This document discusses cubitus varus and cubitus valgus deformities of the elbow. Cubitus varus is when the forearm is directed towards the midline, while cubitus valgus is when it is directed away from the midline. Cubitus varus is most commonly caused by malunion of a supracondylar fracture of the humerus. Treatment options include corrective osteotomies such as lateral closing wedge or medial open wedge osteotomies. Cubitus valgus is most often due to non-union of a lateral condylar fracture of the humerus and can cause tardy ulnar nerve palsy if not corrected surgically using procedures like osteotom

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