This document discusses genu varum (bow legs) and provides information on its normal development, differential diagnosis, assessment, and treatment. It notes that genu varum is normal in infants and typically resolves on its own by 18-24 months as the child begins walking. Persistent or worsening bowing after age 2 may indicate an underlying condition. Common causes include physiologic bowing, Blount's disease, rickets, and bone dysplasias. Assessment involves history, exam of limb alignment and growth, and full-length radiographs. Treatment depends on the etiology but may include stretching, bracing, or corrective osteotomy.

1. GENU VARUM BY DR. AHMED a. Mostafa Q.C.H. 2011

3. Genu valgum( knock-knees )

4. Very unusual!

5. Antero-lateral ? neurofibromatosis?

6. Postero-medial ? leg length difference?

7. Antero-medial ? fibular deficiency?What’s normal ?

11. Maximal varus is present at 6 to 12 msof age.

12. With normal growth, the lower limbs gradually straighten with a zero Tibio femoral angle by 18 to 24 months of age. (when the infant begins to stand and walk). Asian Journal of Sports Medicine, Vol 1 (No 1), March 2010, Pages: 46-53

14. Valgus deformity is maximal at around age 3-4 years (12 degrees).

16. The greater degree of valgus in females may be due to their wider pelvis.

17. Differential diagnosis of genu varum: Physiologic Pathologic A. Blount’s disease B. Hypophosphatemic or nutritional rickets C. Posttraumatic D. Postinfectious E. Congenital deformities F. Focal fibrocartilaginous dysplasia G. Metaphysealchondrodysplasia H. Fibrous dysplasia I. Osteogenesisimperfecta J. Renal osteodystrophy

19. May be due to persistence of severe physiologic bowlegs (the most common etiology), a pathologic condition, or a growth disorder.11 Persistent genu varum in the older child

21. Focal and systemic conditions may lead to the deformity.

25. Developmental milestones,

26. Other nutritional or medical problems.

27. History of trauma or infections

28. Exogenous metal intoxication , (lead and fluoride).

30. Limb deformities and presence of short stature may indicate the possibility of bone dysplasia or a generalized growth disorder.

32. ASSESSMENT Examination :

35. Done in stance and supine.

36. Greater than 6 cm is abnormal.

37. Ruling out the deformity of the feet e.g. metatarsus varus or valgus which may represent torsional deformity of the limb .

42. 36 Take radiograms when : A 3 years and older and the varusdeformity is not improving or is getting worse, The medial bowing is unilateral or asymmetric, The angulation is acute in the proximal tibialmetaphysis immediately below the knee, The possibility of a pathologic condition.

48. Localized.

49. Progressive.

50. Not expected for age.Exaggerated physiologic deformities:

52. TREATMENT

60. The brace is worn until the deformity has been corrected which usually takes about 1 year.

63. GENU VARUM FROM INFANCY TO ADULT LIFE

64. NORMAL VARUS IN INFANCY Corrects spontaneously

65. Pathological GENU VARUM Blount’s disease Rachitic

66. Osteoclasis at age of three correction and plaster

67. Rachitic bow legs Tibia vara legs straight

68. Late rickets bialateral osteotomy

69. Blount disease infracondlyar osteotomy

70. FEMORAL BOW LEGS Bilateral supraconylar osteotomy

71. O.A. G.VARUM High tibialostetomy Standing films are essential

72. POST-TRAUMATIC GENU VARUM Depressd medial condyle inspite of fixation Corrective osteotomy and bone graft

73. OSTEOMYELITIS GROWTH PLATE AFFECTION GENU VARUM

74. CHONDROSTEODYSTRPHY MULTIPLE EPIPHYSIO-METAPHYSEAL 4 YEARS 9 YEARS

75. RENAL RICKETS Age ten years

76. RENAL RICKETS Pseudo-fractures,wide epiphyseal plate

77. OSTEOGENESIS IMPERFECTA Sofield multiple level osteotomies

78. Thank you

79. Principles of Evaluation and Treatment; Genu varum is physiologic until the age of 18 to 24 months, and treatment is unnecessary.

80. (2) In a child with normal stature and findings compatible with physiologic bowing, radiographic documentation is unnecessary. Photographs are less expensive and just as valuable.

81. (3) If radiographs are deemed necessary, full-length standing films of the entire lower limbs are required for the evaluation of the mechanical axis and the site of deformity. (4) Shortness of stature should signal the likelihood that a constitutionaldisorder is the cause of genu varum.

82. (5) Idiopathic tibia vara is the most common pathologic cause of bowlegs in the child. Bracing may be effective in the early stages, but this has not been established by prospective controlled clinical trials.

83. (6) Surgical correction of tibia vara can be guided by the principle that reestablishing a normal mechanical axis in the early stages will allow normal growth to occur.

84. (7) There are various types of internal and external fixation, all of which are satisfactory. (8) Treatment of genu varumsecondary to constitutional disorders must be tailored on an individual basis.