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Low Cost Knock knees (Genu valgum) Surgery And Treatment

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Low Cost Knock knees (Genu valgum) Surgery And Treatment Powered By Docstoc
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    Knock Knees
      Genu
     Valgum

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     DEFINITION
• Defined by position of knees such that,
  when standing with knees together, the
  medial malleoli are not touching.




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 Normal Development
• Most children are “bowlegged” from birth
  until around 3 years old, then become
  “knock kneed” until age 4 to 5, and
  straighten towards adult alignment by age 6
  to 7.




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                   CAUSES
        Unilateral                         Bilateral
• Asymmetric growth:                • Physiological: common
                                    • Metabolic: renal
1-Trauma.                              osteodystrophy, rickets,
                                       hypophosphatemia.
2-Infection.                        • Neuromuscular: cerebral
                                       palsy.
                                    • Haemotological:
3-Tumor to tibia.                      myelodysplsia
                                    • Skeletal dysplasia:
                                       congenital dislocation of
                                       patella
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     Presentation
• Knees touch each other while
  standing.
• Legs are curved inwardly.
• Too much distance between feet.




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  EXAMINATION
In the consultation room:
1- Always compare the two
  knees.
2- Watch the patient walk.
3- Looks at the knees whilst
  standing.
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   Measurement of intermalleolar
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           distance
• intermalleolar
  distance is a Distance
  between two malleoli
  when the knees are
  gently touching with
  legs in adduction.
• Up to 3 and a half
  inches (9 centimeters)
  with child lying down
  is acceptable.
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              Possible Complications

• Difficulty walking (very rare).

• Self-esteem changes related to cosmetic
  appearance of knock knees.

• If left untreated (for patients with intermalleolar
  distance which is more than 9 cm and for age group
  < 7 years), knock knees can lead to early arthritis of
  the knee.



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 Management
      RAPRIOP

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             Reassurance
1- Most parents are happy to be reassured that their child's
   deformity is within normal limits and will disappear.

2- Some may need their confidence boosted by returning
   for fresh measurements to be made six-monthly until
   they are convinced it is disappearing.

3- For those who are still sceptical, radiographic
   examination may be sufficient to alleviate their anxiety
   with or without the addition of an orthopaedic opinion.


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               Advice
• To measure natural
  improvement, Advice Parents
  to take photographs of the child
  in standing with their kneecaps
  pointing forward every 6
  months.

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      Prescription (Treatment)
   Non-Operative                          Operative
• Special shoes,                 • Epiphysiodesis
  exercise programs,               (physeal stapling) of
  splints and braces are           medial side, or
  not recommended, as              corrective osteotomy
  these conditions                 in children < 10 years
  usually correct and              old with intermalleolar
  improve over time                distance < 10 cm.
  with normal growth.

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       When to Refer ?
• Age > 7 years with knock knees.

• Unilateral problem i.e Asymmetry of legs.

• Intermalleolar distance > 3.5 inches (9
  cms).

• Associated symptoms e.g Pain, Limp.
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            Investigations
         X-rays                       Laboratory tests
• No X-ray required until <        • CBC, phosphorus,
  18 months of age, then             creatinine and alkaline
  AP and lateral standing            phosphotase may be
  full leg length views.             ordered if a systemic or
                                     metabolic abnormality is
                                     suspected.




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 Observe (Follow Up)
  • Observe the patient every 6
             months.




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                  Prevention
• There is no known prevention for normal
               knock knees.




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  •   .


Thank you

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posted:7/16/2012
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