21 - blount's disease

blount's disease is ?

a- genu valgus
b- tibia vara
c- flat foot
d- genu recurvatum

answer is b . tibia vara



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Definition Blount's disease, Blount-Barber disease, nonrachitic bowlegs in children.

Radiographic Appearance Physiologic bowing typically show flaring and bowing of tibia and femur in a symmetric fashion and is normal in children < style="color: rgb(0, 0, 255);">

Pathology Blount's Disease is one which affects the bone development of toddlers and older children. Most often, it starts as bow-leggedness which does not improve in a child between two and four years of age. Seeking appropriate treatment in a timely matter can help your child develop normally. Bow-leggedness in toddlers is particularly common most especially in those who walk at an early age and those who are slightly overweight for their age and height. But legs that are bowed and which do not correct by age two are cause for concern and investigation to see if Blount's Disease is a possibility. What happens with Blount's Disease is that as the child grows and the legs are bowed, some children have the tendency, for unknown reasons, to develop bones which continue to bow. It is a vicious circle. The bow-leggedness causes further bow-leggedness which perpetuates the problem. So as the legs continue to grow abnormally the child is forced to walk with knees that bulge outward and continue to get worse. What often accompanies this is a condition called internal tibial torsion. What this is, is toes which turn inward below the knee. The toes point obviously inward and some children even have a tendency to fall down more often with this infliction. When bow-leggedness and tibial torsion occur together it is a red flag g that it is probably Blount's Disease.

Treatment: What treatment involves initially in most cases, depending on age, is having your child wear one or more braces on the legs. They would be what is called a KAFP brace which stands for Knee-Ankle-Foot Prosthetic. The brace begins at the top of the thigh and extends to the tip of the toes, following underneath the foot. There are a variety of styles but the goal is the same -- to correct the abnormal development in the knee and hopefully straighten the leg. Once a brace has been designed for your child which involves making a cast of the leg and fitting it to your youngster, there will be follow-up exams and ongoing x-rays to follow the progress and be sure the brace is working effectively. If it does not do its job over a period up to 12 months or more, then corrective surgery is an option. Obviously, this is not the preferred option but it can occur, particularly if Blount's Disease is not caught early on.

Image 1 Blount's Disease

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- Infantile Blounts Disease: (pathologic tibia vara)
- differential diagnosis and examination
- most common form of disease;
- growth disorder of medial portion of proximal tibial physis;
- characterized by medial angulation& internal rotation of proximal tibia;
- etiology is related to repetitive trauma to posteromedial proximal tibia physis from ambulating on a knee with varus alignment;
- infantile tibia vara is seen between 2-4 years of age;
- usually bilateral;
- associated with internal tibial torsion;
- children w/ tibia vara are usually in upper percentiles of weight (for age)& began walking early;
- this contrasts w/ dysplastic children who present w/ bow legs but who are in the lower percentiles for height and weight;
- gait is characterized by painless varus thrust in stance phase;

- Radiographs:
- show metaphyseal diaphyseal angle of >11 deg early (this angle is formed by lines between metaphyseal beaks& perpendicular
to the longitudinal axis of the tibia);
- radiographs show a localized deformity at proximal tibial level w/ a medial metaphyseal lesion;
- in contrast, the common physiologic bowlegs involves both the tibia &distal femur (during 2nd year);