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Genu varum
and Genu valgum
Etiology – Incidence – Diagnosis
R. Ganger, MD, PhD
Orthopaedic Hospital Vienna – Speising (www.oss.at)
Department of Pediatric Orthopaedic Surgery (F. Grill)
Lower Limb Development
Frontal plane alignment:
• Physiologic variations: the range of normal knee angles
changes with age
• Account for the greatest number of referrals
(including torsional problems) of children to orthopaedists
- Genu varum: bow legs
- Genu valgum: knock knees
Lower Limb Development
Frontal plane alignment:
• Genu varum: bow legs
• Genu valgum: knock knees
Lower Limb Development
Frontal plane alignment:
• Genu varum: bow legs
• Genu valgum: knock knees
Newborn 6 months 18 months
30 months 4-6 years
Lower Limb Development
Frontal plane deformities:
• Genu varum or Genu valgum outside normal range (+/- 2 SD)
• Normal or abnormal
• History: inquire about the onset
• was there an injury, illness
or infection?
• is the deformity progressing?
• is the general health good?
• are other familiy members affected?
Lower Limb Development
Frontal plane deformities:
• Genu varum or Genu valgum outside normal range (+/- 2 SD)
• Normal or abnormal?
- Body height and body proportion
- Other present deformities
- Unilateral or bilateral
- Leg length difference
- Laboratory examination: metabolic?
Lower Limb Development
Frontal plane deformities:
• Genu varum or Genu valgum outside normal range (+/- 2SD)
• Warnings:
- Asymmetrical deformity
- Progression
- Pain
- Leg length difference
Lower Limb Development
Frontal plane alignment:
• Standard imaging: AP-long leg standing radiogram,
patella pointing straight forward
incorrect correct
Lower Limb Development
Frontal plane alignment:
• Standard imaging: Teleradiogram
Normal alignment
but LLD:
left side: - 3 cm
Lower Limb Development
Frontal plane alignment:
• The majority of children with bow legs before age of 2 yrs. and
knock knees presenting before 6 yrs. will resolve spontaneously
Natural history:
• benign
• selfcorrecting deformity
Correction devices (twister cables, night splints, shoe wedges)
are unnecessary.
Anual clinical checks are recommended.
Lower Limb Development
Frontal plane malalignment:
• The minority of children with unilateral deformity, progression,
leg length discrepancy and pain need further investigation.
Pathological genu varum / valgum:
• M. Blount
• Rickets, Vit.D - resistent rickets,
• Deformities after infection, trauma,
tumor.
Lower Limb Development
Frontal plane malalignment:
• M. Blount
Lower Limb Development
Frontal plane malalignment:
• Epi-, metaphyseal dysplasia:
Lower Limb Development
Frontal plane malalignment:
• Pseudoachondroplasia:
Lower Limb Development
Frontal plane malalignment:
• posttraumatic:
Lower Limb Development
Frontal plane malalignment:
• after infection:
Lower Limb Development
Frontal plane alignment:
Goal:
• Physiological deformities are best observed
• Pathological deformities are treated surgically to achieve
straight legs at same length
Lower Limb Development
Normal lower limb alignment: Diagnosis
Frontal plane:
• Mechanical axis
Lower Limb Development
Normal lower limb alignment: Diagnosis
Frontal plane:
• Anatomical axis
Lower Limb Development
Normal lower limb alignment:
Frontal plane:
• Mechanical axis
versus
• Anatomical axis
Femur:
difference of 6°
Tibia:
same
Lower Limb Development
Normal lower limb alignment:
Sagittal plane:
Lower Limb Development
Lower limb malalignment: Diagnosis
Deformity analysis:
Frontal plane:
• Varus, valgus, translation
Sagittal plane:
• Antecurvation, recurvation, translation
Axial plane:
• Rotation, lengthening or shortening
Lower Limb Development
Malalignment test acc. to Paley and Herzenberg:
• Identify the source(s)
of the
mechanical axis
deviation
Femoral deformity
Lower Limb Development
Malalignment test:
• Identify the source(s)
of the
mechanical axis
deviation
Tibial deformity
Lower Limb Development
Malalignment test:
• Identify the source(s)
of the
mechanical axis
deviation
Femoral and tibial
deformity
Lower Limb Development
Tibial mechanical axis planning:
Frontal plane:
Lower Limb Development
Tibial mechanical axis planning:
Frontal plane:
Lower Limb Development
Tibial mechanical axis planning:
Frontal plane:
• Digital planning
with
TraumaCad
program
Lower Limb Development
Tibial mechanical axis planning:
Frontal plane:
• Digital planning
with
TraumaCad
program
Lower Limb Development
Tibial mechanical axis planning:
Frontal plane:
• Digital planning
with
TraumaCad
program Deformity: 4°
Correction: 8.5°
With Auto Alignment:
MAD 7mm med
Individual Alignment:
MAD 1mm med
Lower Limb Development
Tibial mechanical axis planning:
Frontal plane:
• Digital planning
with
TraumaCad
program
Lower Limb Development
Tibial mechanical axis planning:
Frontal plane:
• Digital planning
with
TraumaCad
program
Thank you for your attention!
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