[Deviations in the axes of the lower extremities]

Area of Science:

• Orthopedics
• Pediatric Orthopedics
• Biomechanics

Background:

• Lower extremity axis deviations are common during childhood growth.
• Physiological changes occur in the femoral neck-shaft angle and lower leg alignment.
• Pathological deviations are rare but can result from congenital issues, trauma, infection, or metabolic diseases.

Purpose of the Study:

• To describe physiological and pathological axis deviations in the lower extremities.
• To outline treatment strategies for significant deviations, particularly coxa vara.
• To highlight surgical interventions for lower leg axis deformities in children and adolescents.

Main Methods:

• Review of physiological axis changes during growth (femoral neck-shaft angle, knee valgus).
• Discussion of pathological causes and associated conditions like coxa vara and pseudarthrosis.
• Description of surgical correction methods: Y-shaped osteotomy for femoral neck and external fixators for lower leg deformities.

Main Results:

• Femoral neck-shaft angle decreases from 150° at birth to 120° at skeletal maturity.
• Lower leg varus at birth transitions to valgus after walking, normalizing before age ten.
• Coxa vara necessitates treatment to prevent pseudarthrosis; Y-shaped osteotomy is recommended.
• Lower leg deviations >15° often require operative intervention.

Conclusions:

• Physiological axis changes are normal, but pathological deviations require timely intervention.
• Pauwels' Y-shaped osteotomy is effective for coxa vara with pseudarthrosis.
• External fixators are advantageous for correcting lower leg axis deviations in pediatric patients, enabling early weight-bearing.