Module 50, General Orthopaedist Level
A three year old white male sustained a fracture of the left proximal
tibia while jumping off a chair. The minimally displaced fracture was located
in the proximal tibia just below the growth plate. The fracture line could
barely be seen but the leg had slightly more valgus than the opposite side.
Treatment consisted of a long leg cast for six weeks. Upon removal of the
cast a slight valgus deformity was noted. Four months after the fracture
a progressive valgus deformity was noted. Examination revealed full range
of motion of the left knee. There was 20 degrees of genu valgum on left
and 10 degrees on the right. The mechanical axis from the x-ray was measured
at 8 degrees on the right and 16 degrees on the left.
Question 50A
The cause of this valgus deformity is all due to unreduced fracture deformity.
Question 50B
The
best treatment at this stage is to place the child in a in a single upright
KAFO with a varus tension strap.
Question 50C
The
parents are very concerned and just want to have this leg straightened.
You say that could be done with a definite correction of the deformity
permanently however you feel this may still remodel and recommend continued
monitoring.
Question 50D
This
type of fracture is common and only rarely goes on to have a progressive
valgus deformity.
Question 50E
This
is one fracture pattern of childhood in which anatomic reduction is important.
Go to Next Question Module, Go
to Pediatric Orthopaedist Level Modules, Go
to Question Module Home Page, Go
to Case Presentation Home Page, Orthopaedic
Department Home Page.
