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Torsional, Angular, and Deficiency Disorders of the Lower Extremity

  • Frederic Shapiro
Chapter

Abstract

This chapter describes (i) the rotational and torsional lower extremity deformities included in the descriptive terms in-toeing and out-toeing that are generally self-correcting with growth and (ii) the relatively few femoral and tibial angular and limb deficiency disorders where the primary sites of deformation occur in the metaphyses and diaphyses that are among the most difficult childhood orthopedic conditions to treat.

Keywords

Torsion and angular deformities: in-toeing, out-toeing Rotation versus torsion Femoral anteversion and retroversion Internal and external tibial torsion Clinical examination Foot progression angle Thigh-foot angle Transmalleolar axis Spontaneous correction with growth common Defined instances of non-correction with growth needing osteotomy correction Severe torsional malalignment syndrome Congenital pseudarthrosis of tibia: types, pathoanatomy, value of multimodal treatment resecting pathologic tissue, apposing healthy bone, augmenting bone repair, and applying effective stabilization Metaphyseal-diaphyseal curvature (rickets, osteogenesis imperfecta) with or without adjacent joint obliquity Self-correcting posteromedial tibial-fibular angulation with calcaneovalgus foot deformity Deficiency disorders: classifications Bone and soft tissue pathoanatomy Lower extremity length discrepancy Management with surgical correction/amputation for femoral disorders (proximal femoral focal deficiency, congenital short femur, distal femoral dysplasia) Fibular hemimelia Tibial hemimelia 

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Frederic Shapiro
    • 1
    • 2
  1. 1.Visiting Scholar, Stanford University School of Medicine, Department of Medicine/Endocrinology (Bone Biology)Palo AltoUSA
  2. 2.Formerly, Associate Professor of Orthopaedic Surgery, Harvard Medical SchoolBoston Children’s HospitalBostonUSA

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