Article

Angular deformities of the lower limb in children.

Department of Orthopedic Surgery, Tehran University of Medical Sciences, Tehran, IR, Iran.
Asian journal of sports medicine 03/2010; 1(1):46-53.
Source: PubMed

ABSTRACT Angular deformities of the lower limbs are common during childhood. In most cases this represents a variation in the normal growth pattern and is an entirely benign condition. Presence of symmetrical deformities and absence of symptoms, joint stiffness, systemic disorders or syndromes indicates a benign condition with excellent long-term outcome. In contrast, deformities which are asymmetrical and associated with pain, joint stiffness, systemic disorders or syndromes may indicate a serious underlying cause and require treatment.Little is known about the relationship between sport participation and body adaptations during growth. Intense soccer participation increases the degree of genu varum in males from the age of 16. Since, according to some investigations, genu varum predisposes individuals to more injuries, efforts to reduce the development of genu varum in soccer players are warranted. In this article major topics of angular deformities of the knees in pediatric population are practically reviewed.

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    ABSTRACT: To find the effectiveness of the early surgery (2-3 years of age)as a very important prognostic factor affecting the outcomes in Thai children with infantile tibia vara and all the prognostic factors including the usefulness of arthrographic study in correcting the deformity. From 1994 to 2004, sixteen children aged average 3.61 years old (2.08-7.0) were treated in Siriraj Hospital and diagnosed as infantile tibia vara by Langenskiold radiographic staging were included in the present study and retrospectively reviewed with an average of 6.4 years follow up (range 6 month - 11.1 years). All cases were initially treated by surgery because of low compliance for brace or brace failure. They consisted of 3 boys and 13 girls. There were 24 legs including the bilateral involvement in 8 cases (2 boy and 6 girls). After arihrography, the midshaft fibular osteotomy was performed then the proximal tibial dome-shaped valgus osteotomy was done and fixed with 2 pins. The desired position was 12 degree knee valgus . The patients were divided in two groups, 1)group A,the successful group with the knee becoming normal without any deformity after single osteotomy, 2)group B,the recurrent group with recurrence of the varus deformity required further corrective osteotomies to make normal axis of the knee. All variables were analyzed and compared between group A and group B. The general characteristics and radiographic findings were recorded in 1)age, 2)sex, 3)side, 4)weight in kilogram and in percentage of normal or overweight(obesity) compared with the standard Thai weight chart, 5)tibiofemoral angle (TFA) pre and postoperative treatment, 6) metaphyseal diaphyseal angle (MDA), 7)the medial physeal slope angle (MPS, 8)The preoperative arthrographic articulo-diaphyseal angle (ADA), 9.arthrographic articulo-medial physeal angle (AMPA). There were 14 legs in group A and the remaining 10 legs were in group B (average 2.4 operations). All cases healed in good alignment of the legs without major complication. All patients who were operated on early before 3 years old were 100% cured by single osteotomy in group A(11 legs). Arthrography was useful in evaluating the knee joint and drawing the angle. Considering the prognostic factors affecting the outcomes after surgery, there were 6 prognostic factors . First, the age less than 3 years old (P<0.001). Second, the normal weight (P<0.047). Third, the Langenskiold stage 1-2 (P=0.002). Fourth, the MPS angle equal or less than 59 degree (P < 0.001). Fifth, the ADA preperative angle equal or less than 18 degrees (P<0.001). Sixth and the last factor, the TFA angle postoperative treatment, equal or more than 10 degrees valgus (mean 13 degrees valgus) (P=0.009).In multivariate analysis with stepwise logistic regression of these 6 prosnostic factors, the MPS angle had the most important significance. The proximal tibial valgus osteotomy was a very important factor(P < 0.001). The 6 prognostic factors and usefulness of arthrography were identified. The authors suggest that surgery should be performed early in Thai children who have met these criterias 1)age of the patients more than 2 years old, 2)Langenskiold roentgenographic characteristics of infantile tibia vara stage 2 or more at the time of diagnosis, 3)Low compliance for brace treatment.or brace failure but not more than 3 years old. The surgery should not be delayed more than 3 years of age by waiting for effectiveness of brace treatment in Thai children with infantile tibia vara. The early proximal valgus dome- shaped osteotomy was a very important controllable prognostic factor by surgeon decision.
    Journal of the Medical Association of Thailand = Chotmaihet thangphaet 10/2005; 88 Suppl 5:S72-9.
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    ABSTRACT: Background There is a greater prevalence of lower extremity malalignment in obese children during static posture; however, there has been less examination of dynamic joint function in this cohort. Therefore, the purpose of this study was to determine kinematic differences exist between obese and non-obese children that would support previously reported static joint malalignment. Methods Forty children were classified as obese (N = 20) or non-obese (N = 20). Lower extremity joint kinematics were collected during five walking trials at a self-selected pace. Peak joint displacement and amount of joint motion throughout the gait cycle (calculated as the integrated displacement curve) were analysed for group differences. Findings Non-obese children had greater peak knee and hip extension during gait; however, there were no group differences in the integrated sagittal displacement curve. Obese children had greater peak angular displacement and integrals of angular displacement for peak hip adduction, hip internal rotation, and foot abduction (toe-out) than non-obese children. Obese children also had greater peak knee external rotation than non-obese children. Interpretation Non-obese children showed greater range of motion in the sagittal plane, particularly at the hip and knee. Frontal and transverse plane differences suggest that obese children function in a more genu valgum position than non-obese children. Static measures of genu valgum have been previously associated with pediatric obesity; the findings indicate that there are also dynamic implications of said malalignment in obese children. Genu valgum presents increased risk of osteoarthritis for obese children and should be considered when prescribing weight bearing exercise to this cohort.
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