Angular deformity

Angular Deformity
• There are normal changes in the angular
alignment of the extremities that occur as
growth proceeds.
• When the child begins to stand mild bow
legs are commonly present ,known as
physiologic bowing
• Between 2-3 yrs the physiologic bowing
changes to mild knock-knee
• Between the age of 3-5 yrs there is often
more valgus than after 6yrs
• It changes to adult angular configuration
to about 5-8o of genu valgus
. Differential diagnosis in a child with angular
deformity :
1. physiologic 2.Blounts 3.Rickets
4.growth plate injury ( trauma/ infection)
 History
• When the deformity was first noted is important
• Whether the deformity is improving or worsening
• Nutrition history -adequate vit D intake
-sunlight exposure
. Early walker and obese
. History of significant limb trauma/infection
. History of admission due to generalized neonatal
sepsis may reveal squeal of undiagnosed
osteomyelitis
. Family history of bowing/genu valgus
 Phsiologic bowing
• Most common type ,present primarily between 1-
2yr ,Involves both tibia and femur
• No ligament instability is found at the knee
• No lateral thrust is seen when walking
• Serum studies are normal
• X-rays: bowing involves both tibia and femur
: delayed in the ossification of medial
epiphysis of distal femur and proximal tibia
. No treatment is needed as improvement occurs
over a period of several months
• Should not be diagnosed after 3yrs of age
 Blount’s disease (Tibia vara)
• Bowing occurs in the proximal tibia only
• Occurs primarily in obese child and early walker
at 9-10 months
• Common in blacks
• Progressive bowing, asymmetrical bowing
significant bowing that persists after the age of 2
• Caused by abnormal function of the medial
portion of the proximal tibial growth plate
 Blount’s disease
• The medial physis is subjected to excessive
forces as a large or obese baby walks early with
normal physiologic bowing
• Lateral portion of the physis continues to grow
normally
• Results in permanent damage of the affected
physis if it remains untreated
• Bowing may be unilateral or bilateral ,no pain
• Bowing is seento begin at or just below the knee
• Thigh is not bowed
• Lateral thrust may be noticed during walking
 Blount’s …
• Dx is confirmed by standing A-P x-ray of
both lower limbs after the age of 2yrs
• The medial portion of the proximal tibial
metaphysis demonstrate a beak ,with
some delay in ossification
• Metaphyseal-diaphyseal angle greater
than 11o require treatment
• Treatment : brace < 3 yrs
: corrective osteotomy
 Rickets

• Metabolic imbalance of calcium/phosphate

results in lack of calcification of the osteoid
• History of upper respiratory infection and
diarrhea
• Growth and development is delayed
• Hypotonic muscles
• Widened metaphysis at the wrist and knee
• Angular deformities of the lower limbs
• Serum calcium/ phosph.abnormalities, alkaline
phosphatase
.x-ray widened physis ,cupping of the metaphysis
 Rickets
• Treatment
-vitamin D supplements( Nutritional
Rick.)
- braces are ineffective
- corrective osteotomy
 Knock-Knees or Genu valgum
• Physiologic valgus of the knees is present
between the ages of 3 and 5yrs.
• When valgus is asymmetrical or if it
persists past the age of 5 ,Rickets
• Idiopathic Knock knees
 Growth plate injury
• Damage to the physis due to injury
• Damage to the physis due to infection
(find out history of admission during the
neonatal period)
septic arthritis is likely to destroy part or
whole of epiphysis if the child is < 2yr old.
growth arrest /angular deformity will result