Uncovered posterolateral rotatory elbow instability with cubitus varus deformity correction

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Elbow Biomechanics

Background:

• Cubitus varus deformity, often resulting from childhood supracondylar fractures, can predispose individuals to elbow instability.
• Posterolateral rotatory instability (PLRI) is a complex condition involving the lateral collateral ligament (LCL) complex.
• Delayed diagnosis of LCL deficiency can occur in the presence of cubitus varus, even without initial instability symptoms.

Observation:

• A young male patient with a history of childhood supracondylar fracture presented with longstanding cubitus varus.
• Following a corrective distal humeral osteotomy, the patient developed symptomatic PLRI and LCL deficiency.
• Associated findings included medial olecranon overgrowth, causing triceps snapping and secondary ulnar neuropathy.

Findings:

• Surgical intervention involved LCL reconstruction using a free triceps tendon graft and an extra-articular olecranon osteotomy.
• The graft was secured with bioabsorbable screws, and the triceps vector was laterally redirected.
• The patient achieved a full recovery with no residual symptoms at the final follow-up.

Implications:

• This case underscores the potential for occult PLRI in patients with cubitus varus, necessitating careful evaluation.
• It highlights the importance of addressing LCL integrity during corrective osteotomies for cubitus varus.
• Lateralizing the triceps vector and LCL reconstruction may be crucial adjuncts in preventing or treating post-osteotomy instability.