Dr.V.Sarthy

Asst Professor

Dept of Orthopaedics

SSSMCRI

COXA VARAGENU VARUMGENU VALGUM

Parts Of a Bone

epiphysis

Growing Bone

Growth plate

Growing Bone

Describing deformities….

Coxa.Genu.Cubitus.Hallux.Mannus.Talipes.Pes.Etc….

Varus & Valgus

In relation of the DISTAL, part to the MID-LINE

Genu

Genu

Coxa

Cubitus

NORMAL VALGUS VARUS

Heel.

Hallux.

Coxa Vara

•The normal femoral neck–shaft angle is 160 degrees at birth, decreasing to 125 degrees in adult life. An angle of less than 120 degrees is called coxa vara.

COXA VARA

• Defect of endochondralossification in the medial part of the femoral neck.

CONGENITAL ACQUIRED

• Coxa vara can develop if the femoral neck bends or if it breaks.

Congenital Coxa Vara.

Management.• H-E Angle 40 – 60 degree : OBSERVE

• >60 degree : Corrective VALGUS Osteotomy.

Acquired Coxa Vara.

•Rickets.

•Osteo Dystrophies.

•Perthes Disease.

•Epiphyseolysis.

•Osteomalacia.

•Fibrous Dysplasia.

•Infection.

•Tumor.

•Pagets Disease.

•Pathological Fracture.

•Fracture Malunion.

In Children: Adults/ Any age:

Treatment.• Only if there is MARKED Shortening.

• Corrective Osteotomy.

Genu Varum & Genu Valgum

Knock Knees Bow Legs

BOW LEGS AND KNOCK KNEES IN CHILDREN

•Physiological bow legs and knock knees:

• Bow legs in babies and knock knees in 4-year-olds are so common that they are considered to be normal stages of development.

Physiological – Most of the time.

When to Worry?

• In the occasional case where, by the age of 10, the deformity is still marked

• - (i.e. the intercondylar distance is more than 6 cm or the intermalleolar distance more than 8 cm), operative correction should be advised.

What to Measure:

Inter Malleolar Distance.(< 8 cm)

Inter Condylar Distance.(< 6 cm)

How to Treat?•Hemi Epiphyseodesis.

•Stapling.

•Corrective Osteotomy.

•Distal Femoral

•Proximal Tibial.

Pathological Bow leg & Knock Knee.Disorders which cause distorted epiphyseal and/or

physeal growth may give rise to bow leg or knock knee:

• Skeletal dysplasias.

• The various types of Rickets.

• Injuries of the epiphyseal and physeal growth cartilage.

Management.

•Treat the Primary cause if possible.

• If angulation is severe, operative correction will be

necessary, but it should be deferred until near the

end of growth lest the deformity recur with further

growth.

Corrective Osteotomy.

Blounts Disease.

• This is a progressive bow-leg deformity associated with abnormal growth of the posteromedial part of the proximal tibia.

Pathology.

Clinical Features:

•Over Weight Children.

•Early Walkers.

•Common among Negroid Children.

•Bilateral in 80%

X-Ray.

Metaphyseo – Diaphyseal Angle < 11 degrees - Normally)

Management.

•Progressing Deformity:

•Surgical Correction:

1. Corrective Osteotomy.

2. Elevation of the Epiphysis.

3. Excision of the bony bar & Fat pad placement.

4. Always perform a Fasciotomy to avoid Compartment Syndrome.

5. If Shortening ensues- Perform Lengthening at a later stage.

Osteotomy & Epiphyseal Elevation.

Osteotomy, Epiphyseal Elevation.

Genu Varum & Valgum in Adults.

•Sequel to childhood deformities.

•Secondary to:

•Arthritis.

•Ligamentous Injuries.

•Fractures.

•Pagets Disease.

Management.

•With No Associated Arthritis: Corrective Osteotomy.

•Uni Compartmental Arthritis:

•Corrective Osteotomy or Partial Joint Replacement.

•Bi Comparmenntal Arthritis:

•Total Joint Replacement.

What is this?

Thank You.