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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