CASE 7 Cubitus Varus



                                    CASE 7

Cubitus Varus

What happened ?                     Progressive or not ?                 Hand Dominence ?

Look
Alignment                               Gunstock Deformity , demonstrated by Abduction of Shoulder
Attitude                                  Internally rotated Upper Extremity
Overlying skin normal , no muscles wasting on arm , forearm,hand on volar , dorsal ,medial and lateral sides , normal thenar , hypothenar emineces , normal looking finger nails

Feel – Temperature
            Superficial Palpation – Middle and Distal Arm ,Elbow , Forearm , Wrist and Hand
            Deep Palpation –         Lateral Epcondyle , Olecranon Fossa , Medial Epcondyle ,
Ulnar Nerve ,Along Olecranon process continue distally to wrist , Piano Key sign in Wrist , Radial Styloid process , along shaft move proximally to elbow joint
                                                                3 bony point relationship

Movement (Active/Passive)  - Flexion / Extension
(Measure extension at corrected position) check if he/she reaches mouth or not
                                                Supination / Pronation
 Measurement                          Deformity
Ligamentous Stability              MCL , LCL

Neurovascular Structures         Sensory , Motor , Reflexes – Radial / Ulnar / Median Nerve
Importance of checking hand to mouth is to remain alert on patient function of the extremity which might be  important in daily life.

Investigation
X-ray Elbow – also on opposite side to measure Cubitus Valgus for symmetry 
AP
                                    Bauman’s Angle
Metaphyseal-Diaphyseal Angle increases.

Lateral
            Cresecent Sign

Management
Know patient expectation
                                    Largely for cosmetic correction.
Surgery
                                    Lateral Closing Wedge Osteotomy (French) / Medial Opening wedge                                        with BG 
                                    Dome Osteotomy recently. 
                                    Oblique with Derotation
                                    Step Cut Osteotomy

Causes for Cubitus Varus

                                                 1.Varus Tilt

                                                  2.Medial Column Collapse

                                                 3.Medial Displacement









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