CUBITUS VARUS
Cubitus varus is a medical condition that affects the elbow joint. It appears as a type of deformity in which the forearm bones are angled inward. This causes the elbow to point outward in a “V” shape. A congenital abnormality or a traumatic injury to the elbow, such as a fracture, can cause the deformity. Cubitus varus can lead to difficulty in performing everyday tasks. For instance, carrying objects can also result in pain and weakness in the affected arm. Treatment for cubitus varus may include physical therapy, bracing, or surgery. However, it all depends on the severity of the condition and the individual patient’s needs.
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Cubitus Varus
Cubitus Varus, which is commonly known as gunstock deformity. It is the most common complication of a broken arm bone (right above the elbow) in children. The deformity includes improper bone formation in the sagittal plane and internal rotation deformity in the axial plane. It also includes the loss of coronal alignment, which causes the distal forearm and hand to deviate to the midline of the body. The body handles the deformity well and corrects movement problems by shoulder motions. Both of these abnormalities might not require repair, but surgeons usually repair the coronal plane deformity. In the majority of instances, malunion appears as the cause of the deformity: The following may cause Cubitus Varus as well.
- Type I impacted or comminuted supracondylar fractures.
- Fractures of type II that appear rotationally unstable and become cast-treated with a subsequent loss of reduction
- Type III ignored or poorly fixed fractures.
Should Surgeons Fix These Deformities?
A youngster with cubitus Varus often has an ugly deformity and a good range of motion (ROM) at the elbow. Even though some research claims that the functional arc is preserved despite an uneven flexion arc and a restriction of elbow flexion range on the afflicted side. According to other writers, the malformation has no functional effects.
Studies have revealed, however, that long-term follow-up of kids with cubitus varus might lead to issues including a higher risk of lateral condyle fractures or other secondary fractures, posterolateral elbow discomfort and instability, and delayed ulnar nerve palsy. The clinical importance of several studies of elbow joint morphology and alignment changes in cubitus varus continues. Despite the fact that patients are frequently asymptomatic, and the patient ignores the deformity, the aforementioned consequences as well as aesthetic issues usually necessitate surgical intervention. However, even though doctors believe that surgery works well to correct this deformity, therapy works well in some cases too.
QUESTIONS AND ANSWERS
What is Cubitus Varus in children, and what causes it?
Cubitus varus refers to a condition characterized by an abnormal inward angulation of the forearm at the elbow, causing the arm to deviate towards the body. In children, this condition occurs as a result of a supracondylar humerus fracture, which is a common childhood elbow injury. When the fracture heals improperly, it can lead to a deformity in the alignment of the forearm bones, resulting in cubitus varus.
What are the common symptoms and signs of cubitus varus in children?
Children with cubitus varus may have visibly angled forearms at the elbow, often referred to as “gunstock deformity.” Other symptoms may include limited range of motion in the affected elbow, difficulty fully extending the arm, and potential discomfort or pain in the elbow region. The severity of the deformity and associated symptoms can vary based on the extent of the condition.
How do doctors diagnose Cubitus Varus
Diagnosis involves a physical examination and imaging studies, such as X-rays, to assess the degree of deformity and confirm the diagnosis. Treatment options depend on the severity of the cubitus varus. In mild cases, doctors will just observe and monitor the patient. Especially if the child does not experience significant functional limitations or pain. Doctors may recommend physical therapy to improve range of motion and strength. In more severe cases where the deformity affects function or causes discomfort, doctors may recommend surgery to realign the bones and correct the deformity.
When it comes to children and their medical conditions, parents need to think of the very best — Medical city Children’s Orthopedics and Spine Specialists.
When to do the Surgery?
Our surgeons believe that the body should heal before a corrective surgery occurs and about a year period covers that healing. Our surgeons consider the patient’s needs, their potential for growth, and their physical condition when determining a planned procedure.
Surgical Approach
There are three surgical techniques: medial, lateral, and posterior. The lateral technique appears as the most popular since it offers good exposure with minimum dissection. Surgeons believe that the correction of complex osteotomies requires a posterior approach that offers a larger amount of exposure.
Which Deformities Need Correction?
A tri-planar malformation called cubitus varus consists of varus, hyperextension, and internal rotation. The defects that need correction continue as the subject of intense discussion. Some experts advise correcting hyperextension in children older than 10 years old since the possibility of remodeling decreases after that age. In younger children, the hyperextension deformity will reconstruct with time. Authors that favor tri-planar osteotomy to address all three abnormalities have argued for rotational correction.
Others, however, have questioned the need for such intricate techniques and stated that rotational abnormalities don’t even require correction. The ultimate option will rely on the surgeon’s preferences and experience. At Medical City Children’s Orthopedics and Spine Specialists, we think that in the majority of instances, lateral closed wedge osteotomies to treat varus in the sagittal plane produce successful outcomes. Older children may also benefit from hyperextension correction.
The Fixation Techniques to Keep the Osteotomy Stable
Surgeons consider many different stabilization techniques. Such as a cast above the elbow, k wires, a single or double cortical screw, screws with tension wire loops, plates, and external fixators. According to doctor reports, threaded wires or Steinmann pins work better than smooth K wires since they purportedly back out with the loss of fixation. For younger children with smaller bones and postoperative cast support, surgeons will use wires and screws.
With a reconstructive plate or a one-third tubular plate, surgeons stabilize osteotomies in older kids. This will provide a firmer fixation with fewer risks of fixation loss. This may allow for early mobilization depending on fixation stability, which is advocated by some. However, doing so necessitates that the distal fragment be large enough to accommodate at least two wires. Furthermore, this procedure becomes problematic for young children’s cooperation and pin tract care.
Depending on the size of the bones, smaller children may benefit from K wires whereas older children may need plate fixation. French reported using screws with wire loop fixation, although this approach has a significant risk of fixation loss. It has been successful in employing reconstruction plates with little danger of fixation loss. In order for the osteotomy to function well with the least amount of danger of fixation loss, we at Medical City Kids Ortho suggest a reconstruction plate fixation.
What Issues or Difficulties Might Cubitus Varus Correction Cause?
Correcting cubitus varus can involve a surgical procedure to realign the bones of the forearm and reposition the elbow joint. While the goal of the procedure is to improve function and reduce pain, there are potential risks and complications associated with any surgery, including:
- Pain: Although the surgery is performed to relieve pain, some patients may experience temporary or persistent pain after the procedure.
- Stiffness: A loss of motion in the affected arm, which could make it difficult to perform certain activities, such as reaching overhead.
- Nerve and blood vessel injury: There is a risk of nerve and blood vessel damage during surgery, which could lead to weakness, numbness, or other symptoms.
- Infection: As with any surgical procedure, there is a risk of infection.
- Implant failure: If metal implants are used during the procedure, there is a risk that they could loosen, break, or cause other complications.
It’s important to keep in mind that these risks and complications may vary from patient to patient. Our surgeon will discuss the potential benefits and risks of the procedure with each individual patient before proceeding with surgery. Additionally, Doctors will institute precautions during the surgical procedure to minimize the risk of any complications.
Our Management Protocol
Medical City Kids Ortho recommends surgical treatment for all cubitus varus abnormalities. However, the child and parents must make the final choice after a thorough discussion of the benefits and drawbacks. At Medical City Kids Orthopedics and Spine Specialists, we choose lateral closed wedge oblique equal limb osteotomies. Surgeons consider the angles of the break and strategies to bring the very best outcomes when planning an osteotomy before surgery. The osteotomy is closed, and the wedge is removed intraoperatively. The carrying angle is examined together with limb alignment. The osteotomy is prolonged to attain >5° of carrying angle if the limb is still in varus. Surgeons use reconstruction plates with three or four holes for fixation.
Rehabilitation
In order to avoid complications including subsequent fractures, lateral instability, and nerve palsies, doctors and surgeons believe that surgery is the best outcome for a cubitus varus deformity. Surgeons correct the abnormality by conducting a lateral closed wedge osteotomy. Surgeons reduce complications by using the proper stabilization, ideally with a plate and screw. The look and placement of the scar as well as the post-correction lateral bump constitute two factors that might influence the aesthetic outcome of the repair and surgeons take these into account when making a choice.
Why Choose Medical City Children’s Orthopedics and Spine Specialists
The very first reason to choose Medical City Children’s Orthopedics and Spine Specialists for your child is because we are experts in children’s health. There is sometimes a small difference between different elbow injuries. Parents want their child treated for the exact cause and we can deliver that treatment. We do it all the time in our Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX offices. To obtain the very best diagnosis and treatment, we invite parents to give us a call to make an appointment for their child for any pain coming from their child’s elbows.
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Footnote:
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