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

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Frontal plane alignment:
Genu varum: bow legs Genu valgum: knock knees

Newborn

6 months

18 months

30 months

4-6 years

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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?

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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?

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Frontal plane deformities:
Genu varum or Genu valgum outside normal range (+/- 2SD) Warnings:

- Asymmetrical deformity

- Progression
- Pain

- Leg length difference

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Frontal plane alignment:
Standard imaging: AP-long leg standing radiogram, patella pointing straight forward

incorrect

correct

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Frontal plane alignment:
Standard imaging: Teleradiogram

Normal alignment but LLD: left side: - 3 cm

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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.

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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.

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Frontal plane malalignment:
M. Blount

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Frontal plane malalignment:
Epi-, metaphyseal dysplasia:

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Frontal plane malalignment:
Pseudoachondroplasia:

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Frontal plane malalignment:
posttraumatic:

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Frontal plane malalignment:
after infection:

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Frontal plane alignment:

Goal:
Physiological deformities are best observed Pathological deformities are treated surgically to achieve straight legs at same length

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Normal lower limb alignment: Diagnosis
Frontal plane:

Mechanical axis

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Normal lower limb alignment: Diagnosis
Frontal plane:

Anatomical axis

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Normal lower limb alignment:
Frontal plane:

Mechanical axis
versus

Femur: difference of 6

Anatomical axis
Tibia: same

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Normal lower limb alignment:
Sagittal plane:

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Lower limb malalignment: Diagnosis
Deformity analysis:

Frontal plane: Varus, valgus, translation

Sagittal plane: Antecurvation, recurvation, translation Axial plane: Rotation, lengthening or shortening

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Malalignment test acc. to Paley and Herzenberg:
Identify the source(s) of the mechanical axis deviation

Femoral deformity

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Malalignment test:
Identify the source(s) of the mechanical axis deviation

Tibial deformity

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Malalignment test:
Identify the source(s) of the mechanical axis deviation

Femoral and tibial deformity

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Tibial mechanical axis planning:
Frontal plane:

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Tibial mechanical axis planning:
Frontal plane:

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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!