Definition
- Increased carrying angle of the elbow
- Normal carrying angle is about 10 to 15 degrees, greater in females
- Measured between the long axes of the arm and forearm with the elbow extended and supinated
- Cubitus varus is the usual deformity after supracondylar fracture, while cubitus valgus follows lateral condyle problems
Aetiology
- Nonunion of a lateral condyle fracture, the most common cause
- Malunion of distal humeral fractures
- Lateral physeal growth arrest
- Turner and Noonan syndromes
- Radial head excision in adults can increase the carrying angle
Clinical Features
- Visible valgus with the elbow extended
- Compare the carrying angle with the other side
- Tinel and Froment signs for ulnar nerve involvement
- Intrinsic wasting in established neuropathy
Investigations
- AP and lateral radiographs of both elbows
- Lateral condyle nonunion shows a mobile, proximally migrated fragment
- Nerve conduction studies for ulnar neuropathy
- CT for osteotomy planning
Complications
- Tardy ulnar nerve palsy, often decades after injury
- Elbow instability and pain
- Fishtail deformity of the distal humerus
- Posterolateral rotatory instability in severe deformity
Management
- Observe if asymptomatic
- Ulnar nerve transposition for neuropathy
- Distal humeral varus osteotomy for symptomatic deformity
- See Cubital Tunnel Syndrome
- Osteotomy and nerve transposition are often combined
- Lateral condyle nonunion in children can be fixed with bone graft when the fragment is large
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.