Angular deformities of lower limb in children: Correction for whom, when and how?

Abstract

Angular deformities are common presentations in childhood and adolescent age group. It is important to differentiate a true deformity from a physiological deformity, this requires measurement of the intercondylar and intermalleolar distance. Once a true deformity is diagnosed, the apex of the deformity requires to be established. Lower limb frontal plane deformities are evaluated with a true AP standing radiographs of the entire lower limb from hip to ankle. Mechanical or anatomical axis calculation gives the apex (CORA) as well as the magnitude of deformity. Frontal plane deformities require surgical intervention. In younger children, growth modulation surgery allows correction of the deformity with minimal morbidity and without the need for osteotomy. Older children, adolescents and adults require corrective osteotomy. The corrective osteotomy can be closed wedge, open wedge, or a dome osteotomy. The osteotomy may be stabilized with internal fixation with plate and screws or an intramedullary implant as is dictated by the level of osteotomy and the local bony anatomy. External fixators allow gradual and precise correction of the deformity.

Management of ankle valgus in a skeletally immature patient by tension band plate hemiepiphysiodesis: A case report

“…Therefore, sufficient growth was present to attain the desired correction. Gupta et al had suggested that to achieve a 20° correction, a minimum of 2 years of growth must be remaining [5]. On the contrary, hemiepiphysiodesis in a younger patient can cause a rebound deformity following the removal of the device.…”

Digital Preoperative Planning for High Tibial Osteotomy using 2D Medical Imaging

“…Other studies have discussed the preliminary planning of high tibial osteotomy [14], [22]. Based on different osteotomy problems, the need for planning also varies.…”

“…The intersection of these straight lines involves mechanical [14], [15] or anatomical axes [16] It is also influenced by the need or regulation of the osteotomy itself i.e. varus gene defect [14], valgus [17] or recurvatum [18].…”

“…The intersection of these straight lines involves mechanical [14], [15] or anatomical axes [16] It is also influenced by the need or regulation of the osteotomy itself i.e. varus gene defect [14], valgus [17] or recurvatum [18]. This selection also depends on the selection of wedges to be used that is whether open wedge, closed, dome and also a combination.…”

O papel da estereorradiografia na avaliação das deformidades dos membros inferiores

“…Axis deviations in the coronal plane are commonly observed in developing children and are usually corrected by physiological mechanisms typical of growth ( 2 ) . However, when such deviations persist, they can lead to gait dysfunction, predisposing to joint changes such as chondropathy, instability, and, occasionally, early osteoarthritis ( 3 ) . Among the acquired causes of axis deviations in pediatric patients, trauma is the most common; trauma can cause deformities due to fractures, especially physeal or transphyseal fractures, repetitive stress on the growth plate, or osteochondral injuries ( 1 ) .…”