Cubitus Varus

Cubitus varus or bow elbow or gunstock deformity is the result of malunion occurring as a complication of supracondylar fracture of the humerus. It occurs in only the extension type of supracondylar fracture of the humerus, causing a reduction or loss of the carrying angle.

Various aetiologies have been suggested. The usual aetiology of cubitus varus deformity is malunion of distal humeral fragment rather than growth disturbance. Osteonecrosis with or without growth arrest is rare but a very important cause of varus deformity.

Cubitus varus deformity has no tendency for spontaneous correction but it always has to be corrected. Treatment options include:

  1. Observation with expectant remodelling:Not appropriate because although hyperextension may remodel to some degree in a young child, in an older child little remodelling occurs even in the joint’s plane of motion. Hence, it is not recommended.
  2. Hemiepiphysiodesis and growth alteration:It is used to prevent cubitus varus deformity in a patient with medial growth arrest and progressive deformity, rather than correcting it. It has no role in a child with a normal physis.
  3. Corrective Osteotomy:Osteotomy is the only way to correct a cubitus varus deformity with a high probability of success. Options include;
  • Medial open wedge osteotomy, which causes lengthening of medial aspect of humerus causing stretching of ulnar nerve
  • Lateral closing wedge osteotomy with or without simultaneous correction of rotation, also known as French osteotomy
  • Step cut osteotomy.
  • Arch osteotomy
  • Pentalateral osteotomy
  • Oblique osteotomy with derotation.
  • Dome osteotomy

The various osteotomies performed can be fixed using metal plates, stainless steel wires, screws and staples. Unstable internal fixation allows the osteotomy fragment to slip into a varus position in a number of patients.

Advantages of Dome osteotomy

  • provides maximum stability of maintaining the correction
  • avoids lateral condyle becoming more prominent
  • its scar is more cosmetically acceptable
  • no lateral translation of humero-ulnar axis
  • all rotational and angulational deformities can be corrected simultaneously
  • early mobilization and rehabilitation





Cubitus valgus is a deformity in which the forearm is angled out away from the body when the arm is fully extended. When your palm is facing upward and your arm is extended, you may have cubitus valgus if your carrying angle, or the degree to which your arm is angling away from your body, exceeds 15 degrees.The angle is often more pronounced in women.


There are two possible causes for cubitus valgus:

  • A congenital condition
  • A Fractures

A Fractures

  • Non union lateral condyle
  • Malunited fracture lateral condyle
  • Trochlear osteonecrosis
  • Malunited intercondylar fracture
  • Malunited medial condyle fracture

A Congenital Condition

The two congenital conditions that commonly cause cubitus valgus are

  • Turner syndrome
  • Noonan syndrome.

Turner syndrome is a chromosomal disorder in which a female is born with only one X chromosome. People with Turner syndrome experience a number of other symptoms, including short stature and delayed puberty. Treatment usually involves hormone replacement therapy.

Noonan syndrome is another genetic disorder that results in delayed development. It’s usually caused by a genetic mutation, but sometimes doctors aren’t sure why it develops. While there’s no cure for Noonan syndrome, there are a number of treatments that can help minimize its effects.


  • Hyperextension Deformity
  • Limited Flexion
  • Lateral tilt and Medial angulation at elbow joint.
  • Wasting of muscles
  • Prominence of Medial condyle humerus
  • Tenderness
  • Thickening and irregularity of supracondylar ridges
  • Lateral epicondyle tip higher
  • Internal rotation deformity with increased internal rotation
  • Decrease external rotation which is compensated by much more mobile shoulder joint


Cubitus valgus is a known cause of ulnar neuropathy. This is a disorder involving the ulnar nerve, which is one of the three main nerves in your arm.

Ulnar neuropathy most often occurs when the ulnar nerve becomes compressed or irritated, causing numbness, tingling, and occasionally weakness. Most of the time treatment involves limiting physical activity and wearing a brace. However, if these conservative treatments don’t work, surgery may be necessary.

Cubitus valgus can also lead to a condition called tardy ulnar nerve palsy, a type of ulnar neuropathy. This is a chronic condition that is commonly associated with cubitus valgus.

Ulnar nerve palsy is progressive, in that it usually gets worse over time. You may experience a loss of sensation in your fingers, especially your ring and little finger, as well as loss of coordination, tingling and burning, pain, and weakness.

There are a number of treatments for the symptoms of ulnar nerve palsy, including over-the-counter medications and physiotherapy.



  • Hot fermentation can be used to ease joint stiffness.
  • Gentle soft tissue release can be done in arm and forearm musculature.
  • Gentle active and active-assisted exercises using a wand and be taught in pain- free limit- frequently in a day.
  • Isometric exercises for arm and forearm musculature can be addressed.
  • Avoid weight lifting .
  • Splint



With a dome-shaped supracondylar osteotomy, we can correct the cubitus valgus deformity and avoid the development of a medial epicondylar prominence.