| Varus genu deformity is a common deformity in children's development.It is characterized by coronal angulation of the limbs and lateral displacement of the tibia relative to the femur.If bilateral knee eversion is malformed,also be called "X" leg,expression is to stand or lie flat when double knee draws close after double medial malleolus exists apparent distance.Such as unilateral knee eversion deformity,also known as "K" leg deformity.According to the causes of children's genu valgus,we can divide them into physiological genu valgus,pathological genu valgus and traumatic genu valgus.Children are born with 10 lower limbs.15.Varus varus straightens with age,about 1 1/2 years.Valgus develops gradually after age 2,reaches its maximum at age 3,and reaches adult level by age 11.Therefore,clinically,children aged 2-6 years will present with genu valgus deformity.Pathological genu valgus deformity refers to the structural defect or pathological change in children's epiphyseal plate,which causes asymmetric growth on both sides of epiphyseal plate and presents as genu valgus deformity.Common causes are epiphyseal or epiphyseal tumors,metabolic diseases such as rickets,congenital hypothyroidism,congenital skeletal dysplasia,and so on.Traumatic varus genu deformity is caused by trauma,and most of them are caused by fractures of adjacent knee joints,mainly including fracture of distal femoral metaphysis,fracture of distal femoral metaphysis,fracture of proximal tibia metaphysis and fracture of proximal tibia metaphysis.Different from adults,most of children's ectropion deformity is caused by asymmetric growth of epiphyseal plate caused by trauma.Part ? Study on the etiology of traumatic genu valgum deformity Objective: Traumatic knee eversion is mostly caused by traumatic fractures of adjacent knee joints,including distal femoral metaphyseal fractures,distal femoral metaphyseal fractures,proximal tibial metaphyseal fractures and proximal tibial metaphyseal fractures.Different from adults,most of children's ectropion deformity is caused byasymmetric growth of epiphyseal plate caused by trauma.The causes of traumatic genu valgus deformity were analyzed by retrospectively analyzing the different types of fractures adjacent to the knee.To provide help for prevention and treatment of traumatic genu valgus deformity.Methods: From September 2015 to May 2018,18 cases of children with genu valgus deformity caused by trauma,including 7 males and 11 females,with an average age of 8years(4-15 years)were selected.Based on the original cause of injury,age,fracture site,imaging and treatment,the causes of valgus genu were analyzed.Results: Among the 18 cases,2 cases were caused by indirect violence due to wrestling,and 16 cases were caused by direct violence on the lateral side of the knee in straight position.Two cases of distal femoral fracture,a case for completeness fracture of the distal femoral stem epiphyseal end,a case for distal femoral lateral epiphyseal injuries(Salter-Harris ? type fractures).All the other 16 cases were tibial fractures,among which 15 cases were proximal metaphyseal fracture,and 1 case was proximal tibial metaphyseal fracture combined with tibial diaphysis fracture.For complete distal metaphyseal fracture of femur,open reduction by picker's needle fixation and long leg tubular plaster fixation were adopted.The epiphyseal fracture of distal femur was closed reduction,fixed by picker's needle and lower limb cast.For tibial metaphysis fractures,most of them were fixed by conservative treatment with tubular plaster,and some were fixed by closed reduction via picke needle.Tibial metaphyseal fracture combined with tibial diaphyseal fracture was fixed by closed reduction and external percutaneous fixator,and the metaphyseal fracture was fixed by picker's needle.Analyze all children with traumatic knee valgus appear the cause of children for older children,especially a big weight,if for completeness,unstable fracture,if reset adopt strong fixed,the poor,and the premature fracture has healed ago lost weight above all can cause a reset Angle,genu valgus appear gradually increase.If trauma caused by distal lateral femoral or tibial proximal lateral epiphyseal injuries,especially the falling injury caused by Salter-Harris ? and ? epiphyseal fracture.Cause the formation of lateral bone bridge of the distal femur or proximal tibia,resulting in asymmetric growth of epiphyseal plate of the medial and lateral sides,and also cause knee ectropion deformity.In clinical practice,there are more cases where indirect or direct violence causes injury ofproximal medial tibia metaphysis.The strong primordial violence causes lacerations of the proximal tibia soft tissue,including the periosteum,and the goose foot tendon.Three tendons of sartorius,gracilis and semitendinosus attach to the medial side of the proximal tibia to form the goose foot tendon.Together with the periosteum of the medial proximal tibia,the goose foot tendon restricts the growth of the medial proximal tibia.Tear injury of periosteum or goose foot tendon will lead to loss of medial restrictive growth effect,excessive growth of medial epiphysis plate,excessive growth of medial epiphysis plate of proximal tibia,separation of functional medial cartilage,asymmetric growth of medial and lateral sides,and emergence of genu valgus deformity.Conclusion: Therefore,for children's fractures adjacent to the knee joint,such as the epiphysis fracture of the distal femur and the epiphysis fracture of the proximal tibia and the epiphysis fracture of the proximal tibia,we must be careful about the possibility of knee ectropion during the healing process.Whether it is manual reduction or surgical reduction,be sure to fully correct the eversion deformity,or even mild varus.For older or heavier children,we can consider the use of plate screw fixation or external fixation frame fixation.Avoid early loading before fracture healing to prevent loss of reduction Angle.For patients with severe medial tissue injury of the proximal tibia,it is suggested to open reduction,remove the periosteum embedded in the fracture end,and repair the injured goose foot tendon,which can reduce the incidence of genu valgus deformity.Combined with the common etiology and common factors of traumatic knee ectropion in children,we summarized the high risk assessment table of traumatic knee ectropion in children,expecting to bring help to the clinical prevention and treatment of traumatic knee ectropion in children.Part ? Preoperative plan for surgical correction of traumaticgenu valgum deformity in adolescentsObjective: Compared with epiphyseal surgery,osteotomy is more difficult,damaging and risky for adolescents with varus knee deformity.By discussing some common problems before osteotomy and perfecting the detailed preoperative plan and preparation,we can reduce the operation time,difficulty and risk and get twice the result with half the effort.Methods: The preoperative plan was discussed and evaluated in detail in sevenaspects related to osteotomy and orthopedics.Through lower limbs a test to the line MAT with Stevens knee six partition method to assess whether there is the knee valgus deformity,by measuring the Angle of femoral distal lateral mLDFA MPTA and proximal tibial medial Angle to assess the source of genu valgum,mechanical shaft PMA by measuring the proximal and distal DMA mechanical shaft for deformities of angulation CORA point selection,by measuring the length of the PMA and DMA to understand differences in the length of the body,on both sides according to the characteristics of different children to evaluate the surgical operation time and method,According to the distance from CORA point to the knee joint,the position of osteotomy line and the selection of osteotomy mode for osteotomy were evaluated,and the fixation after osteotomy was determined according to the Angle of correction needed after osteotomy,the age of the child,the site of osteotomy,bone and soft tissue conditions.Professor Paley's pre-operative CORA method of mechanical axis and anatomical axis provides a precise orthopedic principle for the correction of limb deformity in children.The preoperative measurement and planning of CORA method is mainly based on the standard full-length radiographs of both lower limbs in standing position.However,compared with adults,the compliance of children is poor,especially the children who cannot go to the ground for the first time injury,and it is difficult to obtain the standing lower limb film clinically.We adopted the ipev3 d scanner,which is an infrared scanner and runs the Captevia scanner,and we can get 3D images of the limbs easily and painlessly.The3 D images were used to measure the included Angle TFA of the femoral mechanical axis and the tibial mechanical axis,and the differences of the eversion angles of bilateral limbs were evaluated.Results: Before orthopedic osteotomy for traumatic genu valgus deformity in adolescents,standard full-length films of both lower limbs should be taken.By measuring the mechanical axial direction of the lower extremity,the lateral Angle of the distal femur and the medial Angle of the proximal tibia,we can know whether there is genu valgus and determine the origin of genu valgus.By measuring the proximal mechanical axis and distal mechanical axis of the everted long bone,measuring its angular rotation center point,evaluating the bilateral limb length difference,and evaluating the position and method of osteotomy.The Captevia3 D scanning imaging we used can quickly obtain the full-length imaging of the lower floor in a non-invasive manner at the bedside,and quickly evaluatethe presence of valgus deformity of the lower limbs at the early stage through the measurement of TFA.Conclusion: Although orthopedic osteotomy for adolescents is difficult to operate and has a high risk of injury,our detailed and standardized preoperative plan can minimize the difficulty and risk of surgery.Part ? Surgical correction of traumatic genu valgum deformity in adolescentsObjective: For adolescents with less than one year of growth space or closed epiphyseal plate,we recommend osteotomy for correction of knee ectropis.For intraoperative correction of ectropion deformity,a steel plate can be used to fix it.Due to the strong healing and shaping capacity of children's bones,we recommend the use of Ilizarov ring external fixator technique to correct eversion deformity.Compared with steel plate fixation,this method has small damage,can avoid epiphysis of injury,short fixation time,convenient removal,and can be transarticular fixation when necessary.The Ilizarov technique is used to gradually correct the deformity after surgery,reducing the risk of common peroneal nerve injury.Meanwhile,it can be adjusted at any time after surgery according to the deformity,and shortened or delayed according to the unequal length of bilateral limbs.Methods: From September 2015 to May 2018,18 cases of children with genu valgus deformity caused by trauma,including 7 males and 11 females,with an average age of 8years(4-15 years)were selected.8 abnormal turning Angle < 10 degrees,conservative treatment,self-correction with growth.9.The abnormal turning Angle was >,10 degrees.After 18 months of observation,there was no improvement.One patient was 15 years old with close epiphyseal,and was treated with supracondylar femoral osteotomy and Ilizarov ring external fixator.For adolescents with growth space less than one year,or with closed epiphyses,we used osteotomy combined with Ilizarov annular external fixator technique to restore the varus deformity of the frontal surface of the knee and the mechanical axis of the lower limbs.Open or closed wedge osteotomy was performed at the apex of angular deformity,and the proximal perforating module was connected with the distal perforating module by hinge.The front and rear axial hinges were placed in the center of the angular orthostaticaxis ACA,and the proximal and distal bone pieces rotated around the ACA to correct the ectropion deformity.A rotatory hinge was placed on the outside to restore valvulus deformity by extending the conduction force of lateral rotation.An angular brace was used as the rotatory hinge.Results: Of the 18 children,8 received conservative treatment with an eversion Angle of less than 10 degrees,9 received "8" plate epiphyseal block,and 1 received supracondylar osteotomy.In the "8" plate fixation group,the average postoperative reexamination of the full-length weight-bearing sheets of both lower limbs was conducted3 months,and the follow-up period was 6-24 months,during which all the "8" plate was removed within 18 months.None of the 9 cases showed screw fracture,and one case showed screw loosening and displacement.Children with supracondylar femoral osteotomy were fixed with Ilizarov annular frame after osteotomy,and extension of lateral rotary hinge was performed 1 week after surgery.Extend it three times a day,one time by1 mm.Anteroposterior X-ray film was reviewed once a week,and the appearance of the lower limbs was significantly improved after the proximal and distal transosseous modules were parallel.Stop rotating hinge extension,replace axial hinge and rotating hinge for straight rod fixation.When the full-length films of both lower limbs were reexamined,it could be seen that the mechanical axis of the lower limbs shifted outwards from the center point of the knee joint to the medial side.Axial device assisted to walk,never load to partial load,until full load walking.During the rehabilitation process,the proximal half ring was removed through module conversion to gradually reduce the external fixation components.Four months after the operation,the X-ray film showed bone healing at the osteotomy,and the external fixator was removed.Postoperative evaluation was conducted in four aspects: malformation appearance and bilateral ankle spacing;MAD deviation of the mechanical axis of the lower extremity and the position of the mechanical axis of the lower extremity in Stevens' partition;measurement of the distal lateral femoral Angle mLDFA and the medial proximal tibial Angle MPTA.Conclusion: For patients in the rapid growth stage with growth potential greater than one year,we recommend the use of distal medial femur and proximal medial tibia epiphyseal block.Compared with the "U" type nail,we recommend the use of "8" plate for epiphyseal block.This method has the advantages of small injury,simple operation and temporary growth block.The internal fixation of "8" plate should be removed immediatelyafter the alignment of lower limbs returns to normal.For most children with traumatic genu valgus deformity,minimally invasive surgery with "8" plate can achieve ideal results.For adolescents with less than one year of growth space or closed epiphysis,epiphyseal block is not effective.We recommend supracondylar or proximal tibial osteotomy.Compared with epiphyseal block,osteotomy is more difficult to operate,has greater injury and higher risk.Therefore,the completion of detailed preoperative planning and preparation can reduce the operation time,difficulty and risk,and achieve twice the result with half the effort. |
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