By;

Nurul Sylvana ShorayaC 111 06 001

Advisor:

dr. Andresanto Lengkongdr. A. Dhedie Prasatia Sam

Supervisor:dr. Muhammad Sakti, Sp.OT

Orhtopedic dan TraumatologyFaculty of Medicine Universitas Hasanuddin

Makassar2011

BLOUNT DISEASE

Description

Bowing of the legs normal

stage of growth for

infants and toddlers.

This phase called

physiologic bowing and

resolves spontaneously

by approximately 2 years

of age

Infantile form:

at 0-4 years

old

Juvenile form:

at >4-9 years

Adolescent

form: >10

years old

Classification:

Infantile Form

Infantile tibia vara

most common cause of

pathologic bowing in

young

The juvenile form is

much less common

The infantile form is more

common in girls.

The juvenile or adolescent

form is more common in boys.

The disorder is more common

in African American children

than those of other races

Incidence Prevalece

Risk Factors

African American ethnicity

Obesity

Early age of walking

Etiology

Decreased growth of the proximal medial tibial growth

plate (physis) varus angulation (bowing).

Overweight may cause disturbance growth plate

Internal rotation of the proximal tibia

Pathophysiology

The growth plate islands of densely packed cartilage

cells with more hypertrophy than normal, islands of

almost acellular fibrous cartilage, & abnormal groups of

capillaries

Adolescent & Infantile tibia vara ; 14 & 40 months of age

increasingly bowed legs (usually bilateral involvement).

Adolescent presentation varus deformity (bowing); but

many of the patient also have medial knee pain (unilateral)

If untreated, the infantile form severe

The juvenile and adolescent forms severe

Some internal tibial torsion usually is present along with the

bowing

Signs and Symptoms

Imaging

Radiography Appropriate radiographs: A

long leg AP view The metaphyseal

diaphyseal angle differentiates Blount disease and physiologic varus: <11° is physiologic varus. > 160 indicates Blount

disease. Values between 11° and

16° signify a risk of potential Blount disease.

Reveals a medial physeal bar

Physical Exam

Record : height, weight

The finding ; short stature suggests rickets /a skeletal dysplasia

Note the location of any pain.

Record the gap : the medial sides of the knees, check knee ROM

Assessment tibial torsion

Routine knee examination, observe gait, & measure the foot progression angle

Treatment

Differential Diagnosis

Brace Illustrations:

Complications

Recurrence of deformity abnormal limb alignment &degenerative arthritis.

Limb-length inequality Post osteotomy neurovascular

complications

Prognosis

the Recurrence rate1. Treated after 4 years old (70-75%) than

in patients treated before 4 years old (20-30%)

2. Early osteotomy (before 4 yo) if bracing is not successful.

Patients with late treatment or incomplete treatment ; risk of arthritis of the knee.

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