eMedicine Specialties > Orthopedic Surgery > Pediatrics

Genu Valgum, Pediatrics: Workup

Author: Peter M Stevens, MD, Professor, Director of Pediatric Orthopedic Fellowship Program, Department of Orthopedics, University of Utah School of Medicine
Coauthor(s): Michael C Holmstrom, MD, Consulting Surgeon, Department of Orthopedics, The Orthopedic Specialty Hospital (TOSH)
Contributor Information and Disclosures

Updated: Jul 19, 2007

Workup

Laboratory Studies

  • When an underlying syndrome is suggested by the physical findings and history, consultation with a geneticist and workup are warranted. If metabolic bone problems are a concern, relevant hematologic and urine studies are warranted, along with consultation with an endocrinologist. In a select few patients, bone densitometry studies may be warranted.

Imaging Studies

  • Radiography
    • The criterion standard for documentation of genu valgum is a standing AP radiograph of the lower extremities, taken with the patellae facing forward. This study permits direct visualization of both the true and the apparent limb lengths and alignment. The length of each femur and tibia is measured, and any diaphyseal deformities (which would be missed on a scanogram or teleroentgenogram) are clearly visible. The mechanical axis is a line drawn from the center of the head of the femur to the center of the ankle; this line should bisect the knee. In normal variations, this line is still in the central 50% of the knee. Genu valgum is defined by lateral deviation of the axis or deviation toward or beyond the joint margin. The deformity may be in the femur, the tibia, or both. The normal lateral distal femoral angle is 84° (6° of valgus), and the medial proximal tibial angle is 87° (3° of varus).
    • When physeal abnormalities are suspected, obtain AP and lateral radiographs of the hip or knee (or fluoroscopy) to have better visualization of the physis. If a skeletal dysplasia is suggested, a skeletal survey is warranted.
    • A sunrise or Merchant view of the patellae may reveal tilt, subluxation, and, occasionally, osteochondral defects or loose bodies. Finally, it may be helpful to obtain an AP radiograph of the left wrist for bone age, to ensure remaining growth (ideally at least 12 mo) is adequate to allow for correction of a deformity by growth manipulation.

Other Tests

  • Other than a well-documented physical examination and appropriate radiographs, other tests and diagnostic procedures are seldom necessary.

Histologic Findings

Depending upon the underlying etiology of genu valgum, epiphyseal, physeal, and/or metaphyseal histologic abnormalities may be present. However, biopsy of the bone rarely is necessary or helpful. Such invasive procedures may have an adverse effect upon physeal growth and the outcome of treatment.

More on Genu Valgum, Pediatrics

Overview: Genu Valgum, Pediatrics
Workup: Genu Valgum, Pediatrics
Treatment: Genu Valgum, Pediatrics
Follow-up: Genu Valgum, Pediatrics
Multimedia: Genu Valgum, Pediatrics
References
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References

  1. Blair VP 3rd, Walker SJ, Sheridan JJ, Schoenecker PL. Epiphysiodesis: a problem of timing. J Pediatr Orthop. Aug 1982;2(3):281-4. [Medline].

  2. Blount WP, Clarke GR. The classic. Control of bone growth by epiphyseal stapling. A preliminary report. Journal of Bone and Joint Surgery, July, 1949. Clin Orthop. 1971;77:4-17. [Medline].

  3. Boakes JL, Stevens PM, Moseley RF. Treatment of genu valgus deformity in congenital absence of the fibula. J Pediatr Orthop. Nov-Dec 1991;11(6):721-4. [Medline].

  4. Bowen JR, Johnson WJ. Percutaneous epiphysiodesis. Clin Orthop. Nov 1984;(190):170-3. [Medline].

  5. Bylski-Austrow DI, Wall EJ, Rupert MP, et al. Growth plate forces in the adolescent human knee: a radiographic and mechanicalstudy of epiphyseal staples. J Pediatr Orthop. Nov-Dec 2001;21(6):817-23. [Medline].

  6. Gabriel KR, Crawford AH, Roy DR, et al. Percutaneous epiphyseodesis. J Pediatr Orthop. May-Jun 1994;14(3):358-62. [Medline].

  7. Goff CW. Histologic arrangements from biopsies of epiphyseal plates of children before and after stapling. Correlated with roentgenographic studies. Am J Orthop. May 1967;9(5):87-9. [Medline].

  8. Healy WL, Anglen JO, Wasilewski SA, Krackow KA. Distal femoral varus osteotomy. J Bone Joint Surg Am. Jan 1988;70(1):102-9. [Medline].

  9. Horton GA, Olney BW. Epiphysiodesis of the lower extremity: results of the percutaneous technique. J Pediatr Orthop. Mar-Apr 1996;16(2):180-2. [Medline].

  10. Kramer A, Stevens PM. Anterior femoral stapling. J Pediatr Orthop. Nov-Dec 2001;21(6):804-7. [Medline].

  11. Liotta FJ, Ambrose TA 2nd, Eilert RE. Fluoroscopic technique versus Phemister technique for epiphysiodesis. J Pediatr Orthop. Mar-Apr 1992;12(2):248-51. [Medline].

  12. Little DG, Nigo L, Aiona MD. Deficiencies of current methods for the timing of epiphysiodesis. J Pediatr Orthop. Mar-Apr 1996;16(2):173-9. [Medline].

  13. Métaizeau JP, Wong-Chung J, Bertrand H, Pasquier P. Percutaneous epiphysiodesis using transphyseal screws (PETS). J Pediatr Orthop. May-Jun 1998;18(3):363-9. [Medline].

  14. Mielke CH, Stevens PM. Hemiepiphyseal stapling for knee deformities in children younger than 10 years: a preliminary report. J Pediatr Orthop. Jul-Aug 1996;16(4):423-9. [Medline].

  15. Phemister D. Operative arrestment of longitudinal growth of bones in the treatment of bones in the treatment of deformities. J Bone Joint Surg Am. 1933;15:1-15.

  16. Salenius P, Vankka E. The development of the tibiofemoral angle in children. J Bone Joint Surg Am. Mar 1975;57(2):259-61. [Medline].

  17. Stevens PM, Arms D. Postaxial hypoplasia of the lower extremity. J Pediatr Orthop. Mar-Apr 2000;20(2):166-72. [Medline].

  18. Stevens PM, Maguire M, Dales MD, Robins AJ. Physeal stapling for idiopathic genu valgum. J Pediatr Orthop. Sep-Oct 1999;19(5):645-9. [Medline].

  19. Stevens PM, MacWilliams B, Mohr RA. Gait analysis of stapling for genu valgum. J Pediatr Orthop. Jan-Feb 2004;24(1):70-4. [Medline].

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Further Reading

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Keywords

physiologic genu valgum, pathologic genu valgum, adolescent idiopathic genu valgum, knock-knee deformity, osteotomy, hemiphyseal stapling, vitamin D resistant rickets, vitamin D-resistant rickets, guided growth, 8-plate

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Contributor Information and Disclosures

Author

Peter M Stevens, MD, Professor, Director of Pediatric Orthopedic Fellowship Program, Department of Orthopedics, University of Utah School of Medicine
Peter M Stevens, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Limb Lengthening and Reconstruction Society ASAMI-North America, Pediatric Orthopaedic Society of North America, Utah Medical Association, and Western Orthopaedic Association
Disclosure: Nothing to disclose.

Coauthor(s)

Michael C Holmstrom, MD, Consulting Surgeon, Department of Orthopedics, The Orthopedic Specialty Hospital (TOSH)
Michael C Holmstrom, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, Arthroscopy Association of North America, Pediatric Orthopaedic Society of North America, and Utah Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Mininder S Kocher, MD, MPH, Associate Professor of Orthopedic Surgery, Harvard Medical School/Harvard School of Public Health; Associate Director, Division of Sports Medicine, Department of Orthopedic Surgery, Children's Hospital Boston
Mininder S Kocher, MD, MPH is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for the History of Medicine, American Medical Association, American Orthopaedic Society for Sports Medicine, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

George H Thompson, MD, Professor of Orthopedic Surgery and Pediatrics, Department of Pediatric Orthopedic Surgery, Case Western Reserve University; Director, Rainbow Babies and Children's Hospital
George H Thompson, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, and Ohio State Medical Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dennis P Grogan, MD, Clinical Professor, Department of Orthopedic Surgery, University of South Florida College of Medicine; Chief of Staff, Department of Orthopedic Surgery, Shriners Hospital for Children of Tampa
Dennis P Grogan, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Eastern Orthopaedic Association, Irish American Orthopaedic Society, Scoliosis Research Society, and Southern Orthopaedic Association
Disclosure: Nothing to disclose.

 
 
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