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An 18-year-old girl presents with a deformity of the left leg that limits her ability to play basketball and volleyball. She reports pain along the lateral joint line with vigorous activity. A clinical image of the left leg in the supine position is shown in Figure A. A standing alignment radiograph is shown in Figure B with the mechanical lateral distal femoral angle measured at 73° (mLDFA 88°, range 85°-90°), an mechanical medial proximal tibial angle of 87° (mMPTA 87°, range 85°-90°), and a tibial femoral angle of 25°(range 5°-10°). Which of the following is the most appropriate surgical treatment?
Lateral closing wedge proximal femoral osteotomy with medial opening wedge tibial osteotomy
Lateral closing wedge tibial osteotomy
Medial opening wedge femoral osteotomy
Medial closing wedge tibial osteotomy
Medial closing wedge femoral osteotomy
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A 12-year-old skeletally immature female presents with a several year history of bilateral knee pain and lower extremity deformity with her knees rubbing together while she runs. Her medical history is positive for asthma and eczema. She denies constitutional symptoms. She is neurovascularly intact in the bilateral lower extremities. A standing alignment radiograph is shown in Figure A. Which of the following treatment options is most appropriate?
Hip-knee-ankle-foot orthotic (HKAFO)
Distal femoral osteotomy with plate fixation of bilateral distal femurs
Temporary hemiepiphysiodesis across the bilateral medial distal femoral growth plates
Temporary hemiepiphysiodesis across the right medial distal femoral growth plate
Temporary lateral hemiepiphysiodesis of the bilateral distal femoral growth plates
HPI - Progressive bowing of his lower extremities.
Initially presented with bilateral genu valgum and had a corrective osteotomy at 2 years.
Bowing started after surgery. It is associated mild pain following activity.
No other deformity.
No family history.
How would you manage this young boy with painful deformity of his bilateral lower extremities?
HPI - Gradual onset pain while standing for longer time, gait abnormality
Plan of management
HPI - deformity
what is the best site for osteotomy and fixation