Short Case - Cubitus Varus Deformity


Pratap Aryal  14 years  / boy   hospital no 017-1121000 , charikot , Nepal
C/O – Lt elbow deformity for 11 years

History of fall injury at the age of 3 years , and sustained injury around elbow . casted after 12 hours
for 3 weeks ( no documents to know the fractured part in elbow )
Deformity noticed which remained static .
No disabilities but he is not feeling well with the deformity
Personal History – He is a right hand dominant boy studying in class 8.

O/E
Introduction of ownself

Exposure upto Shoulder

Maintain privacy of the patient

Inspection

  Attitude of the Lt upper extremity

  Internally rotated
 Alignment  - cubitus varus deformity
Deformity is exaggerated in shoulder abduction
No wasting of muscles on arm forearm and hand
Normal overlying skin

Palpation
 Overlying temperature – normal
Skin texture – normal
No tenderness of soft tissue and bone
Lateral condyle , olecranon process and medial condyle at same line on extension and form isosceles triangle on flexion of 90 degrees
Movement
   Both active and passive
         Flexion 140 degrees
          Extension –  - 10 degrees
           Supination – 90 degrees
             Pronation  -- - 10 degrees

Measurement

  Cubitus varus deformity - -25 degrees

Distal Neurovasuclar test

 Sensation intact
 Motor intact
 Pulsation of radial / ulnar artert intact

Test hand if he can reach to perineum from back to show that left hand is required for perineal hygiene .



Impression – 14 years old boy with Lt Cuvitus Varus Deformity post  Supracondylar Fracture malunion  11 years back



VIVA

 What’s carrying angle ?
 Angle formed by long axis of arm to forearm .
Female – 14 degrees
Male 7- 10 degrees

Causes of Cubitus Varus deformity
 Malunited Supracondylar fracture
         BECASUSE of history of trauma
                                  No progressive deformity
                                  3 point bony relationship is maintained

How does cubitus varus deformity occur ?
Medial column collapse
IR , Anterior angulation contribute to this deformity.

Why extremity tends  to lie on IR attitude ?
So as to conceal the deformity.

How to treat this deformity ?
 Surgically
 Osteotomies
       Lateral closing Wedge Osteotomies , translation
       Medial Opening Wedge Osteotomy
                (    Donor site morbidity , graft dislodgement  and non union )
       Dome Osteotomy
       Step Cut osteotomy
        French Osteotomy
Classical one is Lateral closing wedge Osteotomy and fixation with TBW.

Complication of Cubitus Varus Deformity
   Elbow Instability
     Lateral condyle fracture
      Later Tardy Ulnar nerve Palsy

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