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    Cubitus Varus, Elbow Joint, Mitali Joshi

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    Kapil Lakhwara
    Cubitus varus, also known as gunstock deformity, is a malalignment of the distal humerus resulting in a change from normal valgus alignment to varus malalignment. It is most commonly caused by a malunited supracondylar fracture in children. Surgical correction is often required using osteotomies like lateral wedge or dome osteotomies fixed with plates, screws or external fixators to restore normal carrying angle. Complications can include persistent deformity, stiffness, nerve injuries and non-union if not treated properly.

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    Cubitus Varus, Elbow Joint, Mitali Joshi

    Uploaded by

    Kapil Lakhwara
    118 views13 pages
    Cubitus varus, also known as gunstock deformity, is a malalignment of the distal humerus resulting in a change from normal valgus alignment to varus malalignment. It is most commonly caused by a malunited supracondylar fracture in children. Surgical correction is often required using osteotomies like lateral wedge or dome osteotomies fixed with plates, screws or external fixators to restore normal carrying angle. Complications can include persistent deformity, stiffness, nerve injuries and non-union if not treated properly.

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    Elbow Deformities

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    Cubitus varus, also known as gunstock deformity, is a malalignment of the distal humerus resulting in a change from normal valgus alignment to varus malalignment. It is most commonly caused by a malunited supracondylar fracture in children. Surgical correction is often required using osteotomies like lateral wedge or dome osteotomies fixed with plates, screws or external fixators to restore normal carrying angle. Complications can include persistent deformity, stiffness, nerve injuries and non-union if not treated properly.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    118 views13 pages

    Cubitus Varus, Elbow Joint, Mitali Joshi

    Uploaded by

    Kapil Lakhwara
    Cubitus varus, also known as gunstock deformity, is a malalignment of the distal humerus resulting in a change from normal valgus alignment to varus malalignment. It is most commonly caused by a malunited supracondylar fracture in children. Surgical correction is often required using osteotomies like lateral wedge or dome osteotomies fixed with plates, screws or external fixators to restore normal carrying angle. Complications can include persistent deformity, stiffness, nerve injuries and non-union if not treated properly.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 13

    Cubitus varus

    Cubitus Varus
    INTRODUCTION
    Cubitus varus (gunstock deformity) is a malalignment of the
    distal humerus that results in a change of carrying angle from the
    physiologic valgus alignment (5-15 degrees) of the arm and
    forearm to varus malalignment.
    = Gunstock deformity / bow elbow .
    Normally arm is aligned in valgus with respect to arm in full extension with
    medial angulation. Decrease in valgus with neutral alignment (loss of
    angulation) is called “cubitus rectus”. It is still a deformity as it deviates from
    the normal for population.
    Distal humeral deformity – varus , extension , internal rotation .
    CAUSES
    • Post-traumatic malunited supracondylar # (most common).
    • Malunited intercondylar #.
    • Malunited medial condyle #.
    • Infective : medial growth plate damage .
    • Vascular : osteonecrosis of trochlea.
    • Neoplastic
    INCIDENCE
    • b/w 5-10yrs of age( basically in children due to immature skeleton ) .
    • Reason : metaphyseal area of the distal humerus is the weakest region
    around elbow , so s.c# are most common & frequent falls in children while
    playing , cycling .
    Functional limitation
    • Limited flexion , due to hyperextension associated with varus malunion .
    On Examination
     Inspection :
    Hyperextension deformity
    Limited flexion
    Medial tilt and lateral angulation at elbow
    Wasting of muscles
     Palpation :
    lat.epicondyle appears prominent due to rotation of distal fragment .
    Decrease in carrying angle .
    3 point relationship do not make an equilateral triangle .
    Graded by severity :
    Grade I : loss of physiological valgus angle .
    Grade II : 0-10⁰ of varus
    Grade III : 11-20⁰ of varus
    Grade IV : > 20⁰
    INVESTIGATION
    X-ray
    AP-view :
    Decrease in normal physiological valgus .
    Increase in Baumann’s angle=Humero-capitellar angle , to assess the normal relationship
    of distal humerus & measured on AP projection of elbow .
    Lateral view :
    Normally – no overlap b/w lat.epicondylar & olecranon epiphysis .
    If – significant tilt of distal fragment +ve → overlap found = Crescent Sign .
    TREATMENT
    Surgical : corrective osteotomy
     Lateral wedge osteotomy
     Dome osteotomy ( less complication & maximum stability of
    correction )
     Modified French osteotomy
     Medial open wedge osteotomy

    French osteotomy Modified French osteotomy


    Posterior longitudinal approach . Postero-lateral approach .
    Detach whole of triceps . Lateral half of triceps detached .
    Ulnar nerve explored . Ulnar nerve not explored .
    Medial cortex broken . Medial cortex intact so more stability .
    FIXATION Modalities :
    stabilisation methods vary from simple above elbow cast , k wires , Steinmann pin
    , single or double cortical screw to screw with tension wire loops , plates & external
    fixators .
    In young child , wires should be used with smaller bone & should be used with
    postoperative cast support .
    Osteotomies with older children may be stabilised with one third tubular plate or
    reconstruction plate . This will offer more rigid fixation with less chances of loss of
    fixation & may allow early mobilisation depending upon stability of fixation .
    Complications of osteotomy
    • Persistant deformity , posterolateral elbow pain & instability .
    • limitation of flexion range although functional arc maintained
    • Stiffness ( myositis ossificans )
    • Nerve injury (ulnar neuropathy / tardy ulnar nerve injury)
    • Lateral prominence ( prominence of distal fragment – French osteotomy )
    • Non-union
    • Osteomyelitis (mostly in external fixation case )
    • Scar
    • Lateral condylar #
    Thank you

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