Windswept Deformity a Disease or a Symptom? A Systematic Review on the Aetiologies and Hypotheses of Simultaneous Genu Valgum and Varum in Children

Abstract

Objective: The objective of this study is to create an overview of the possible aetiologies of windswept deformity and to emphasize the points of attention when presented with a case. Methods: A systematic search according to the PRISMA statement was conducted using PubMed, African Journals Online, Cochrane, Embase, Google Scholar, and Web of Science. Articles investigating the aetiology of windswept deformity at the knee in children, and articles with windswept deformity as an ancillary finding were included. The bibliographic search was limited to English-language articles only. The level of evidence and methodological appraisal were assessed. Results: Forty-five articles discussing the aetiology of windswept deformity were included. A variety of aetiologies can be brought forward. These can be divided into the following groups: ‘Rickets and other metabolic disorders’, ‘skeletal dysplasias and other genetic disorders’, ‘trauma’ and ‘descriptive articles without specific underlying disorder’. With rickets being the largest group. Interestingly, in the group without a specific underlying disorder, all patients were from African descent, being otherwise healthy and presented with windswept deformity between two and three years of age. Conclusion: We have presented an overview that may help identify the underlying disorder in children with windswept deformity. A step-by-step guide for clinicians who see a child with windswept deformity is provided. Even though, according to the Oxford level of evidence, most articles have a low level of evidence.

Non-Surgical Strategies for Managing Skeletal Deformities in a Child with X-Linked Hereditary Hypophosphatemic Ricket: Insights and Perspectives

“…In late childhood and adolescence, when deformities such as severe varus, valgus, or windswept lower leg deformities become more pronounced, treatment often involves surgical interventions [4,14]. Surgical interventions like guided growth surgery offer a less invasive option for correcting coronal plane deformities, allowing patients a quicker return to normal activities [3,4,[6][7][8]10].…”

Side-to-Side Flipping Wedge Osteotomy: Virtual Surgical Planning Suggested an Innovative One-Stage Procedure for Aligning Both Knees in “Windswept Deformity”

“…However, in ambulatory children, this deformity mainly affects the knees and is also referred to as varo-valga knees. A recent systematic review revealed that there were fewer than 200 documented non-neurologic pediatric cases, typically attributed to causes such as rickets, metabolic disorders, genetic skeletal dysplasias, or trauma [8]. Nevertheless, the etiology remains unknown in most cases.…”

“…In this study, we present a case of "windswept deformity" of the knees in a 15-yearold boy. "Windswept deformity" is defined as the phenotypical presentation of a varus and valgus deformity with variable localization and underlying pathologies [8]. A recent systematic review identified 184 cases of children with "windswept deformity" reported in the literature in patients affected by rickets or skeletal dysplasias in the majority of cases [8].…”

“…"Windswept deformity" is defined as the phenotypical presentation of a varus and valgus deformity with variable localization and underlying pathologies [8]. A recent systematic review identified 184 cases of children with "windswept deformity" reported in the literature in patients affected by rickets or skeletal dysplasias in the majority of cases [8]. Considering the rarity of this deformity and the wide range of potential underlying causes, there is currently a lack of evidence-based guidelines for surgical treatment.…”

“…Depending on factors such as the patient's age and the severity of the deformity, various approaches have been described by different authors. These approaches may include acute correction techniques, gradual correction methods, or guided growth procedures [8].…”