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- Defined as persistent or worsening genu valgum in patient older than 7 years
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- Physiologic = Bilateral - within charts
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- Idiopathic (diagnosis of exclusion)
- Secondary due to -
- Dysplasias - MED (screen other joints), SED (screen spine),
- Metabolic - Rickets (usually varus), Other Metabolic diseases
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- Trauma (distal femur #, cozen #)
- Infection
- Tumors - Osteochondroma, Enchondroma
- Syndromes/ congenital - Fibula hemimelia, CFFD
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- May lead to patella instability and dislocation
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- Generally hemiepiphysiodesis or osteotomy
- Skeletally immature - placement of medial physeal spanning plates; Heuter Volkmann Law
- Need to follow up closely for over correction
- Time intervals not rigorously studied
- Skeletally Mature - osteotomy DFO
- Evaluate mLDFA and MPTA to correct appropriate (commonly in distal femur
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- Can either be lateral opening or medial closing osteotomy
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- Line 1 = from femoral head to center of tibia interspinous point
- Line 2 = line from center of ankle to tibia interspinous point
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- Wylie et al. 2016 Arthroscopy Systematic review and meta-analysis.
- No difference in outcomes and revision rates for either technique
- However medial closing wedge is theoretically better closing wedge - can WB, lower rates of delayed union.
- Lateral opening wedge if smaller, medial closing wedge if bigger correction (theoretically lower rate of non union)