Cubitus varus and valgus

Cubitus varus and valgus by Dr Bipul Borthakur

1. CUBITUS VARUS AND CUBITUS VALGUS DR. BIPUL BORTHAKUR PROFESSOR, DEPT OF ORTHOPAEDICS, SMCH

2. INTRODUCTION Normal alignment of elbow joint is determined by measuring the Carrying angle Normal carrying angle – 5 to 15 deg More in females than in males

3. DEFINITION Cubitus varus – it’s a condition where the forearm is directed towards the midline Cubitus valgus – it’s a condition where the forearm is directed away from the midline

4. CUBITUS VARUS Synonyms – Bow elbow or Gunstock deformity Most common cause is Malunion of supracondylar fracture of humerus Rarely, osteonecrosis with or without growth disturbance Causes of malunion Malreduction or loss of proper reduction when treated conservatively Treatment by local bone setters Severely comminuted fracture

5. CUBITUS VARUS Patient usually presents with Previous h/o trauma to elbow H/o institutional treatment or local treatment Deformity of elbow joint – on extension of elbow Gunstock deformity Cosmetic problem – major issue to be addressed No functional disability as such Ulnar nerve irritation and neuropathy in those who present very lately

6. CUBITUS VARUS Investigations: Plain radiograph of elbow AP and lateral view Assess the Carrying angle

7. CUBITUS VARUS Treatment – cubitus varus has no tendency for spontaneous correction by remodelling. Hence has to corrected surgically Mostly done for cosmetic reasons Options available are: Hemiepiphysiodesis and growth alteration – in patients with medial growth arrest and progressive deformity Corrective osteotomies – Commonly done Distraction osteogenesis by Ilizarov technique

8. CUBITUS VARUS Corrective osteotomies Lateral closing wedge osteotomy (French osteotomy) Medial open wedge osteotomy – stretches ulnar nerve Dome osteotomy Others – Step cut, Arch, Pentalateral and Oblique osteotomy

9. CUBITUS VARUS French Osteotomy

10. CUBITUS VARUS Distraction osteogenesis by Ilizarov technique

11. CUBITUS VALGUS Most common cause is non-union of lateral condylar fracture of humerus Sometimes cubitus varus can also be seen Physiological cubitus valgus varies from 3 to 29 deg Other causes are – Turner’s and Noonan syndrome

12. CUBITUS VALGUS H/o previous trauma to elbow along with fracture lateral condyle of humerus Patient presents with external deformity of elbow joint Usually asymptomatic till patient develops TARDY ULNAR NERVE PALSY

13. CUBITUS VALGUS Tardy ulnar nerve palsy is due to gradual stretching of the ulnar nerve during the progression of valgus deformity of elbow Symptoms – tingling and paraesthesia over ulnar nerve distribution Can also be seen in cubitus varus (friction neuropathy), medial condyle #, olecranon # and Monteggia fracture dislocation

14. CUBITUS VALGUS Investigations Plain radiograph AP and lateral view of elbow Assess the Carrying angle Nerve conduction studies

15. CUBITUS VALGUS Treatment Deformity correction for cosmetic reasons – Osteotomies, Ilizarov technique Anterior transposition of ulnar nerve for Tardy ulnar nerve palsy MILCH OSTEOTOMY

16. CUBITUS VALGUS

17. THANK YOU