Management of post-traumatic genu valgus deformity in adolescent by proximal tibial corticotomy with bone lengthening by Ilizarov method: a case report

Abstract

Introduction: Genu Valgus and Varus are the most common lower limb deformities at knee level, seen in childhood. Genu valgus is more common about 10%, where knee/knees turn inward, causing the appearance of the knees to be touching each other while the ankles remain apart. Genu Valgus is a normal physiological process in children’s; it may be pathological due to various causes. Physiological genu valgus is greatest at the age of 3-4 years and spontaneously resolves by the age of 7 years. When valgus deformity is persistent or worsening after 7 years of age is called pathological genu valgus. Cosmetic abnormality is common complaint. Abnormal circumduction gait, knees touching on medial aspect and LLD found on examination. Plan x-ray A/P view in standing position of full both lower limbs with pelvis provides diagnosis and treatment plan information. Case presentation: A 15 years old girl came with the complaints of abnormal walking due to right knee bending inwards, also during standing position. She was perceived pain in right knee during walking and longtime standing position. She has H/O- fractured proximal tibia (Rt.) more than 6 months ago due to trauma and treated by plaster. Plaster removed after 3 months. One month later she developed pain in knee joint during walking and right knee gradually bend inwards. O/E- Bil genu valgus right > left. Clinically, right knee -300 and left knee -100 There was 1.5 cm shortening of right lower limb than left. Both right and left lower limb with pelvis full radiograph was done. In x-ray both femurs and knee joints were normal. In radiograph, the medial and lateral surface of right tibia with fibula bends medially. Left tibial surfaces and fibula appears almost normal. The right tibia at the point of 14 cm from upper end there was maximum angulation point. The degree of genu valgus was evaluated by CORA method and treatment plan set accordingly. There was 300 medial bending of right tibial shaft and about 100 of left tibial shaft. The patient was diagnosed as post traumatic unilateral right tibial genu valgus following proximal tibia fracture. The patient was treated by proximal tibial corticotomy with Ilizarov frame. Aim: The aim of the treatment is restoration of normal mechanical axis. Objective: To assess the effectiveness and outcomes of the treatment method. Result: After complete union and consolidation, substantial evidence was checked and confirmed by both clinical and radiological. There was no abnormal gait and pain during walking. Mechanical axis of right lower limb was restored as normal. The final outcome is excellent. Conclusion: Genu valgus is common in children and observation is the first line of treatment. Physiological variant treated conservatively. Pathological genu valgus needs management according the cause. When surgical correction is indicated, corrective osteotomy usually done but there is so many complications and needed repeated surgery. In post-traumatic proximal tibial genu valgus effectively corrected by Ilizarov with corticotomy, which minimize complications, Due to early mobilization and decrease hospital stay time, resulting cost effective and found excellent final outcome.