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







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