Elbow Deformity Correction

Common Deformities

1. Cubitus Varus (“Gunstock deformity”)

• Most common

• Typically post–supracondylar fracture

2. Cubitus Valgus

• Often due to:

  • Lateral condyle nonunion

• May lead to tardy ulnar nerve palsy

3. Flexion / Extension Deformity

• Sagittal plane malalignment

4. Rotational Deformity

• Often under-recognised

• Important for cosmetic and functional outcome

Etiology

• Malunion after fracture (most common)

• Growth disturbance

• Physeal injury

• Congenital deformity

Clinical Presentation

• Cosmetic deformity

• Functional limitation (less common)

• Elbow instability (rare)

• Ulnar nerve symptoms (cubitus valgus)

Physical Examination

• Carrying angle assessment

• ROM evaluation

• Neurovascular examination

Always assess ulnar nerve function

Imaging

X-ray

• AP and lateral views

• Measure:

  • Carrying angle

  • Deformity plane

3D CT (Advanced)

• Complex deformities

• Preoperative planning

Indications for Treatment

Nonoperative

• Mild deformity

• No functional limitation

Operative

• Significant cosmetic concern

• Functional limitation

• Progressive deformity

• Ulnar nerve symptoms

Surgical Options

1. Osteotomy (Mainstay)

Types

Closing Wedge Osteotomy

• Most common

• Technically simple

Opening Wedge Osteotomy

• Allows gradual correction

• Requires graft

Dome Osteotomy

• Multiplanar correction

• Technically demanding

Step-Cut Osteotomy

• Good rotational control

• Stable construct

2. Fixation Methods

• Plates and screws

• K-wires (pediatric cases)

3. Ulnar Nerve Management

• Consider:

  • Anterior transposition

  • Especially in cubitus valgus

Preoperative Planning (Critical)

• Identify deformity:

  • Coronal

  • Sagittal

  • Rotational

Many deformities are multiplanar

Postoperative Management

• Early ROM (depending on fixation stability)

• Physiotherapy

• Monitor neurovascular status

Complications

• Loss of correction

• Nonunion

• Nerve injury (ulnar nerve)

• Infection

• Residual deformity

Prognosis

• Excellent cosmetic results

• Functional improvement variable

• Best outcomes with accurate planning

Pits & Pearls

• Cubitus varus is mainly a cosmetic problem

• Most deformities are multiplanar → plan carefully

• Stable fixation allows early motion

• 3D planning improves accuracy

Pitfalls

• Ignoring rotational deformity

• Inadequate correction

• Poor fixation

• Missing ulnar nerve involvement

Mini Decision Algorithm