What is Deformity?
Deformity is a general term used to describe bending and deformities of bones. Knee deformities are popularly known as “O” legs or “X” legs and are one of the most common reasons for applying to a pediatric orthopedic clinic. Apart from this, deformities involving the hips, feet and upper extremities are also encountered.
The mentioned deformities should be evaluated in detail and should be determined whether they are a condition seen during normal growth or caused by another condition such as underlying trauma, vitamin deficiency, etc. For example, deformities that usually occur with walking after birth and that we know will improve in the following years are followed without the need for children to use a special device. However, there is no treatment option other than surgery, especially for deformities that occur after trauma and still do not improve after a long time. In addition, such deformities, which we call pathological, may cause problems in the future as the load distribution in the knee, hip and ankle is disturbed, and therefore needs to be corrected.
What are the Causes of Deformities?
A large group of deformities are congenital. Later ones are usually seen with diseases and trauma that impair bone quality. The most common among these is a condition called rickets, which develops with vitamin D deficiency. However, it is pleasing that when vitamin D is replaced in this group, the problem is largely resolved and the patient does not need to undergo major surgeries. In some congenital diseases and curvatures that increase during the child’s growth period, it is necessary to take precautions at the right time.
There are stages of normal leg development in children. When he first starts walking, the leg is in an “O” shape. As his gait accelerates, this image starts to improve, after the age of three, full recovery occurs, and after the age of five, an adult-type leg shape occurs. Normal development continues in this way. Families usually apply to the clinic when their children first start walking, during the period called normal curvature of the leg or introversion. If there is no problem in the joint area of the child, if his general health is good, if his diet is good, if there is no problem with his development that attracts the attention of the pediatrician, it is necessary to inform the family and comfort them; because it is known that the curvature will be almost completely corrected and it is enough to wait in these patients.
To state the points that families should pay attention to about their children; When the child comes to the ready position with their legs together, they can look at how many fingers there are between the knees. For example, if this gap is three fingers, they can follow up on two fingers after six months and whether it gradually improves. Families who come to the clinic are told how to follow up. They are asked to make this measurement every three to six months. When necessary, necessary examinations (such as x-rays) can be made and detailed evaluations can be made.
In adults, deformities can be seen due to previous diseases or trauma. These deformities can be seen in every part of the body and in every angle – direction. Since bone development is completed, deformity treatment in adults is usually performed surgically. At this point, an evaluation should be made depending on how much the current deformity affects the daily life, functions and appearance of the person, and the surgical decision should be made accordingly.
Deformity Diagnosis Stage
For diagnosis, first of all, the deformity area is determined in the physical examination. The movements in the joints around the bone where the deformity is seen are examined. Then, a radiological evaluation of the existing area is made. Although x-rays are usually sufficient at this stage, 3D evaluation with computerized tomography (CT) can be performed from time to time for the evaluation of complex deformities or for surgical planning. In addition, blood parameters related to bone development and metabolism such as calcium and phosphorus can be checked. Detailed blood tests are performed on the suspected condition. Depending on the size of the problem, patients are referred to endocrinology and sometimes genetics, if necessary. By collaborating with these departments, criteria such as whether the patient’s disease is congenital or not due to hormone deficiency are evaluated and the treatment is determined in the light of this information.
How Is Deformity Treated?
While determining the method to be used in the treatment phase, we evaluate the age of the patient, the degree of deformity and the reason for its occurrence. According to the result, it is aimed to correct the deformity with non-surgical treatments called conservative or surgical procedures.
Deformity Surgery Process
The most important criterion in treatment is age. At a young age, if the problem will increase as the patient grows, first of all, treatments are applied to stop the progression. For this purpose, there are treatments for non-surgical correction of leg curvatures using various orthoses, but a proven effect of these has not yet been demonstrated.
The most common treatment in childhood is growth guide plates placed in the bone growth zone. These small plates allow the bone to straighten as desired. This method is an easy procedure and less risky compared to more difficult surgeries such as bone cracking and bone fracture. If the child is brought in late and according to the calculations, this method will not be enough to correct, then the procedure of correcting the bone by cutting comes to the fore. This is the most common surgical method used in adults. X-ray films are taken, a detailed examination is made. How many degrees from which part of the bone is corrected, what kind of result will be obtained, how the patient’s limb will appear is calculated in the computer environment. Accordingly, the treatment program is arranged.
Regular follow-up after surgery is very important. The patient is followed up with x-ray films and clinical examination. Wound care is the most important in the early postoperative period, which is applied by the specialist who performed the surgery. The next goal is to strengthen the muscles of the patient with physical therapy and to ensure that the patient returns to his daily life as quickly as possible.