Case 22 Genu Valgum

Case 22

Genu Valgum

Introduction

Exposure

Lower Extremity –

Gait     - Varus / Valgus thrust or walks slowly on a plodding manner loading knees on lateral compartment

Squating – Symmtrical with both the heels at the same level 

Alignment

           

Pelvis Leveled

            Both patella facing forward ,

Genu Valgum deformity on Right side

            Upper Extremity overlying Greater Trochanter

No flexion contracture at knee

Archs at feet normal

Posterior

( Measure Genu Valgum once you see this and continue downward ..)

Attitude not any partcular on lower extremities

Sitting again

Local Examination

Look               Skin / With our any Swelling / Discharge all around thigh / knee and leg

                        Quadriceps Wasting +

                        See other stigmata – Rickets , CP , Dysplasia, Ligamentous Laxity

Feel                 Temperature

                        Tenderness- not any over thigh / knee and leg

Movements     Flexion / Extension

                        Crepitations

Measurent – Q angle

                        Intermalleolar Distance

                        Leg Length Discripancy

                        Any Flexion Contracutre

Stability

                        Patellar Aprehension / Clark’s test / Patellar Tilt and Glide / Ober’s test                                   Varus / Valgus

                        Anterior Drawer,Posterior Drawer,Lachman’s ,End points

Distal Circulation

Distal Sensation

Examination – Hip / Ankle / Foot

Neurology – Sensation / power / Tone / Reflexes

Discussion

Describe the deformity

Description – 15 years old boy with a 15 degrees Genu Valgum Deformity Right Side with Intermalleolar distance of 12 CM with 15 degrees Q – angle with 2 cm quadriceps wasting without any Leg Length Descripency.

How to investigate this ?

Orthoscanogram LE Right Side

Serum Calcium and Vit. D level

X-ray hand to assess bone age

Treatment

Medical treatment with Calcium Supplement

Use of Splints

Surgery

Based on  Age

            Physis Open – Growth Modulation

            Physis Closed – Osteotomies at CORA