GENU VALGUM & VARUM.pptx

GENU VALGUM & VARUM
Concise presentation on,
Etiology
Clinical Features
Clinical Assessment
Treatment
Osteotomy

Ref : Essential orthopaedics by Maheswari
Textbook of orthopedics by Ebnezar
Apley's System of Orthopaedics and Fractures

Prepared by Binisha Sebby
Final MBBS student,
Dr SMCSI MC,
Karakonam

1. GENU VARUM GENU VALGUM BINISHA SEBBY Dr SMCSI MC Karakonam

2. ANATOMIC AXIS OF FEMUR ANATOMIC AXIS OF TIBIA (5-7degree) Normal knee is approximately  6° valgus

3. PHYSIOLOGICAL Bow legs & Knock knees Considered as normal stages of development Usually disappears when child grows ,around 7-8 yrs By age of 10 , still marked – Operative correction Stapling of physes Corrective osteotomy Hemi epiphysiodesis

4. GENU VARUM Lateral angulation of the knee with longitudinal axis of both tibia and femur deviating medially. Also called as BOW LEGS

5. ETIOLOGY UNILATERAL BILATERAL Growth abnormalities of upper tibial epiphysis Congenital causes Infections like osteomyelitis Postural abnormalities Trauma near growth epiphysis of femur Developmental disorders Tumour affecting lower end of femur & upper end of tibia Metabolic disorders(rickets)& Endocrine disorders Degenerative disorders ( Osteoarthritis of knee ) Occupational disorders Idiopathic Paget’s disease Blounts disease ( tibia vara )

6. BLOUNTS DISEASE Abnormal growth of posteromedial part of proximal tibia Growth plate near the inside of the knee either slow down or stop making new bone.  Children usually over weight & early walkers Ugly deformity - complaint Spontaneous resolution rare

7. X RAY Proximal tibial epiphysis flattened medially Adjacent metaphysis beak shaped TREATMENT Corrective osteotomy Hemi epiphysiodesis  

8. CLINICAL FEATURES PRIMARY DEFORMITY SECONDARY DEFORMITY Lateral angulation of knee Internal torsion of distal tibia In toeing of both feet Patella face outward while walking Tight medial & lax lateral structures

9. CLINICAL ASSESSMENT INTERCONDYLAR DISTANCE Distance between knees with child standing and heels touching Normal : < 6 cm Genu Varum - Increased

10. PLUMB LINE TEST Normally a line drawn from ASIS to middle of patella, if extyended down strikes the medial malleolus GENU VARUM : Medial malleolus will be medial to this line

11. TREATMENT Lateral epiphyseal stapling

12. Lateral closing wedge osteotomy Medial opening wege osteotomy OSTEOTOMY

13. GENU VALGUM Medial angulation of knee with outward deviation of longitudinal axis of both tibia and femur Also called as KNOCK KNEE

14. UNILATERAL BILATERAL Trauma Congenital disorders Osteomyelitis Idiopathic Tumors Developmental disorders( eg. Epiphyseal dysplasia) Endocrine disorders( eg. Thyroid disorders) Metabolic disorders( eg. Rickets) Paralytic disorders Traumatic disorders Infective disorders Inflammatory disorders( Rheumatoid arthritis ) Degenerative disorders ETIOLOGY

15. CLINICAL FEATURES PRIMARY DEFORMITY SECONDARY DEFORMITY Medial angulation of knee Distal end of femur & proximal tibia rotated externally Compensatory internal torsion of distal tibia Lateral dislocation of patella Tight lateral & lax medial structures Flat foot

16. CLINICAL ASSESSMENT INTERMALLEOLAR GAP Distance between the 2 medial malleoli when knees are lightly touching and patella facing forwards. Normal : <8 cm Genu valgum – Increased, >10 cm

17. PLUMB LINE TEST Normally a line drawn from ASIS to middle of patella, if extyended down strikes the medial malleolus GENU VALGUM : Medial malleolus will be lateral to this line

18. Q ANGLE Angle formed between Quadriceps muscle and patellar tendon Draw a line from ASIS to the midpoint of patella and then from the midpoint of the patella to the tibial tubercle. Angle formed between. Normal Males – 14 degree Females – 17 degree Genu Valgum – Increased Q angle

19. TREATMENT MILD ( Around 4 years) Medial heel raise Knock knee braces Medial epiphyseal stapling

20. Severe ( > 10 cm IM at 10 years ) OSTEOTOMY Medial Closing wedge osteotomy Lateral Opening wedge Osteotomy