Functional and Radiological Outcomes of Three-Dimensional versus Modified French Osteotomy in Pediatric Gunstock Deformity

Background: Cubitus varus (gunstock deformity) is a common complication of malunited supracondylar humerus fractures in children, causing functional impairment and cosmetic concerns. Traditional Modified French osteotomy corrects angular deformity but often fails to address rotational and sagittal components. Aim of the study: To compare the functional and radiological outcomes of Three-Dimensional (3D) Osteotomy versus Modified French Osteotomy in pediatric cubitus varus. Methods & Materials: A prospective comparative study was conducted on 40 patients (aged 8–20 years) at BSMMU, Dhaka. Participants were equally divided into 3D Osteotomy and Modified French Osteotomy groups (n=20 each). Perioperative outcomes, radiographic parameters, functional recovery (MEPS), patient satisfaction, and complications were evaluated. Statistical significance was set at p<0.05. Result: 3D Osteotomy demonstrated significantly shorter union time (10.25±1.29 vs 12.25±1.71 weeks), better correction of carrying angle (11.10°±2.13 vs 9.40°±2.62; p=0.035), reduced internal rotation deformity (2.25°±1.65 vs 5.60°±1.76; p=0.001), and improved humeral alignment (p=0.007). Functional scores were higher (MEPS 91.50±5.64 vs 86.00±7.18; p=0.015), with more excellent outcomes (75% vs 40%) and greater patient satisfaction (85% vs 55%). Complications such as nerve injury and loss of correction were more common in the Modified French group. Conclusion: Three-dimensional osteotomy offers superior functional restoration, radiological accuracy, and patient satisfaction compared to Modified French osteotomy, despite longer operative time and higher blood loss. It provides a more comprehensive correction for pediatric cubitus varus deformity.