Angular and Rotational LL Deformities in Children角和旋转畸形的儿童会.ppt

Angular deformities of LL: Bow legs. Knock knees. Rotational deformities of LL: In-toeing. Ex-toeing. Leg aches. CDH. Feet problems. Irritable hip. Angular LL Deformities of LL Angular DeformitiesNomenclature Bow legs Knock knees Angular DeformitiesRange of Normal Varies With Age During first year : Lateral bowing of Tibiae During second year : Bow legs (knees tibiae) Between 3 – 4 years : Knock knees Angular DeformitiesEvaluation Should differentiate between “physiologic” and “pathologic” deformities Angular DeformitiesEvaluation Physiologic Pathologic Angular DeformitiesCauses Physiologic Pathologic Angular DeformitiesEvaluation Angular DeformitiesEvaluation Angular DeformitiesEvaluation Angular DeformitiesEvaluation Angular DeformitiesEvaluation in bow legs / genu varum Inter-condylar distance in knock knees /genu valgum Inter- malleolar distance Use goneometer measures angles directly Serum Calcium / Phosphorous ? Serum Alkaline Phosphatase Serum Creatinine / Urea – Renal function X-ray when severe or possibly pathologic Standing AP film long film ( hips to ankles ) with patellae directed forwards Look for diseases : Rickets / Tibia vara (Blount’s) / Epiphyseal injury.. Measure angles. Angular DeformitiesWhen To Refer ? Pathologic deformities: Asymmetrical. Localized. Progressive. Not expected for age. Exaggerated physiologic deformities: Definition ? Rotational LL Deformities Frequently seen. Concerns parents. Frequently prompts varieties of treatment. ( often un-necessary / incorrect ) Rotational Deformities Level of affection : Femur Tibia Foot Rotational DeformitiesFemur Ante-version = more medial rotation Retro-version = more lateral rotation Rotational DeformitiesNormal Development Femur : Ante-version : 30 degrees at birth. 10 degrees at maturity. Tibia : Lateral rotation : 5 degrees at birth. 15 degrees at maturity. Rotational Deformit