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