Genu Varum And Genu

Valgum
Definition
• Genu varum  the tibia bone curves laterally
• Genu Valgum (knock knees)  a condition where the knees are close
to each other but the legs are separated from each other
Epidemiology
Physiological Genu Varum usually occurs in children aged <2 years
Pathology less common, especially with increasing age.
Physiological genu valgum  usually occurs in the second and third years of
life.
Causes such as hereditary multiple exostoses, Down syndrome, and skeletal
dysplasia, often occur in patients aged 3-10 years.
Idiopathic valgum genu in adolescents may be passed on to the family or can
occur sporadically.
In countries where malnutrition is common and access to medical assistance
is limited the incidence of valgum and varum is higher
Etiology and Risk Factor
Genu Valgum
- Disruption in leg bone growth  which causes a shift in the
axis mechanically so that the pathological pressure is placed on the lateral
femur and tibia
- Incorrect sleeping position  such as stomach prone
- Long lasting rotational disturbances and limb shape.
- Using disposable diapers in a way and when it is not right it is difficult for
children to find a stable foot position
- Female sex factors that have a wider pelvis than men relative to women
experience more frequent valgum.
- Post traumatic. Trauma is the most common cause for genovalgum 
Fractures of the distal femur and proximal tibia fractures
Genu Varum
- Blount disease  This disease attacks the tibia affecting the burden on the tibia
the tibia fails to grow normally
- Metabolic. Nutrition and vitamin D  resistant rickets lack calcification in the
bone in the joint area, the bones become more flexible.
- Congenital Achondroplasia  defect in endochondral bone formation.
- Obesity tends to have the foot shape of Genu varum
Patogenesis and Genu Valgum Genu Varum
Patophysiology Marked by the presence of slack in the The combination of internal torque and
medial collateral ligament of the knee joint. tibial varus together with external
-Normally newborns cannot experience genu
femoral torsion (rotated toes out). Genu
valgum or internal femoral torsion unless
varum is a physiological thing when a
abnormalities occur since the fetus due to
newborn is related to fetal intrauterine
genetic changes, metabolic abnormalities, or
position and will be corrected
trauma.
- Genu valgum appears when the child's spontaneously. But if the child's sleeping
sitting habits are wrong, namely sitting with and sitting habits are wrong, that is
the knees in front, the femur goes in and the sleeping in a prone position with the
legs back facing out. knees and feet in or sitting with feet in,
this can make the genu varum
pathological. Genu varum is also found
in rickets, tibia vara (Blount's disease) or
trauma to the epiphyseal plate.
Clinical Manifestation
- Short body posture because the lower extremity of the child forms
an abnormal tibia and femur alignment (forming a medial or lateral
angle).
- Abnormal road patterns  often cause difficulty walking in children,
because the child's steps will slow down.
- Knee joint pain and intermittent patellar dislocation  The fulcrum
disturbance occurs in the knee joint over compressing the knee joint
and the structures surrounding the knee joint pain can also occur
intermittent patellar dislocation or subluxation.
Diagnosis
- Anamnesis
- Physical examination
Femoral-tibia angle: the angle between the thigh and the lower leg
Measurement of distance between bone markers:
Intercondylar distance (genu varum) The distance between the medial femoral condyle
on the knee
Intermolar distance (genu valgum) The distance is both medial malcolus at the ankle
Pay attention to the way of walking with attention focused on the knee when the step goes
to determine the formation of lateral thrust or medial (medial thrust). Children with
physiological varum or valgum in the knee generally do not develop angle formation. But in
pathological conditions, angular formation usually shows knee ligamentous weakness
which can increase the potential for increased severity of the deformity.
- Supporting investigation  Gold Standard plain photo  Antero-posterior
- Genu Varum assesses the metaphysical-diaphysis angle (MDA) of the varum
angle which is formed usually <11, while in the tibia vara the angle is formed >
11.
- Genu Valgum measures the mechanical axis (axis drawn from the middle of the
femur's head to the middle of the ankle joint). Under normal conditions this line
will be precisely halved from the ankle joint or still in 50% of the middle part of
the ankle joint.
Management
Genu varum and genus valgum physiology (usually occurs at the age of
<2 years)  Observation.
Non-operative
-Brace treatment corrects varus deformity due to disruption of
pathological growth of proximal-medial tibial.
Operative
-Guide growth (transient hemiepiphysiodesis)  returns the
mechanical axis to be neutral
- Osteotomy to straighten the extremities and provide a temporary
neutral mechanical axis to correct malrotation and restore the same leg
Complication and Prognosis
- Post-op complications such as infection, compartment syndrome,
recurrent deformity, and growth disorders.
- Patellofemoral degenerative arthritis
- Early arthritis of the knee joint Gait deviation (gait)

Prognosis
Prognosis for adolescents is good if the deformity is treated before
mature bone.