Primary hyperparathyroidism (PHPT) in adolescents is rare and has severe manifestations as compared to adults. Skeletal involvement in primary hyperparathyroidism in the form of deformities like genu valgus, genu varus and cubitus varus is rare and limited to case reports and case series. There is only one case of genu varus with genu valgus on the contralateral extremity (windswept deformity) that has been reported to date in the literature. We report the case of a 19-year-old male who presented with isolated progressive bending of his legs at the knee (windswept deformity) for three years. He was found to have hypercalcemia, hypophosphatemia, high alkaline phosphatase, high intact parathyroid hormone (iPTH), normal 25-hydroxy vitamin D level and a normal kidney function test. A diagnosis of primary hyperparathyroidism was made. On imaging studies, a left inferior parathyroid adenoma was localized and was successfully removed surgically. Serum calcium and iPTH normalized post-operatively. The patient is being planned for corrective osteotomy after stabilization of alkaline phosphatase levels.
Hyperparathyroidism, Primary ; Genu Varus ; Genu Varum

No abstract available.
Genu Varum*

High tibial osteotomy (HTO) is a commonly used treatment for genu varum and medial compartment osteoarthritis. Recently open wedge HTO has been the preferred method due to its facilitated technique, fewer neurovascular and joint injuries, etc. In open wedge HTO materials such as autogenous, allogenous bone graft and tricalcium phosphate (TCP) are used to help with bone union and have a role in filling in the empty space. However the authors of this study report on two cases of nonunion 1 year after HTO using TCP block.
Genu Varum ; Joints ; Osteoarthritis ; Osteotomy* ; Transplants

PURPOSE: This study examined the effects of squatting with different foot positions on the muscle activation of the vastus medialis oblique (VMO) and vastus lateralis (VL) muscles in subjects with genu varum. METHODS: Thirty four subjects participated in this study. Surface electromyography was used to measure the muscle activation of the VMO and VL muscles at the knee angles (15°, 60°) at three foot positions (internal rotation, neutral position, external rotation) during squatting. RESULTS: Muscle activation differences at different knee angles and foot positions differed significantly between the VMO and VL muscles in both the varus and normal groups. In addition, there was a significant difference according to the knee angles with the foot in external rotation in the VMO and VL ratio. In the varus group, however, the VMO and VL ratio were significantly different only with the feet in internal rotation. In the muscle activation changes of the knee angle differences in the foot position, there was no significant difference in the varus group, but both the VMO and VL muscles were significant different in the normal group. CONCLUSION: In both groups, regardless of the foot position, muscle activation of the VMO and VL muscles increased with increasing knee flexion angle. In the normal group, when squatting with the feet in external rotation, the VMO and VL muscles activations increased with increasing knee angle. In the varus group, however, the foot position did not affect the VMO or VL muscle activation. This study shows that subjects with genu varum and normal subjects have different VMO and VL muscle activation patterns during squat exercises.
Electromyography ; Exercise ; Foot ; Genu Varum ; Knee ; Muscles ; Quadriceps Muscle

PURPOSE: The aim of this study was to investigate the effects of foot position on dynamic stability in female with genu varum. METHODS: Eight females with genu varum participated in this study and performed the four squat exercise methods that foot position (−45°, 0°, +45°) and 0° squat with band. Center of pressure (COP; anterior-posterior, medial-lateral, traveled distance, ellipse area) and ground reaction force as dynamic stability were measured using footscan system. Multivariate analysis of variance and one-way repeated analysis of variance measurement with Tukey honestly significant difference were used to identify significant differences of foot angle (−45°, 0°, +45°) and 0° squat with band method. RESULTS: In anterior-posterior COP displacement, −45° foot angle and 0° squat with band were significantly showed lower than +45° foot angle squat (p=0.006). Also, in COP traveled distance, 0° squat was significantly showed lower than +45° foot angle (p=0.019). During the descending phase, ground reaction force significantly showed in −45 foot angle was lower than other exercise methods. CONCLUSION: The 0° squat with band exercise showed higher dynamic stability and +45° foot angle squat exercise showed lower dynamic stability in female with genu varum.
Female* ; Foot* ; Genu Varum* ; Humans ; Methods ; Multivariate Analysis

PURPOSE: To report the clinical and radiological results after high tibial osteotomy that was fixed with a long winged modified Steinmann pin. MATERIALS AND METHODS: Forty knees of twenty patients with genu varum, degenerative or physiologic, underwent high tibial osteotomy using a long-winged modified Steinmann pin and four-week cast immobilization. Mean follow up was 36.0 months(5~67 months). Clinical results were assessed using the Knee society score and radiographic measurements, using Bauer 's method and Insall-Savati ratio. Statistical analyses were performed with the paired samples t-test. RESULTS: The corrected angle was varus 3.2+/-2.7 degrees preoperatively, valgus 7.3+/-2.0 degrees postoperatively(p<0.05), and valgus 6.0+/-1.4 degrees at the latest follow up. According to the Knee society clinical rating system, the knee score was 61.8+/-7.2 preoperatively and 92.8+/-2.8 postoperatively (p<0.05). The function score was 77.8+/-5.8 preoperatively and 89.0+/-6.3 postoperatively(p<0.05). The Insall-Salvati ratio was 1.02+/-0.14 preoperatively and 1.00+/-0.15 at the latest follow up(p=0.018). CONCLUSION: High tibial osteotomy with a long-winged modified Steinmann pin could obtain good correction of angles and clinical results with few complications. And this method was also useful in maintaining the correction angles.
Follow-Up Studies ; Genu Varum ; Humans ; Immobilization ; Knee ; Osteoarthritis ; Osteotomy*

PURPOSE: We investigate a new measurement method for bowleg deformity in children to reduce intra-observer and inter-observer error and to assess change in the angles measured with respect to the rotation of the lower leg. MATERIALS AND METHOD: Fifty-one children younger than 3 years old with bow leg were analyzed. To assess the intra-observer and inter-observer error of the Metaphyseal-Diaphyseal Angle, Intermetaphyseal-metaphyseal angle and Tibio-Femoral angle measurements, supine view antero-posterior radiographs of the lower legs were taken at the neutral rotation, at 10 degrees and at 20 degrees internal rotation positions. Also, the effect of the rotation of lower legs upon the measured angle was assessed by comparing and analyzing the angle values with respect to rotations of the lower leg. RESULTS: TInter-observer error showed statistically significant difference (p<0.05). All measured angles showed statistically significant differences with respect to the rotation of the lower legs. The measurement variability introduced by rotation was significantly greater than the intra-observer and inter-observer errors. The Intermetaphyseal-metaphyseal angle measurement had the lowest standard error and the highest correlation coefficient. CONCLUSION: The Intermetaphyseal-metaphyseal angle measurement seems a highly reliable method, which could be clinically utilized. Also, since the rotation of the lower legs influences the metaphyseal-diaphyseal angle, the clinician should consider this effect when studying a simple radiograph for bowleg deformity.
Child* ; Child, Preschool ; Congenital Abnormalities* ; Genu Varum ; Humans ; Leg

Achondroplasia and hypochondroplasia are the two most common forms of short-limb dwarfism. They are autosomal dominant diseases that are characterized by a rhizomelic shortening of the limbs, large head with frontal bossing, hypoplasia of the mid-face, genu varum and trident hands. Mutations in the fibroblast growth factor receptor-3 (FGFR3) gene, which is located on chromosome 4p16.3, have been reported to cause achondroplasia and hypochondroplasia. More than 98% of achondroplasia cases are caused by the G380R mutation (c.1138G>A or c.1138G>C). In contrast, the N540K mutation (c.1620C>A) is detected in 60-65% of hypochondroplasia cases. Tests for common mutations are often unable to detect the mutation in patients with a clinical diagnosis of hypochondroplasia. In this study, we presented a case of familial hypochondroplasia with a rare mutation in FGFR3 identified by next generation sequencing.
Achondroplasia ; Diagnosis* ; Dwarfism ; Extremities ; Fibroblast Growth Factors ; Genu Varum ; Hand ; Head ; High-Throughput Nucleotide Sequencing ; Humans

Restoration of neutral mechanical alignment of the lower limb is an important factor in the treatment of unicompartmental arthrosis. Traditionally, medial opening wedge high tibial osteotomy has been widely performed to correct varus malalignment with unicompartmental arthrosis. However, an ideal indication for the high tibial osteotomy is the knee with metaphyseal tibial varus malalignment. The basic principle of corrective osteotomy is performing an osteotomy at the center of the deformity to prevent abnormal joint line obliquity. If pathologic distal femoral varus deformity is the cause of genu varum, the osteotomy should be performed in the distal femur. Reports of medial opening wedge distal femoral osteotomy (DFO) to correct varus malalignment are rare. We present a case of this very rare and challenging condition in a 47-year-old male, which was successfully treated by medial opening wedge DFO.
Congenital Abnormalities ; Femur ; Genu Varum ; Humans ; Joints ; Knee ; Lower Extremity ; Male ; Middle Aged ; Osteotomy

Nowadays the clinical impression in Korea is that genu varum uncommon though there was high incidence of this deformity by vitamin D deficiency in the early 1900. Authors reviewed the case histories and x-ray of 18 patients treated for this condition at the Dept. of Orthopaedics, St. Mary's hospital for past 5 years: 17 patients were under 5 years of age. 12 patients had rachitic bowIeg and among them four had active ricket. Six patients had physiologic bowleg deformity. Classification in four grades according to severity of bowleg is attempted. Among the cases eleven patients having less than 10 degree of bowleg treated conservatively with good end result, but corrective osteotomy is routinely scheduled for seven patients having bowleg of knee over 10 degree and resist to treatment. Lasting it is stressed that physiologic bowleg shoud be distinguished from pathologic one. Diagnosis of bow leg can not be made before age of 2–3 years, that is, before transitional phase of development of knee angle.
Classification ; Congenital Abnormalities ; Diagnosis ; Genu Varum ; Humans ; Incidence ; Knee ; Korea ; Osteotomy ; Vitamin D Deficiency