This document discusses cubitus varus and cubitus valgus deformities of the elbow. Cubitus varus is a reduced carrying angle, most commonly caused by malunion of a supracondylar humerus fracture. Cubitus valgus is an increased carrying angle, most often due to non-union of a lateral condylar humerus fracture. Both conditions are typically corrected surgically through osteotomies if causing cosmetic issues, with cubitus valgus at risk of tardy ulnar nerve palsy requiring nerve transposition.

1. CUBITUS VARUS AND
CUBITUS VALGUS
Dr. Ponnilavan
Senior Resident

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 – Reduced
carrying angle
 Cubitus valgus – increased
carrying angle

4. CUBITUS VARUS
 Synonyms – Gunstock deformity
 Most common cause is Malunion of supracondylar
humerus
fracture of
 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

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, 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
 Other causes are – Turner’s and Noonan syndrome

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

13. CUBITUS VALGUS
 T
ardy 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. T
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