Clinical and statistical assessment of aetiological factors of genu varum in children
Abstract
Genu varum (bow leg) represents one of the most common lower limb deformities in children. Its aetiology is divided into two main categories, physiologic and pathologic. It poses a source of concern for the parents. In physiologic genu varum, the condition is self-limiting and usually it needs just clinical follow up. In pathologic cases it is liable for progression with time predisposing for mechanical lower limb problems as well as joint complications. In the physiologic variety, it is important to establish the diagnosis so as to avoid unnecessary treatment. In this study we assessed the aetiologic factors affecting the incidence of this condition. The results point that the physiologic type is still the commonest in our locality. The second commonest cause was found to be nutritional rickets while other causes were uncommon or even extremely rare. These results are contrary to the common belief that most of the cases in our locality are attributed to rickets. The purpose behind the study is to clarify the aetiologic contribution of various conditions involved so that to base the subsequent management on solid ground.References
- Kessel L. Annotations on the etiology and treatment of tibia vara. J Bone Joint Surg Br 1970;52:93.
- Ozonoff MB. The lower extremity in pediatric orthopedic radiology, 2nd ed. Philadelphia, PA: WB Saunders, 1992.
- Morrissy RT. Atlas of pediatric orthopaedic surgery. Philadelphia, PA: JB Lippincott, 1992.
- Kling TF Jr, Hensinger RN. Angular and torsional deformities of the lower limbs in children. Clin Orthop Relat Res. Jun 1983;136-47.
- Golding JSR, McNeil-Smith JDG. Observations on the etiology of tibia vara. J Bone Joint Surg Br 1963;45:320.
- Levine AM, Drennan JC. Physiological bowing and tibia vara. The metaphyseal-diaphyseal angle in the measurement of bowleg deformities. J Bone Joint Surg Am 1982;64:1158.
- Hansson LI, Zayer M. Physiological genu varum. Acta Orthop Scand 1975;46:221.
- Salenius P, Vankka E. The development of the tibiofemoral angle in children. J Bone Joint Surg Am 1975;57:259.
- Levine AM, Drennan JC. Physiological bowing and tibia vara. The metaphyseal-diaphyseal angle in the measurement of bowleg deformities. J Bone Joint Surg Am. Oct 1982;64(8):1158-63.
- McKay CP, Portale A. Emerging topics in pediatric bone and mineral disorders 2008. Semin Nephrol. Jul 2009;29(4):370-8.
- Lowdon J. Rickets: concerns over the worldwide increase. J Fam Health Care. Mar-Apr 2011;21(2):25-9.
- Chapman T, Sugar N, Done S, Marasigan J, Wambold N, Feldman K. Fractures in infants and toddlers with rickets. Pediatr Radiol. Dec 9 2009
- Shah BR, Finberg L. Single-day therapy for nutritional vitamin D-deficiency rickets: a preferred method. J Pediatr. Sep 1994;125(3):487-90.
- Casey CF, Slawson DC, Neal LR. Vitamin D supplementation in infants, children, and adolescents. Am Fam Physician. Mar 15 2010;81(6):745-8.
- Greer FR. Issues in establishing vitamin D recommendations for infants and children. Am J Clin Nutr. Dec 2004;80(6 Suppl):1759S-62S.
- Reinker K. Etiology of Blount's disease. The Pediatric Orthopaedic Society of North America 28th Annual Meeting, Orlando, FL, May 16, 1999.
- Bathfield CA, Beighton PH. Blount's disease. A review of etiological factors in 110 patients. Clin Orthop Relat Res 1978;135:29.
- Greene WB. Infantile tibia vara. J Bone Joint Surg Am 1993;75:130.
- Feldman MD, Schoenecker PL. Use of the metaphyseal-diaphyseal angle in the evaluation of bowed legs. J Bone Joint Surg Am 1993;75:1602.
- Rang M, ed. The Growth Plate and Its Disorders. Baltimore: Williams & Wilkins; 1969.
- Bright RW. Physeal injuries. In: Fractures: Fractures in Children. 3rd ed. Lippincott-Raven;1991: 87-186.
- International Working Group on Constitutional Diseases of Bone. International nomenclature and classification of the osteochondrodysplasias (1997). Am J Med Genet. Oct 12 1998;79(5):376-82.
- Ikegawa S. Genetic analysis of skeletal dysplasia: recent advances and perspectives in the post-genome-sequence era. J Hum Genet. 2006;51(7):581-6.
- Heath CH, Staheli LT. Normal limits of knee angle in white children--genu varum and genu valgum. J Pediatr Orthop. Mar-Apr 1993;13(2):259-62.
- Salenius P, Vankka E. The development of the tibiofemoral angle in children. J Bone Joint Surg Am. Mar 1975;57(2):259-61
- Salenius P, Vankka E. The development of the tibiofemoral angle in children. J Bone Joint Surg Am. Mar 1975;57(2):259-61.
