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