Module 50, Pediatric 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 19 degrees on the left (image1). X-rays were repeated at 16 Months post fracture(image 2), the mechanical axis from the x-ray was measured at 8 degrees on the right and 26 degrees on the left and the left femoral tibio angle was 34 degrees. At this time the child was experiencing significant pain and the inability to ambulate. He is now 4.5 years old.

Question 50A

This type of severe progressive deformity is not consistent with valgus deformity secondary to minimal fracture. Further work up for growth plate injury or bone dysplasia should be performed.

Question 50B

Because the child is have problems walking and pain, an osteotomy is indicated.

Question 50C

In discussing the possibility of an osteotomy, you inform the parents that the valgus will probably return fairly rapidly.

Question 50D

These valgus deformities all are supposed to have spontaneous correction.

Question 50E

Partial epiphyseodesis near skeletal maturity or medial epiphyseal stapling are other treatment options to consider