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GENU VARUM

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CONTENTS

• INTRODUCTION

• CAUSES

• CLINICAL FEATURES

• EXAMINATION

• TREATMENT

• REFERENCES

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INTRODUCTION

• The three common deformities are genu varum (bow leg) genu valgum (knock knee) and genu recurvatum (hyperextended knee).• Genu varum is also called bow leg or tibia vara is a

physical deformity marked by (outward) bowing of the leg in relative to the thigh, giving the appearance of an archer’s bow.

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CAUSES

• Physiological/developmental• commonly occurs in childhood. • Bowed legs in a toddler is very common. When a

child with bowed legs stands with his or her feet together, there is a distinct space between the lower legs and knees. This may be a result of either one or both of the legs curving outward. Walking often exaggerates the bowed appearance. • gradually corrected spontaneously as the child

grows.

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Pathological

• Genu varum may also occur in adults. • In both children and adults it may occur as a

consequence of injury or disease. • Disorders which cause distorted epiphyseal and/or

physeal growth may give rise to bow leg or knock knee; • these include some of the skeletal dysplasias and

the various types of rickets, as well as injuries of the epiphyseal and physeal growth cartilage. • A unilateral deformity is likely to be pathological.

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Blount’s Disease• can occur in toddlers as well as in adolescents.• results from an abnormality of the growth plate in the upper part of

the tibia. • Growth plates determine the length and shape of the adult bone. In

a child under the age of 2 years, it may be impossible to distinguish infantile Blount’s disease from physiologic genu varum.

• By the age of 3 years, however, the bowing will worsen and an obvious problem can often be seen in an X-ray.

• Progressive; associated abnormal growth of the posteromedial part of the proximal tibia.

• The condition is bilateral in 80% of cases and black children are affected more. The condition is noticeably worse than in physiological bow legs and may include internal rotation of the tibia.

• Spontaneous resolution is rare.

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A child with Blount’s disease…

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Rickets

• bone disease in children that causes bowed legs and other bone deformities. • Children with rickets do not get enough calcium,

phosphorus or vitamin D.• Nutritional rickets unusual in developed countries. • can also be caused by a genetic abnormality that

does not allow vitamin D to be absorbed correctly. This form of rickets may be inherited.

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In adults…

• common in adults. • may be sequel to childhood deformity and if so usually cause no

problems. • However, if the deformity is associated with joint instability, this

can lead to osteoarthritis of the medial compartment.• Other causes include:• Fracture of the lower part of the femur or the upper part of the

tibia with malunion.• Osteoarthritis• Rarefying diseases of the bone such as rickets or osteomalacia.• Other bone-softening diseases such as Paget’s disease (osteitis

deformans)

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Clinical features

• deformity is usually gauged from simple observation. • Bilateral genu varum can be recorded by measuring the

distance between the knees with the patient standing and heels touching. • Internal rotation is also common in toddlers and

frequently occurs in combination with bowed legs. • The deformity typically do not cause pain. • During adolescence/adulthood however, persistent

bowing can lead to discomfort in the hips, knees, and/or ankles because of the abnormal stress that the curved legs have on the joints.

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Medial compartment in a varus deformity…

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Examination

• should begin with a thorough history taking. • followed by a careful physical assessment to exclude

underlying organic disorders; if necessary by radiographs. • If the patient is under 2 1/2 and has symmetrical bowing, an

X-ray may be required. The likelihood of having Blount’s disease or rickets is greater at this age.

• In Blount’s disease, the proximal tibial epiphysis is flattened medially and the adjacent metaphysis is beak-shaped. The medial cortex of the proximal tibia appears thickened. This is an illusory effect produced by internal rotation of the tibia.

• In contrast to physiological bowing, abnormal alignment occurs in the proximal tibia and not in the joint.

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Physiological… Pathological…

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Treatment

• Physiologic genu varum nearly always spontaneously corrects itself as the child grows. • This usually occurs by the age of 3 to 4 years. • Blount’s disease does not require treatment to improve. If the

disease is caught early, treatment with brace may be all that is needed. • Bracing is not effective however with adolescents with Blount’s

disease. • Untreated infantile Blount’s disease or untreated rickets results in

progressive worsening of the bowing in later childhood and adolescence. • For children with rickets, the condition can be managed with

medications.

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Surgical Treatment

• Physiologic genu varum• In rare instances, physiologic genu varum in the

toddler will not completely resolve and during adolescence, the bowing may cause the child and family to have cosmetic concerns. • If the deformity is severe enough, then surgery to

correct the remaining bowing may be needed.

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Surgical Treatment Cont’d

• Blount's disease. If bowing continues to progress in a child with infantile Blount's disease despite the use of a brace, surgery will be needed by the age of 4 years. Surgery may stop further worsening and prevent permanent damage to the growth area of the shinbone.• Older children with bowed legs due to adolescent

Blount's disease require surgery to correct the problem.• Rickets. Surgery may also be needed for children with

rickets whose deformities persist despite proper management with medications.

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Surgical Procedures

different procedures; two main types.• Guided growth. This surgery of the growth plate stops the

growth on the healthy side of the shinbone which gives the abnormal side a chance to catch up, straightening the leg with the child’s natural growth.• Tibial osteotomy. In this procedure, the shinbone is cut just

below the knee and reshaped to correct the alignment. • After surgery, a cast may be applied to protect the bone

while it heals. • Crutches may be necessary for a few weeks, and exercises

to restore strength and range of motion.

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Before… After…

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References

• Bowed Legs Reviewed by members of POSNA (Pediatric Orthopaedic Society of North America) @ http://orthoinfo.aaos.org/topic.cfm?topic=a00230 Accessed on 01/04/2015.• Hamblen, D. L., & Simpson, H. (2009). Adams's

outline of orthopaedics. Elsevier Health Sciences.• Solomon L, Warwick D, & Nayagam S. (Eds.). (2010).

Apley's system of orthopaedics and fractures. CRC Press.

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THANKS ALL!