Cubitus varus

Cubitus varus

1. Cubitus varus
Ponnilavan

2. Cubitus varus:
•A deformity of elbow resulting
in a decreased carrying angle
(˘so that with arm extended at
the side & palm facing
forward, deviation of forearm
towards midline of body)
CUBITUS -ELBOW(LATIN)
VARUS -Angle inward
•Common complication of
supracondylar fracture of
humerus

3. Carrying angle:
•Angle formed by long axis
of arm and long axis of
FA
•elbow -EXTENDED and
forearm -supinated
•Normal:
Male:5-10degree
Female :10-15degree
•Valgus : >15 degree
•Varus :<5-10 degree

5. Associated deformities of cubitus
varus:
•Internal rotation
•Extension of distal fragment
•Medial tilt
•Type of deformity -static

6. Progressive cubitus varus
deformity after SCH#
•Growth disturbance in distal humerus
especially overgrowth of lateral condyle
can occur & sometimes avascular necrosis
and delayed growth of trochlea with
relative overgrowth of normal lateral side
of distal humerus epiphysis

7. Causes:
•Most common cause is malunited supracondylar
humerus fracture
•Congenital
•Malunited intercondylar #
•Malunited medial condyle#
•Malunited lateral condyle#
•Trochlear osteonecrosis

8. Malunited SCH #
•H/o significant trauma
•Thickening and irregularity of medial and
lateral supracondylar ridge
•Maintained 3 point relationship
•Elbow -Hyperextension
•Internal rotation increased with restricted
external rotation of shoulder

9. Gun stock deformity:

10. Displacements:
•Medial tilt
•Medial displacement
•Internal rotation
•Posterior tilt
•Posterior
displacement
•Proximal migration

11. Measurements on Xray: AP view
A line drawn parallel to
longitudinal axis of
humeral shaft as well as
a bisecting line parallel
to lateral condyle
•Normal:64-81 degree

12. Metaphyseal-diaphyseal angle:
•Transverse line is drawn
through axis of diaphysis.
angle measured between
lateral portion of
metaphyseal line and
proximal portion of
diaphyseal line
•Normal = 90 degree
•>90 degree = varus
angulation
•<90 degree = valgus
angulation

13. Lateral Xray:
•Humeral ulnar wrist
angle: crescent sign
•Presence of this imply
angulation and
rotation

14. Treatment:
•Observation with expectant remodelling
•Hemi epiphysiodesis and growth alteration
•Corrective osteotomy

15. Observation with expectant
remodelling
•Not appropriate because although
hyperextension may remodel to some
degree in a young child, in an older child
remodelling occurs even in joint's plane of
motion.
•Hence, it is not recommended

16. Hemi epiphysiodesis and growth
alteration:
•It is used to prevent cubitus varus
deformity in a patient with medial growth
arrest and progressive deformity,rather
than correcting it.
•It has a no role in child with a normal
physis

17. Corrective osteotomy:
•Medial open wedge osteotomy
•Lateral closing wedge(French osteotomy)
•Oblique osteotomy
•Dome osteotomy
•Step cut osteotomy

18. Approaches:
•Medial, Lateral and posterior
•Lateral: Good exposure with less
dissection
•Posterior: Complex osteotomy require
extensive exposure

19. Pre requisites:
•Atleast 1 year following fracture
•Patient demanding surgery
•Calculation of wedge to be removed by
normal side X ray
•Wedge angle = varus + normal
physiological valgus

20. French osteotomy:
•French, in 1959 first described a lateral
wedge osteotomy held with screws and a
figure of eight wire and this remains the
most popular method of correction.
•Lateral closed wedge osteotomy

22. Modified french osteotomy:
•Modification of French's osteotomy
appears to fulfill these criteria
•Easy procedure ,minimal dissection, little
possibility of nerve damage

23. French osteotomy
•Posterior longitudinal
incision
•ulnar nerve explored
•medial periosteal
hinge
Modified french
osteotomy
•Posterolateral incision
•ulnar nerve not
explored
•medial periosteal and
bony hinge

24. Step cut osteotomy:
•A standard posterior approach used
•Incision extended proximally distal 3rd
upper arm to a distance of 1-2 cm beyon
tip of olecranon distally
•Mobilize ulnar nerve anteriorly
•Triceps muscle split longitudinally
•Circumferential subperiosteal disection
done

25. •Osteotomy was
performed by first making
a proximal, transverse cut
perpendicular to
anatomical axis of
humerus
•Cut was made in a
proximal-medial to distal-
lateral direction
•Next cut perpendicular to
angular correction cut
was made at its lateral
margin creating a step cut
in distal humeral fragment

26. Complications of osteotomy:
•Stiffness
•Nerve injury (radial and ulnar nerve)
•Recurrent deformity
•Non union
•Osteomyelitis
•Malunion

27. THANK YOU