BINISHA SEBBY
ROLL NO 21
ANATOMIC AXIS
OF FEMUR
Normal knee is
approximately 6° valgus
(5-7degree)
ANATOMIC AXIS
OF TIBIA
PHYSIOLOGICAL
Bow legs &
Knock knees
Considered as normal stages of development
Usually disappears when child grows ,around 7-8 yrs
By age of 10 , still marked – Operative correction
Stapling of physes
Corrective osteotomy
Hemi epiphysiodesis
GENU VARUM
Lateral angulation of the
knee with longitudinal axis
of both tibia and femur
deviating medially.
Also called as BOW LEGS
UNILATERAL BILATERAL
E Growth abnormalities of upper tibial epiphysis Congenital causes
T Infections like osteomyelitis Postural abnormalities
I Trauma near growth epiphysis of femur Developmental disorders
O
Tumour affecting lower end of femur & Metabolic disorders(rickets)& Endocrine
upper end of tibia disorders
L Degenerative disorders (Osteoarthritis of
knee)
O
Occupational disorders
Idiopathic
G Paget’s disease
Y Blounts disease ( tibia vara)
BLOUNTS DISEASE
Abnormal growth of posteromedial part of proximal tibia
Growth plate near the inside of the knee either slow down
or stop making new bone.
Children usually over weight & early walkers
Ugly deformity - complaint
Spontaneous resolution rare
X RAY
Proximal tibial epiphysis flattened medially
Adjacent metaphysis beak shaped
TREATMENT
Corrective osteotomy
Hemi epiphysiodesis
CLINICAL FEATURES
PRIMARY DEFORMITY SECONDARY DEFORMITY
Lateral angulation of knee Internal torsion of distal tibia
In toeing of both feet
Patella face outward while walking
Tight medial & lax lateral structures
CLINICAL ASSESSMENT
INTERCONDYLAR DISTANCE
Distance between knees with child standing and
heels touching
Normal : < 6 cm
Genu Varum - Increased
PLUMB LINE TEST
Normally a line drawn from ASIS
to middle of patella, if extyended
down strikes the medial malleolus
GENU VARUM: Medial malleolus
will be medial to this line
TREATMENT
Lateral epiphyseal stapling
OSTEOTOMY
Lateral closing wedge osteotomy Medial opening wege osteotomy
GENU VALGUM
Medial angulation of knee
with outward deviation of
longitudinal axis of both tibia
and femur
Also called as KNOCK KNEE
E Trauma
UNILATERAL BILATERAL
Congenital disorders
T Osteomyelitis Idiopathic
I Tumors Developmental disorders(eg. Epiphyseal dysplasia)
O
Endocrine disorders(eg. Thyroid disorders)
Metabolic disorders(eg. Rickets)
L Paralytic disorders
O Traumatic disorders
G
Infective disorders
Inflammatory disorders(Rheumatoid arthritis)
Y Degenerative disorders
CLINICAL FEATURES
PRIMARY DEFORMITY SECONDARY DEFORMITY
Medial angulation of knee Distal end of femur & proximal tibia
rotated externally
Compensatory internal torsion of distal
tibia
Lateral dislocation of patella
Tight lateral & lax medial structures
Flat foot
CLINICAL ASSESSMENT
INTERMALLEOLAR GAP
Distance between the 2 medial malleoli
when knees are lightly touching and
patella facing forwards.
Normal : <8 cm
Genu valgum – Increased, >10 cm
PLUMB LINE TEST
Normally a line drawn from ASIS
to middle of patella, if extyended
down strikes the medial malleolus
GENU VALGUM: Medial malleolus
will be lateral to this line
Q ANGLE
Angle formed between Quadriceps muscle
and patellar tendon
Draw a line from ASIS to the midpoint of
patella and then from the midpoint of the
patella to the tibial tubercle. Angle formed
between.
Normal Males – 14 degree
Females – 17 degree
Genu Valgum – Increased Q angle
TREATMENT MILD (Around 4 years)
Medial heel raise Knock knee braces Medial epiphyseal stapling
Severe ( > 10 cm IM at 10 years )
OSTEOTOMY
Medial Closing wedge osteotomy Lateral Opening wedge Osteotomy
