This will be a look and proceed case. Examiner will want to see your thought processes in identifying the cause.
- [Stand and Look]
- From front
- “Sir I note bilateral genu valgus with widened intermalleolar distance.”
- UNILATERAL - “This may be due to a unilateral pathology or a systemic pathology with unilateral manifestation” - go on to examine for the cause and complications
- BILATERAL - “This may be idiopathic or pathological i would want to go on to examine to elicit the cause and complications”
- No scars in distal femur proximal tibia, proximal hip
- Does not look to have short stature but i would like to plot on a growth chart, no features of frontal bossing to suggest rickets
- No obvious tibia shortening/ bowing/ missing lateral rays to suggest fibula hemimelia
- Valgus knees with widened intermalleolar distance
- Scars - to suggest previous surgery
- Lumps - osteochondroma! Very commonly come out
- Look for syndromic features
- Rickets
- Fibula hemimelia - missing toes, UL deformities (ulnar club hands)
- From side
- No sagittal malalignment to suggest SED
- From back
- No scoliosis - SED
- [WALK]
- Gait - looking for trendlenberg gait (MED, SED, PFFD), walking aids
- Gait unilateral trendelenberg gait
- Congenital short femur
- Trendelenberg test - “Not positive to suggest pathology in the proximal femur”
- [SIT]
- Evaluate J-sign.
- [LIE DOWN]
- Evaluate knee ligaments
- ACL (absent ACL in hemimelia, CFFD)
- Collaterals (LCL correctibility)
- Measure limb length to look for LLD (Congenital short femur, fibula hemimelia, lengthening on Cozen)
- Evaluate for miserable mal-alignment syndrome. Do rotational assessments
- Complete exam by
- Beighton score
- History - PMHx, symptoms and function
Causes:
Dysplasia - MED, SED
Developmental - Fibula Hemimelia, PFFD
Trauma - Distal Femur, Cozen
Infection
Tumor - Osteochondroma, Enchondroma
Metabolic - RIckets
Idiopathic