Houston Methodist. Leading Medicine

Elbow FAQ

Question:

Our eight-year-old fell while at the new skate park in our neighborhood. Broke her arm above the elbow. Had surgery to repair the problem but ended up with a funny curved look to the elbow. Should we do something about this? It's really just a cosmetic issue. She can use her arm fine.

Answer:

It sounds like your daughter may have ended up with an elbow deformity called cubital varus. This is a common problem in children who have a supracondylar elbow fracture. A supracondylar fracture occurs in the lower portion of the humerus (upper arm bone) just above the elbow. In the normal arm, the bottom end of the humerus flares out on each side forming a part of the bone called the condyles. A fracture just above the condyle is a supracondylar fracture. A cubitus varus deformity gives the elbow an unnatural outward curved angle -- like a bowed leg only affecting the elbow instead. Cubitus refers to the inner soft side of the elbow. Varus is the outwardly bowed angle. When the person with cubitus varus looks down at the carrying angle of the elbow, it's curved in the opposite direction from normal. Correction of the elbow deformity isn't always necessary because there isn't a loss of function. The shoulder works together with the elbow to make up any missing motion. Cosmesis (appearance) requiring surgery may be an issue for some people. There is also the aspect of other complications that can occur later. For example, the uneven angle can put more pressure on one side of the elbow than the other. Arthritis may be a natural result of the uneven load on the joint. This problem is not as common in the elbow joint as it is in the knee, but it can happen. Another problem that can develop is a nerve palsy. The ulnar nerve runs along the inside edge of the elbow. The varus position changes where the muscles are located enough to put compression on the ulnar nerve. Loss of normal sensation and/or motor function can occur. The nerve can be moved slightly to form a different pathway down the arm. This procedure is called a nerve transposition. The best way to find out what is needed for your daughter is to see the surgeon who did the original surgery for an evaluation. If that's not possible, then look for another surgeon, possibly one who specializes in arm and hand surgery. He or she will be able to evaluate your daughter and formulate the best plan based on current knowledge and information about this condition. Takehiko Takagi, MD, et al. Supracondylar Osteotomy of the Humerus to Correct Cubitus Varus: Do Both Internal Rotation and Extension Deformities Need to be Corrected? In The Journal of Bone and Joint Surgery. July 2010. Vol. 92-A. No. 7. Pp. 1619-1626.

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