This document discusses three orthopedic cases: 1) A case of coxa vara with options for valgizing osteotomy and adductor tenotomy surgery using a locking plate or blade plate approach. 2) A case of bilateral genu valgum requiring measurement of tibial axes and potential closed wedge osteotomy of the tibia fixed with K-wires, rush rods or LLC. Foot involvement affects the decision. 3) A case of radial club hand classified using the Bayne and Klug system, with potential ulnar centralization and pollicization surgery involving soft tissue release, osteotomy and pinning or plating.

1. Gashaye T.
Case discussion I

2. Case1 Coxa vara
 Measure the neck shaft angle less
than 110 deg
 And H-E angle probably more
than 60 deg
 Shortening of left femur
 Sever adductor contracture
 Rx option---surgical with valgizing
osteotomy And adductor tenotomy
 But before that ineection should
be rule outed
 Preoperative plan—measure
angle of correction

3.  Implant choice
 Ped locking plate
 Ped angle blade plate
 K wire
 Approach –direct lateral approach to prox femur
• Expose the bone
• Guide pin to femur neck
• Osteotomy to subtroch area
• Correct the varus with translation
• Locking plate or angle blade plate applied

4.  Complication
 Recurrence
 Coxa valga
 AVN
 Growth arrest
 Persistent LLD
 Early degenerative change

5. Spot 1
Bilateral genu valgum

6. Case 2
 I need more hx,PE and proper x ray
both AP and lat x ray of leg including
knee and ankle ?
 Proper Ap and lat x ray of foot and
ankle x ray separately ?
 What happened to the foot?
 Bone genralized osteopenic
 Seems valgus deormity of foot
 ?Ankle degenerative change
 ?Planovalgus

7.  Measure the proximal ,distal tibial mechanical and
anatomic axis
 Identify the CORA
 Closed wedge osteotomy of tibia Anterior approach
 Anterior comp closed fasciotomy
 Fibular osteotomy -proximally
 FIXATION
 K –WIRE
 RUSH ROD
 LLC
 INTRAOP problem
 Stability of osteotomy
 Bone osteopenic fracture and bleeding

8.  The foot condition really affect our decision
seems valgus exaggerated
 Otherwise with correction of the tibbial deformity it
will correct probably

9. Spot 2
 Rocker bottom deformity
 Mostly bilateral CVT

10. Case 3-Radial club hand
 Bayne and Klug
classification most
commonly used

11.  Surgical plan
 Medical condition should be investigate and
optimized
 Elbow range of motion should be adequate
 Age at least 6month to 1yr
 Streaching and splinting for age<2 to3 yrs and
preoperatively
 Plan –ulnar centralization with latter policization
depending thumb status

12.  Bilobed flap design
with soft tissue
release and ulanar
osteotomy if
angulation>30 deg
 Implant
 mostly pinning to the
carpus
 plating
 EX-FIX

13. Spot 3
 DDX
 Osteogeenic
imperfecta
 Fibrous displasia
 Hypophosphatemic
rickets

14.  THANK YOU!