Thesis (Ph.D)-Cairo University, 2023.

Bibliography: pages 130-137.

Genu varum is a common problem encountered in
pediatric orthopedics, may often be managed expectantly and with benign neglect, requiring only parental reassurance.
Most physiological deformities peak between 1 and 3 years (varus) or between 3and resolve spontaneously
Pathological angular deformities can be either idiopathic or due to congenitalsyndromes such as skeletal dysplasia
Varus deformities may result in lateral thrust, ligamentous laxity, and a waddlinggait
Regardless of whether the etiology is idiopathic,dysplastic, or related to anendocrinopathy,
the common goal of surgical treatment is to restore and maintain aneutral mechanical axis
Several methods have been described to attain normal alignment
The purpose of this study is to evaluate acute correction of the genuvarum by high tibial osteotomy without internal implant or external fixator regarding stability of the osteotomy after correction and complications rate.
In our study, weevaluate50limbswithgenuvarum undergoing of high tibial osteotomy,the patients were investigated for the etiology of coronal deformities and medical treatment (if needed) was taken simultaneously with the surgical treatment.
Preoperative measuring of intercondylar distance done for all cases.
Radiological evaluation of the affected knee x-rays (antero posterior standing long films) measuring mechanical axis deviation, lateral distal femoral and proximal medial tibial angles of knee joint were taken in all cases.
Allpatientswereallowedtobearweightafter cast removal.
Fullrangeofmotionofthekneewasencouragedandquadricepsmusclestrengtheningexercisesalsowereadvisedforallcases.
Periodic clinical and radiological follow up evaluations were performed to assess the deformity correctionapproximately every 12 months which included measuring of the intercondylar distance and standinglongfilm x-ray A.P. view.
The mean age was 4.36±0.69 And 72% of the sample was females and more than half 52% of the patients were left side .

Almost of the cases were due to rickets 80% and the other cause were due to blount’s disease 20% .

Age at time of operation of samples of rickets and blount’s etiology were median (IQR) 4(4:4) & 5(5:6) years respectively , also showing percent of female were 70 and 30 in males of rickets group while percent of female were 80 and 20 in males of blount’s group and showing percent of left and right sides equal 50 of rickets group while percent of left side were 60 and 40 in right side of blount’s group .
the MAD follow up at 1 year were normal in 44 cases (88%), abnormal genu varum in 2 cases (4%) and abnormal genu valgum in 4 cases (8%) out of 50 cases
the MAD follow up at 2 years were normal in 42 cases (87.50%), abnormal genu varum in 2 cases (4.17%) and abnormal genu varum in 4 cases (8.33%) out of 48 cases and the other of 2 cases from above, surgical intervention was performed for them,
the MAD follow up at 3 and 4 years were normal in 42 cases (91.30%) and abnormal genu valgum in 4 cases (8.70%) out of 46 cases and the other of 2 cases from above, surgical intervention was performed for them.

the MLDFA angle follow up at 1 year were normal in 6 cases only (12%) and abnormal genu varum in 44 cases (88%) out of 50 cases,
at 2 years post-operative were significantly changed into normal range in 8 cases (16.67%) and abnormal genu varum in 40 cases (83.33%) out of 48 cases and the other of 2 cases from above, surgical intervention was performed for them,,
at 3 years post-operative were normal in 18 cases (39.13%), abnormal genu varum in 26 cases (56.52%) and abnormal genu valgum in 2 cases (4.35%) out of 46 cases and the other of 2 cases from above, surgical intervention was performed for them,
at 4 years post-operative were normal in 18 cases (39.13%), abnormal genu varum in 24 cases (52.17%) and abnormal genu valgum in 4 cases (8.70%) out of 46 cases.


the MPTA angle follow up at 1 year were normal in 40 cases (80%), abnormal genu varum in 8 cases (16%) and abnormal genu valgum in 2 cases (4%) out of 50 cases,
at 2 years post-operative were significantly changed into normal range in 36 cases (75%), abnormal genu varum in 4 cases (8.33%) and abnormal genu valgum in 8 cases (16.67%) out of 48 cases and the other of 2 cases from above, surgical intervention was performed for them,
at 3 years post-operative were significantly changed into normal range in 34 cases (73.91%), abnormal genu varum in 2 cases (4.35%) and abnormal genu valgum in 10 cases (24.71%) out of 46 cases and the other of 2 cases from above, surgical intervention was performed for them,
and 4 years post-operative were significantly changed into normal range in 30 cases (68.18%), abnormal genu varum in 2 cases (4.55%) and abnormal genu valgum in 12 cases (27.27%) out of 44 cases and the other of 2 cases from above, surgical intervention was performed for them.

In our study, revision surgery was low rate, no revision surgery at 1 year follow up, 2 case only at 2 years follow up and 4 cases only at 3 and 4 years follow up out of 50 cases.
In our study, the incidence of recurrence was lower than many studies.
Additionally, complications reported with other techniques such as hardwere failure,physeal violation by the implant, premature physeal closure.
We consider the acute correction of genu varum treated by high tibial osteotomy with above knee plaster cast is the best solution for the treatment of angulardeformitiesbetheyidiopathicorduetoanunderlyingpathologicalcondition.

This technique is simple, cost-effectiveness and lowest rate of recurrence or complications of use internal implants with staples or others .

فى دراستنا هناك 50مريضاتم عمل لهم من قبل اصلاح للتقوس الداخلي بواسطة قطع عظم الظنبوب من سنة 2٠١٦ الى سنة ٢٠١٩ وتمت متابعتهم بعد التدخل الجراحي سنويا و لمدة ٤ سنوات متتابعة خلال الفترة من ٢٠١٩ الى ٢٠٢٣ في مستشفى ابوالريش الياباني – جامعة القاهرة وذلك بعد موافقة لجنة أخلاقيات البحث العلمى بالكليه على البروتوكول وتم أخذ موافقه كتابيه من جميع المرضى على البحث .

وكان هدفنا هو تقييم النتائج طويلة الأمد بعد التدخل الجراحي وكان متوسط عمر المرضى من ٤ إلى ٥ سنوات وكان عدد الذكور ١٤ وعدد الاناث ٣٦.

تم متابعة جميع المرضى بواسطة عمل الاشعات المطلوبة وقياس الزوايا اللازمة بعد العملية وكذلك سنويا لمدة ٤ سنوات متتالية وتم أدراج المرضى صاحبة المعايير االلازمة للدراسة.
وكانت النتائج الاتي
تحسن انحراف المحور الميكانيكي في 42 مريض في متابعة السنة الرابعه .
تحسن زاوية الفخذ الجانبية البعيدة الميكانيكية في ١٨ مريض في متابعة السنة الرابعه .
تحسن زاوية قصبة الساق القريبة الإنسي في ٣٠ مريض في متابعة السنة الرابعة .

Issues also as CD.

Text in English and abstract in Arabic & English.