Knock Knees
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Transcript of Knock Knees
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DEFINITION Defined by position of knees such that,
when standing with knees together, the
medial malleoli are not touching.
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CAUSESUnilateral
Asymmetric growth:
1-Trauma.
2-Infection.
3-Tumor to tibia.
Bilateral
Physiological: common
Metabolic: renal
osteodystrophy, rickets,
hypophosphatemia.
Neuromuscular: cerebral
palsy.
Haemotological:myelodysplsia
Skeletal dysplasia:
congenital dislocation of
patella
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Presentation Knees touch each other while
standing.
Legs are curved inwardly.
Too much distance between feet.
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EXAMINATION
In the consultation room:
1- Always compare thetwo knees.
2- Watch the patient
walk.
3- Looks at the knees
whilst standing.
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Measurement of intermalleolar
distance
intermalleolar
distance is a Distance
between two malleoli
when the knees aregently touching with
legs in adduction.
Up to 3 and a half
inches (9 centimeters)
with child lying down
is acceptable.
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Possible Complications
Difficulty walking (very rare).
Self-esteem changes related to cosmetic
appearance of knock knees.
If left untreated (for patients with
intermalleolar distance which is more than
9 cm and for age group > 7 years), knockknees can lead to early arthritis of the
knee.
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Management
RAPRIOP
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Reassurance1- Most parents are happy to be reassured that their child's
deformity is within normal limits and will disappear.
2- Some may need their confidence boosted by returningfor fresh measurements to be made six-monthly until
they are convinced it is disappearing.
3- For those who are still sceptical, radiographicexamination may be sufficient to alleviate their anxiety
with or without the addition of an orthopaedic opinion.
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Advice To measure natural
improvement, Advice
Parents to takephotographs of the child
in standing with their
kneecaps pointing
forward every 6 months.
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Prescription (Treatment)
Non-Operative
Special shoes,
exercise programs,
splints and braces are
not recommended, as
these conditions
usually correct and
improve over time
with normal growth.
Operative
Epiphysiodesis
(physeal stapling) of
medial side, or
corrective osteotomy
in children > 10 years
old with intermalleolar
distance > 10 cm.
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When to Refer ? Age > 7 years with knock knees.
Unilateral problem i.e Asymmetry of legs.
Intermalleolar distance > 3.5 inches (9
cms).
Associated symptoms e.g Pain, Limp.
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InvestigationsX-rays
No X-ray required until >
18 months of age, then
AP and lateral standingfull leg length views.
Laboratory tests
CBC, phosphorus,
creatinine and alkaline
phosphotase may beordered if a systemic or
metabolic abnormality is
suspected.
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Observe (Follow Up)
Observe the patient every 6
months.
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Prevention
There is no known prevention
for normal knock knees.
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Thank you References:
1- Oxford handbook of Paediatrics.
2- Oxford handbook of General Practice.
3- Knock knees and bow legs for Dr. W J W SHARRAR,
BRITISH MEDICAL JOURNALhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1639432/pdf/b
rmedj00510-0046.pdf
4-Bowlegs and Knock-knee, The Royal Children's Hospital
Melbourne
http://www.rch.org.au/emplibrary/ortho/03BOWLEGS.pdf
5- Knock knee, Medline Plus
http://www.nlm.nih.gov/medlineplus/ency/article/001263.htm
6- Angular deformities of the lower extremity, bow legs and
knock knees, Pediatrics: a primary care approach.