Short Case Clinical Examination - Genu Valgum


  Important imformation from the patients in the short case might be

    Age of the patient

   Family History


                HME , Rickets and bony dysplasias might run in family .


   Deformity


O/e

   after exposure of both lower extremities from umbilicus to toes with an underwear


Gait  and Squatting - comment .They may have circumduction gait.

Standing - Genu Vlagum deformity

                  Quadriceps normal


                  Patella facing forward , forefoot normal



Side - any scars or not around knee

          knee in extension

          hip,  thigh , leg , ankle and foot normal alignment


Back

            Popliteal swelling ,

            thigh and calf normal looking normal

            heel in normal varus


              dont forget to measure Intermalleolar distance

              and Genu Valgum in standing

         

After Lying down

Palpation

          normal temperature compared to opposite side

          no soft tissue and bony tenderness

                 feel patella , facets of articular surface of femur with patella , medial condyle of femur ,                       joint line, medial condyle of tibia , MCL, Popliteal artery pulsation, lateral condyle of                           femur , joint line , lateral tibial condyle , fibular head

         Patella test - Glide , Apprehension , Clarke TEST

Movement

           Knee Flexion , Extension

            Deformity disappears after flexing knee



Measurement

  Leg length measurement and Q angle measurement in supine position


Special tests for MCL and LCL done .


Neurovascular examination

sensation , pulsation of DPA and Anterior tibial artery


Lateral positioning

 Ober's test done


At last or in the beginnning frontal bossing , tooth examination and ligamentous laxity quickly checked.


         

What is your diagnosis ?

Genu Valgum deformity .


What might be the underlying cause ?

 Physiologic Genu Valgum in 2-6 years

Trauma

 Rickets

 Infection

Bony Dysplasia

Ligamentous Laxity, Down's Syndrome , Hereditary Multiple Expostosis



How to proceed ?

X-ray in standing position leg alignment X-ray

   Tibiofemoral angle as per Selenius curve

     normal is 6 +/- 2 degrees

    following two points important for Genu Varum
                Metaphyseal diaphyseal angle of Levine and Drennan 

                             normal < 11 degrees , abnormal > 16 degrees 

                          Important to know in Tibia Vara to distinguish from Physiologic Bowing. (> 11 degrees indicates Tibia Vara

                   Metaphyseal epiphyseal angle normal < 20 degrees


Serum Ca, Phosphorous level , Vit. D level for Rickets


How to treat  ?

Treatment

  Observe

   Medical Treatment

  Bracing - STILL PRACTICED ,

   Surgical Treatment

         Guided growth

                  staples , advantage - reversible

        Osteotomy to correct the deformity















                   





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