A combination of osteotomy and ligament reconstruction is recommended for posterolateral rotatory instability (PLRI) with large cubitus varus deformities. There is a lack of reports regarding ligament donor selection for ligament reconstruction of PLRI with cubitus varus. Two cases of PLRI with cubitus varus have been described. In case one, a 40-year-old woman presented with left elbow pain. She had a cubitus varus deformity, resulting from a childhood elbow fracture. Radiographs showed an 18-degree cubitus varus deformity. A lateral closing wedge osteotomy and double plate osteosynthesis were performed. The lateral collateral ligament (LCL) was reconstructed with autologous triceps fascia. Postoperative radiographs confirmed correction with 10 degrees of the carrying angle (CA). Bone union at the osteotomy site occurred six months later with excellent results. In case two, a 45-year-old man presented an arm with persistent right elbow instability with cubitus varus deformity. This was due to a childhood supracondylar fracture of the right humerus. Radiographs showed a cubitus varus deformity of 25 degrees on the right. The surgical procedure included a lateral wedge osteotomy, double plate fixation, and LCL reconstruction with autologous triceps fascia. Postoperative radiographs confirmed a corrected CA of 5 degrees. Bone union was achieved at the six-month follow-up with satisfactory results. The use of triceps fascia for LCL reconstruction for PLRI due to cubitus varus would provide a minimally invasive and reasonable treatment option.

UNASSIGNED: The aim of this study was to assess the clinical and radiographic outcomes of cubitus varus treatments based on different fixation methods: Locking plate vs. Kirschner-wires (K-wires) and cast fixation.
UNASSIGNED: This retrospective study of 28 patients was performed in lateral-wedge osteotomy for cubitus varus deformity in our hospital from July 2018 to July 2020. 14 patients in group A were treated by locking plate after lateral closing-wedge osteotomy, whereas other 14 patients were treated by K-wires in group B. We measured the bony union and carrying angle. The clinical and radiographic outcomes were assessed according to the Bellemore criteria.
UNASSIGNED: No nonunion, neurovascular injury or myositis ossificans was noted at follow-up. In group A, 1 patient with lateral condylar prominence was found. In group B, 2 patients with pinning site infection were treated successfully with oral antibiotics and 2 patients needed revision surgery for residual varus. According to the Bellemore criteria, statistically significant difference was noted between the two groups (P = 0.0458). In the present study, no statistically significant difference was noted in the length of incision and operation time between the 2 groups (P > 0.05). However, the postoperative carrying angle was significantly different at final follow-up between the 2 groups (P < 0.01).
UNASSIGNED: Compared with K-wires and cast fixation, we recommend the wedge osteotomy with lateral locking plate to treat the cubitus varus deformity because locking plate could achieve better functional and cosmetic results and stabilize the distal humerus rigidly.

UNASSIGNED: Cubitus varus, a common post-traumatic deformity of the elbow in children, poses challenges for both patients and surgeons. Step cut osteotomy has emerged as a reasonable surgical technique to address this condition, offering multiple approaches and modifications.
UNASSIGNED: We present a comprehensive systematic review of techniques for step cut osteotomy in cubitus varus, analyzing 13 studies that meet our inclusion criteria. These studies encompass diverse patient populations, including pediatric and adult cases, and span different geographical regions.
UNASSIGNED: Our systematic review explores three primary osteotomy techniques-Classic Step-Cut Osteotomy, Reverse V Osteotomy, and Modified Step Cut Osteotomy-along with their modifications, providing surgeons with valuable options for individualized correction. Functional outcomes showcase improvements in range of motion, functional scores, and carrying angle, highlighting the technique\'s efficacy in restoring elbow function and enhancing quality of life. Radiological evaluations demonstrate successful corrections of various angles and achievement of bony union, reinforcing the stability and anatomical improvements achieved through step cut osteotomy.
UNASSIGNED: Complication rates are notably low, with transient nerve palsies being the most commonly encountered, often resolving within months. Implant failure and other complications are infrequent, underlining the safety and reliability of step cut osteotomy as a surgical intervention for cubitus varus.While the predominance of retrospective studies and heterogeneity across included studies warrant caution, our systematic review provides a robust and diverse synthesis of evidence. It underscores the significance of step cut osteotomy in managing cubitus varus deformity, emphasizing its versatility, favourable outcomes, and safety profile. Further research with rigorous designs and longer follow-up periods will enhance our understanding of step cut osteotomy\'s role in cubitus varus correction.

OBJECTIVE: Common complications of lateral condylar fractures are lateral condylar overgrowth, lateral bony spur and cubitus varus. Lateral condylar overgrowth or lateral bony spur may appear as cubitus varus on gross examination. Such gross cubitus varus without actual angulation is pseudo-cubitus varus, while a difference of more than 5° in varus angulation on X-ray is true cubitus varus. This study aimed to compare true and pseudo-cubitus varus.
METHODS: One hundred ninety-two children treated for unilateral lateral condylar fracture with a follow-up period of over six months were included. The Baumann angle, humerus-elbow-wrist angle and interepicondylar width of both side were compared. More than 5° in varus angulation on X-ray was considered cubitus varus. Increase in interepicondylar width was considered lateral condylar overgrowth or a lateral bony spur. The risk factors that could predict the development of a true cubitus varus were analyzed.
RESULTS: True cubitus varus was 32.8%, measured by Baumann angle and 29.2%, measured by humerus-elbow-wrist angle. A total of 94.8% of patients showed an increased interepicondylar width. The predicted cut-off value for 5° varus angulation on the Baumann angle was a 3.675 mm increase in interepicondylar width by ROC curve analysis. The risk of cubitus varus in stage 3, 4, and 5 fractures according to Song\'s classification was 2.88 times higher than that in stage 1 and 2 fractures on multivariable logistic regression analysis.
CONCLUSIONS: Pseudo-cubitus varus is more prevalent than true cubitus varus. A 3.7 mm increase in interepicondylar width could simply predict true cubitus varus. The risk of cubitus varus increased in Song\'s classification stages 3, 4, and 5.

UNASSIGNED: This study aimed to determine the functional and radiographic outcomes following corrective distal humeral osteotomies for the treatment of supracondylar fracture malunions in children. We hypothesized that such secondary reconstructive procedures could restore a reasonable and near-normal amount of functionality in a large patient cohort at a tertiary referral center.
UNASSIGNED: We retrospectively reviewed the clinical and radiological records of 38 children who underwent corrective osteotomy for posttraumatic supracondylar humeral malunion using K-wire fixation. All clinical data were extracted after chart review, including age, sex, dominant side whenever available, follow-up duration, and elbow range of motion preoperatively and at the final visit. Radiographic parameters, including Baumann\'s angle, humeroulnar angle, humerocondylar angle, and elbow range of motion were evaluated preoperatively, postoperatively, and at the final visit to identify the surgical correction outcomes.
UNASSIGNED: The mean age of the patients at fracture was 5.6 (±2.7) years, and the mean age at surgical intervention was 8.6 (±2.6) years. The mean follow-up period of the current series was 28.2 (±31.1) months. Baumann\'s angle, humeroulnar angle, and humerocondylar angle were successfully restored to physiological ranges (72.6°, 5.4°, and 36.1°, respectively). Postoperatively, elbow extension improved from -22° (±5.7) to -2.7° (±7.2) versus flexion from 115° (±13.2) to 128.2° (±11.1). Three revision surgeries (8%) were encountered.
UNASSIGNED: Corrective osteotomy of the distal humerus with K-wire fixation is a reliable method to efficiently correct malunion of the distal humerus in different planes, thereby improving elbow range of motion and appearance.
UNASSIGNED: level IV: Retrospective therapeutic study.

Background: Cubitus varus deformity is a common complication of untreated elbow fractures in children. However, cubitus varus in osteogenesis imperfecta (OI) children is a rare but challenging situation. To the author\'s knowledge, this is the first study discussing the correction of cubitus varus deformity in patient with OI. Case Presentation: Here we report a case of a 7-year-old OI girl with cubitus varus deformity due to a supracondylar fracture of humerus 3 year ago. The patient\'s parent gave a history of supracondylar fracture of left humerus in 2015. Without medical intervention, the patient was admitted into our institution for corrective surgery with the diagnosis of osteogenesis imperfecta and cubitus varus deformity in the left arm. Result: Medications including calcium, vitamin D and bisphosphonates were administered before the corrective surgery of cubitus varus, and a single locking plate was used to fixate the osteotomy. After the surgery, the appearance and range of motion (ROM) of the left arm was almost normal. Combined with gradual rehabilitation, the ROM of the left arm was normal without pain during daily use within the 1-year follow up. The hardware was removed as the nailing of the forearm fractures was performed at the same time. In the latest follow-up in September 2021, the appearance and ROM of the left arm was normal. Conclusion: Cubitus varus is a common deformity in children with elbow injuries, but it presents a challenging situation in compound fractures in OI patients. Locking plate combined with meticulous pharmacological intervention provides a good option for corrective surgery of cubitus varus in patients with OI.

BACKGROUND: After displaced supracondylar humerus fractures (SCHF) in children, residual deformities are common with cubitus varus (CV) being the clinically most visible. Distal fragment malrotation may lead to instability, fragment tilt and subsequent CV. Detection and assessment of malrotation is difficult and the fate of post-traumatic humeral torsion deformity is unknown. The aim of this study was to evaluate the incidence of humeral torsion differences in children with surgically treated SCHF and to observe spontaneous changes over time.
METHODS: A cohort of 27 children with displaced and surgically treated SCHF were followed prospectively from the diagnosis until twelve months after trauma. Clinical, photographic, sonographic and radiological data were obtained regularly. Differences in shoulder and elbow motion, elbow axis, sonographic humeral torsion measurement and radiological evaluation focusing on rotational spur were administered.
RESULTS: Six weeks after trauma, 67% of SCHF children had a sonographically detected humeral torsion difference of > 5° (average 14.0 ± 7.6°). Of those, 44% showed a rotational spur, slight valgus or varus on radiographs. During follow-up, an average decrease of the difference from 14° (six weeks) to 7.8° (four months) to 6.5° (six months) and to 4.9° (twelve months) was observed. The most significant correction of posttraumatic humeral torsion occurred in children < 5 years and with internal malrotation > 20°.
CONCLUSIONS: After displaced and surgically treated SCHF, most children had humeral torsion differences of both arms. This difference decreased within one year after trauma due to changes on the healthy side or correction in younger children with severe deformity.
UNASSIGNED: Therapeutic Level IV.

Preoperative planning is of paramount importance in saving time as well as helping achieve a more precise correction of the deformities. Along with preoperative measurements, customized cutting guides can facilitate intraoperative correction of the deformity with higher confidence. In this report, we are presenting the application of preoperative planning and 3D printed customized cutting guides for correcting cubitus varus alignment of the elbow in an 18 year old male with satisfactory intraoperative and postoperative results.

Elbow injuries are common in children and while majority heal very well, some result in deformities of the elbow. Although deformities such as cubitus varus and non-progressive cubitus valgus are considered cosmetic by the paediatric orthopaedic surgeons and intentionally ignored, they are not always benign and can result in functional deficit due to instability, pain, tardy nerve palsies and osteoarthritis later in life. Similarly congenital and developmental conditions that do not cause major functional loss in childhood, become very disabling in adults due to increasing functional demands. Congenital radial head dislocation and radioulnar synostosis fall into this category. In this paper we discuss clinical presentation, treatment options and outcomes of common elbow conditions presenting later in the life.

BACKGROUND: Cubitus varus has been regarded as poor functional and cosmetic consequences of supracondylar humerus fracture in children. The aim of this study was to assess the clinical and radiologic outcomes of cubitus varus based on fixation methods: K-wire and cast fixation or external fixation.
METHODS: 40 consecutive patients with cubitus varus secondary to supracondylar fractures were enrolled between October 2015 and December 2018. Following lateral closing-wedge osteotomy, the method of K-wire and cast fixation was chosen as group A (n = 21) while the method of external fixation was defined as group B (n = 19), retrospectively. We measured the bony union, elbow joint range of motion, and carrying angle. The clinical and radiographic results were assessed according to the Bellemore criteria.
RESULTS: No significant difference between the 2 groups in terms of age, gender, operation duration, union time, and postoperative elbow range of motion (P > .05). A significant difference was noted in postoperative carrying angle and results according to Bellemore criteria in group B (P < .05). No nonunion, myositis ossificans, or neurovascular injury was found at follow-up in 2 groups. In group A, revision surgery was needed for residual varus in 1 patient and lateral condylar prominence was found in 2 patients. In group B, a superficial pin-site infection occurred in 2 patients who were treated successfully with oral antibiotics.
CONCLUSIONS: Both K-wire and external fixation after lateral closing-wedge osteotomy are reliable and effective for the treatment of cubitus varus in children. Compared with K-wire method, external fixation could achieve better functional and cosmetic results with a shorter learning curve.