Introduction |
- Genu valgum is a normal physiologic process in children
- therefore it is critical to differentiate between a physiologic and pathologic process
- Epidemiology
- distal femur is the most common location of primary pathologic genu valgum but can arise from tibia
- Etiologies
- bilateral genu valgum
- physiologic
- renal osteodystrophy (renal rickets)
- skeletal dysplasia
- Morquio syndrome
- spondyloepiphyseal dysplasia
- chondroctodermal dysplasia
- unilateral genu valgum
- physeal injury from trauma, infection, or vascular insult
- proximal metaphyseal tibia fracture
- benign tumors
- fibrous dysplasia
- osteochondromas
- Ollier's disease
- Prognosis
- the threshold of deformity that leads to future degenerative changes is unknown
- deformity after a proximal metaphyseal tibia fracture (Cozen) should be observed, as it almost always remodels
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Anatomy |
- Normal physiologic process of genu valgum
- between 3-4 years of age children have up to 20 degrees of genu valgum
- genu valgum rarely worsens after age 7
- after age 7 valgus should not be worse than 12 degrees of genu valgum
- after age 7 the intermalleolar distance should be <8 cm
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Treatment |
- Nonoperative
- observation
- indications
- first line of treatment
- genu valgum <15 degrees in a child <6 years of age
- bracing
- indications
- rarely used
- ineffective in pathologic genu valgum and unnecessary in physiologic genu valgum
- Operative
- hemiepiphysiodesis or physeal tethering (staples, screws, or plate/screws) of medial side
- indications
- > 15-20° of valgus in a patient <10 years of age
- if line drawn from center of femoral head to center of ankle falls in lateral quadrant of tibial plateau in patient > 10 yrs of age
- technique
- to avoid physeal injury place them extraperiosteally
- to avoid overcorrection follow patients often
- growth begins within 24 months after removal of the tether
- distal femoral varus osteotomy
- indications
- insufficient remaining growth for hemiepiphysiodesis
- complications
- peroneal nerve injury
- perform a peroneal nerve release prior to surgery
- gradually correct the deformity
- utilize a closing wedge technique
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