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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

Femur: difference of 6

Anatomical axis
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!