Figure 8 - uploaded by Jamie Ferguson
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AP radiograph of a child with Achondroplasia. Note the varus centred at the knee with marked metaphyseal flaring and relative overgrowth of the fibula.
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There is a broad collection of different conditions that can lead to tibial bowing. In this article we review the causes of tibial deformity in children and give an overview of the management of this group. Readers should gain an awareness of the varying presentations of these different conditions and be able to differentiate between the relatively...
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Aims:
Recurrence of deformity following high tibial osteotomy (HTO) for infantile tibia vara (ITV) is common. The purpose of this study was to identify risk factors for recurrent deformity following HTO for ITV and to develop a simple scoring system to quantify the risk of recurrence in each patient.
Patients and methods:
We identified 69 patien...
Citations
... One of the etiologies of Blount disease is mechanical factors which are likely overweight, and the age to start walking is less than 12 months. [20][21][22] The pathology is that standing and receiving excessive weight, especially on the medial side of the tibia, will cause growth disturbances according to Heuter-Volkman's law. [23][24][25][26] From the histopathological examination, anatomical and functional disorders of chondrocytes and disorders of ossification of the epiphyseal plate were found. ...
Background: Genu varum is the condition of the legs that bend inward, leading to walking disruptions. However, data on genu varum are still lacking to prevent the disease. This study aimed to identify the epidemiology of patients with genu varum in preventing, managing and determining the prognosis and as a source for future research.Methods: This research is a descriptive study using a retrospective research design. The sampling technique used is a total sampling of genu varum patients gained from the Department of Orthopedics and Traumatology database, medical records from Dr. Soetomo General Academic Hospital Surabaya, and patients' home visits. The target population is all genu varum patients from 2010-2018.Results: The total sample was 31 patients, 21 patients were male (67%), and 10 patients were female (32%). The average age of patients was 4.3 years. The first complaint of the disease was, on average, realized at 1.8 years. The birth weight data obtained an average of 3.49 kg. The average body mass index is 26.3. Langenskiold stage I,II,III,IV,V,VI type; 2 (3%), 43 (70%), 2 (3%), 5 (8%), 2 (3%), 8 (13%). Eighteen patients (58%) had bilateral Blount disease and 7 patients (22%) had unilateral Blount disease, and only six patients (20%) had physiologic genu varum. Eighteen patients were carried out conservative methods, and 13 underwent operative methods.Conclusion: Blount disease is the commonest cause of genu varum in Dr. Soetomo General Academic Hospital, specifically infantile. The highest number of patients are male and those who underwent operative treatment.
... Leg bowing in children is a multifactorial condition; therefore, understanding the difference between its causes is relatively important to identify and manage each case accordingly [1]. ...
... Rickets one of the commonest differentials in children with leg bowing; it is a disease of varying etiologies, which lead to insufficient mineralization of bone and cartilage by decreasing the level of serum calcium and/or phosphate [1,2]. ...
... However, it is important to keep in mind other causes of leg bowing [1]. Physiological leg bowing for example, which may attribute to the angulation in neonates and infants. ...
Objective: Familial Blount disease is a rare developmental disorder that results in acute varus angulation of the proximal tibia. In this case report, we present a young male child along with his mother and two of his siblings who presented with Blount disease, we reviewed the etiology, risk factors and the most common differentials and the common approach of this rare disease. This presentation of bilateral progressive leg bowing, turned out to be Blount disease after a thorough clinical/radiological workup. Methods: A single case of reviewed for this case study. The patient an 8 year old male who presented with progressive bilateral leg bowing was examined, investigated and managed accordingly. We also reviewed the etiology, risk factors, differentials and common approach to a patient with Blount disease. Results: The patient was referred to the orthopedic clinic and was scheduled for bilateral epiphysiodesis. Conclusion: When evaluating leg bowing in children, many causes should be ruled out before making a diagnosis. This case documents a rare cause behind leg bowing in children that pediatricians/general physicians should always keep in mind.
... Non-surgical therapy is usually applied for degree I and II in patients who are less than 3 years old, while degrees III -VI is for patients who are older than 3 years old and or for those who are failed in non-surgical therapy. Deformity of genu therapy degree III-VI usually requires surgery; it also usually results permanent sequelae 9,10 . ...
... Previous studies in stage I and II of genu deformity with the use of braces (brace/splint) 11 is the right way to improve the angle of the proximal tibia varus 5,15 . One method of brace installations that is often used is Knee ankle foot orthosis (KAFO) 9,12 . This method fixes the knee in the extension position and gives the medial space to become valgus. ...
Background: This research is motivated by the absence of therapeutic pants in patients with genu deformity, so innovations to create latest medical products are needed to prevent the disease. One of the innovations is development of therapeutic pants for genu varum and genu valgum. Objective: It aims to research and develop therapeutic pants to improve comfort of children with genu varum and genu valgum.Methods: This study used Research and Development (R&D) approach. It consisted of 3 phases, namely phase I, II, and III or product trials.Result: From the literary study in phase I, it was obtained that materials used to make the therapeutic pants were cotton cloth fabric and foam. In the second phase of the research, it was also discovered that designs and shapes of the pants were as needed. The results of product trials or phase III of this study involved 5 respondents; it showed that the use of therapeutic pants in toddlers resulted comfort and satisfaction for them.Conclusion: The therapeutic pants are proven to increase comfort in toddlers with genu varum and genu valgum.
... Bilateral presentation mostly occur, especially in infants, yet it is not unusual to have unilaterally-affected limbs. 4 The exact etiology of Blount disease remains unclear. Multiple factors were assumed to be the contributing elements to this disease. ...
Blount disease is a rare growth disorder of the medial aspect of the proximal tibial physis, with abrupt medial angulation leading to varus angulation of the proximal tibia and medial rotation of the tibia. Multiple factors such as ethnicity, genetics, and mechanical stress are thought to be contributing element to this disease. Treatment depends on the age of the patient and severity of the condition. A diagnosis of Blount disease is
based on clinical, laboratory and standing alignment of x-ray. The natural history of untreated Blount disease is progressive and non-resolving varus deformity which produce joint deformity and growth retardation. Proper management of patient with obese and Blount disease is nutritional and surgical procedure. Hereby we presented a six year old girl with juvenile blount disease related to obesity.
... According to the direction of the apex of the deformity, they can be classified in anterolateral, anteromedial and posteromedial. [1][2][3] CPMBT is characterized by a calcaneal valgus deformity and is the most benign of all the congenital deformities of the tibia. [1][2][3][4][5] If there is a large angulation of the diaphysis, the deformity is usually obvious at birth. ...
... [1][2][3] CPMBT is characterized by a calcaneal valgus deformity and is the most benign of all the congenital deformities of the tibia. [1][2][3][4][5] If there is a large angulation of the diaphysis, the deformity is usually obvious at birth. [1][2][3] However, if there is only a slight angulation, only a thorough examination of the lower limbs can identify it. ...
... [1][2][3][4][5] If there is a large angulation of the diaphysis, the deformity is usually obvious at birth. [1][2][3] However, if there is only a slight angulation, only a thorough examination of the lower limbs can identify it. 1 CPMBT is distinguishable from the anterolateral bowing due to the absence of pseudoarthrosis or association with type I Neurofibromatosis (featured in 50% of the latter) and distinguishable from the anteromedial bowing because it is not associated with the absence of fibula or lateral segments of the foot. ...
A term newborn, from a medically supervised pregnancy, had a hypoplasia of the right leg bones and ipsilateral deviation of the foot on the obstetric ultrasounds and presented at birth with a medial deviation of the inferior third of the right leg and dorsiflexion of the right foot. A right leg x-ray showed a congenital posteromedial bowing of the tibia (CPMBT). A favorable outcome was achieved with a conservative approach at eleven months old. CPMBT is the most benign of all the congenital deformities of the tibia. Usually it is obvious at birth as a calcaneal valgus deformity. It tends to resolve spontaneously, thus a conservative approach is adopted in most cases. Limb length discrepancy is the main complication, and so follow-up is recommended until skeletal maturity. Due to the rarity of these deformities, an early recognition and referral are fundamental.
... Depending on the anatomy of the proximal tibial metaphysis, Langenskiöld has classified the disease into six stages: (1) medial beaking, (2) saucer-shaped defect, (3) saucer deepens into a step, (4) epiphysis bent down over medial beak, (5) double epiphysis and (6) development of a medial physeal bony bar. 3 Rickets is a very close differential diagnosis and the characteristic radiological findings of rickets, such as cupping, fraying and splaying of metaphyses, are absent in Blount's disease. Moreover, involvement of upper limbs and enlargement of costochondral junctions (rickety rosary) can differentiate rickets from Blount's disease. ...
... A report of two cases and valga. [1][2][3][4][5][6] Regardless of the pathology, proper surgical management of the lower limb deformity relies on accurate radiological assessment. [1] Ensuring precise alignment of the lower limb's mechanical axis is an important factor in surgical planning of the patients with leg deformities. ...
Background: The purpose of this study was to investigate the agreement between the three-dimensional (3D) weight-bearing radiological measurements of leg deformities in the presence of leg rotation and knee flexion in a biplanar stereoradiography system (EOS imaging) and measurements of computed tomography (CT) scans.
Methods: Upright biplanar X-rays of six Sawbones; with deformity were registered in no flexion/rotation angle, in 10° and 20° of axial rotation, and 10° and 20° of knee flexion. A CT scan of each bone was registered in supine position, and the 3D reconstruction of each bone was generated. Two-dimensional (2D) lengths and deformity angles were measured on the plain X-rays by two independent observers. Two independent observers generated the 3D reconstructions of the biplanar X-rays and the leg deformity parameters were measured in 3D using custom-developed software. 2D and 3D measurements were compared to CT measurements performed by two observers and repeated three times. The intraclass correlation and limit of agreement between the three measurement techniques were evaluated using Bland-Altman plots.
Results: The intraclass correlations were good to excellent for the three imaging modalities (intraclass correlation coefficients = 0.71-0.95). Frontal deformity angles and lengths were significantly different in the 2D X-rays and CT (P < 0.05) whereas all the length and deformity measurements were comparable between CT and 3D X-rays (P > 0.05).
Conclusions: The 3D measurements of the weight-bearing biplanar X-rays were comparable to 3D CT in assessment of the lower limb deformity.
... За кљу чак Упр кос ло шим прог но стич ким фак то ри ма (ма ли уз раст, ве ли ки де фор ми тет), при ме на ста рих и го то во за бо ра вље них ме то да мо же да ти од ли чан ре зул тат ле че ња. Кључ не ре чи: кон ге ни тал на псе у до ар тро за пот ко ле ни це; хо мо лог ни ка лем; ин тра ме ду лар на фик са ци ја Урођена псеудоартроза потколенице излечена већ скоро заборављеном методом -приказ болесника Зоран Вукашиновић 1,2 , Душко Спасовски 1,2 , Игор Шешлија 2 , Исмет Гавранкапетановић 3,4 , Елвир Баждар 3,4 , Зорица Живковић 5 1 Медицински факултет, Универзитет у Београду, Београд, Србија; 2 Институт за ортопедскохируршке болести "Бањица", Београд, Србија; 3 Медицински факултет, Универзитет у Сарајеву, Сарајево, Босна и Херцеговина; 4 Клиника за ортопедију и трауматологију, Клинички центар Универзитета у Сарајеву, Сарајево, Босна и Херцеговина; 5 Клиничкоболнички центар "Др Драгиша Мишовић", Београд, Србија УВОД Уро ђе на псе у до ар тро за пот ко ле ни це убра ја се у нај ве ће иза зо ве у деч јој ор то пе ди ји. Ин ци ден ци ја ове рет ке бо ле сти је све га 4-7 обо ле лих на ми ли он но во ро ђе не де це. ...
... Ја вља се у не ко ли ко об ли ка, од ко јих је нај че шћи (40-80% слу ча је ва) по ве зан с не у ро фи бро ма то зом тип 1 [1]. Де фор ми тет по ста је ви дљив нај че шће до дру ге го ди не, док се у рет ким слу ча је ви ма ди јаг но сти ку је у адо ле сцент ском уз ра сту [2,3]. Већ ви ше од јед ног ве ка ис тра жу ју се ети о ло шки фак то ри од го вор ни за на ста нак кон ге ни тал не псе у до ар тро зе пот ко ле ни це [4] и мо же се ре ћи да ни је би ло ме то де ле че ња ко ја се при ме њу је у деч јој ор то пе ди ји а да се ни је по ку ша ла при ме ни ти на ово ста ње [5,6,7]. ...
Congenital pseudarthrosis of tibia is a rare congenital deformity with progressive evolution. Treatment is vague and difficult, and many methods have been used--from once mandatory early amputation to contemporary operative (Ilizarov method, free microvascular fibular graft) and adjuvant methods (electrostimulation, biphosphonates, bone morphogenetic protein). We present the usage of once popular method of homologous graft insertion and intramedullary fixation.
This is a case report of male patient with pseudarthrosis involving both crural bones (Boyd type 5), diagnosed in neonatal age. Early conservative treatment was unsuccessful, so child never initiated gait. At the age of three and a half years, operative treatment was applied: resection of pseudarthrosis on both tibia and fibula, and osteoplasty of tibia using cylindric homologous graft and intramedullary fixation with transtarsal Steinman pin, followed by long leg cast immobilization. Pin was removed after ten months, and physical therapy was initiated 1.5 year after surgery, with initial to partial weight bearing and short leg cast throughout another year. Two and a half years after surgery complete union of graft was documented, and then full weight bearing was allowed. At final visit, five years and three months after surgery, shin axis was correct, leg lengths were equal, and child had normal walk with full range of motion. X-ray showed complete union of both tibia and fibula.
Despite bad prognostic factors (young age, severe deformity), utilization of obsolete and almost forgotten treatment methods can provide excellent result.
Genu varum is a relatively common finding in children. There are numerous conditions, both congenital and acquired which can be responsible with varying prognoses and treatments. Physiological bowing is seen most commonly and has a benign course, usually spontaneously resolving with growth. Idiopathic tibia vara (Blount's disease) is the most frequently encountered pathological condition; treatment is dependent on the age of the child and severity of the deformity at presentation. Systemic conditions, most of which also result in short stature can also result in genu varum – these include achondroplasia, rickets, renal osteodystrophy and osteogenesis imperfecta. This article gives an overview of clinical assessment of children presenting with tibial deformity, normal variants and discusses frequently encountered pathology in children with genu varum along with current treatment modalities.
Genu varum is a relatively common finding in children. There are numerous conditions, both congenital and acquired which can be responsible with varying prognoses and treatments. Physiological bowing is seen most commonly and has a benign course, usually spontaneously resolving with growth. Idiopathic tibia vara (Blount’s disease) is the most frequently encountered pathological condition; treatment is dependent on the age of the child and severity of the deformity at presentation. Systemic conditions, most of which also result in short stature can also result in genu varum – these include achondroplasia, rickets, renal osteodystrophy and osteogenesis imperfecta. This article gives an overview of clinical assessment of children presenting with tibial deformity, normal variants and discusses frequently encountered pathology in children with genu varum along with current treatment modalities.
