blount disease nurul
TRANSCRIPT
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 °enerative 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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