For the child with specific and identifiable bone dysplasia, medical treatment may have an important role, influencing the outcome. For example, the child with vitamin D–resistant rickets should be on appropriate medication to optimize bone formation and mineralization. Likewise, children with osteogenesis imperfecta may benefit from treatment with bisphosphonates to increase bone density and decrease the risk of fractures. Recognizing the need for holistic care, even optimal medical management does not correct preexisting genu valgum. However, treatment may slow the progression of the condition and prevent recurrence. Bracing and physical therapy may provide a temporary reprieve of symptoms, but they do not afford long-term symptomatic relief.
Guided growth has emerged as the treatment of choice in the growing child; osteotomy should be reserved as a salvage option (or for mature patients). Despite the age of the child or the etiology of the valgus, even children with “sick physes” may be well served by the application of an extraperiosteal 2-hole. This is documented with quarterly follow-up evaluations, including full-length radiographs with the legs straight.
When the mechanical axis has been restored to neutral, the implants are removed. Growth should be monitored because if the valgus recurs, guided growth may need to be repeated. The goal is to correct the deformity, which alleviates the pain and gait disturbance and protects the knee throughout the growing years. If this requires repeated, yet minor, intervention, the benefits still outweigh the cost and risks of (sometimes) repeated osteotomies. If recurrence is anticipated, an option is to percutaneously remove the metaphyseal screw, monitor subsequent growth, and insert another screw as needed.