months. There was no significant difference between the groups in regard to demographic and clinical profile. At final follow up carrying angle, post-operative internal rotation correction, elbow flexion and MEPS score were significantly better in Group A than Group B (p<0.05). 75% had excellent and 25% had good outcomes in group A, but in group B, 40% had excellent results, 50% had good, and 10% had fair outcomes. Conclusion: Three-dimensional osteotomy corrects all the three forms of the deformities and automatically gives the stability, so it permits early mobilization and ensure better outcome than modified French osteotomy for the treatment of gunstock deformity.