This will be a look and proceed case
- [Stand and Look]
- From front -
- “obvious varus deformity of the lower limb with widened intercondylar distance(do not say knee before cover test)
- Bilateral vs Unilateral varus?
- “Sir I note bilateral/ unilateral genu varus with widened intercondylar 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”
- Look for syndromic features
- Achondroplasia - frontal bossing, maxillary hypoplasia, flattened nose bridge
- Rickets - frontal bossing; chest for pectus carinatum or excavatum
- Short stature?
- No scars for previous trauma/ surgeries around knee
- Sides - sagittal alignment
- No kyphosis (rickets)
- Back - coronal alignment
- No scoliosis
- [WALK]
- Look at gait for varus thrust
- [LIE DOWN]
- Feel - no lumps (osteochondroma)
- Evaluate knee - ligaments, correctibility, pain, ROM
- [Unilateral] Evaluate limb length - can be shortened with trauma
- Neurovascular - foot drop, DP
- Complete my exam by
- Charting the child’s height and weight to look for short stature
- XR long film to evaluate mechanical alignments and Chart Tibiofemoral angles on Salenius curve
- History from parents and child
- Clinical symptoms - pain and dysfunction
Remember the causes:
Blounts (Idiopathic) Trauma - Distal Femur Infection with bar Tumor - Osteochondroma, Enchondroma Congenital - Achondroplasia Metabolic - Rickets