blount disiese

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Blount’s Blount’s Disease Disease Yuka Purbani_Nurul Aqilah_Eka Novryanti_Noraine _Nur Ikhwaini_Raswijayanti R ADVISORS : dr. Rangga Arieza dr. Denal Bato Tampak dr. Herbert Yurianto SUPERVISOR : Dr. Notinas Horas Sp.OT

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Progressive bow-leg deformity associated with abnormal growth of the posteromedial part of the proximal tibia. Blount characterized the deformity as an abrupt angulation just below the proximal physisAn irregular physeal line and a wedge-shaped epiphysis with a “beak” at the medial metaphysis. Apparent lateral subluxation of the proximal end of the tibia is often present.

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  • Blounts Disease

    Yuka Purbani_Nurul Aqilah_Eka Novryanti_Noraine _Nur Ikhwaini_Raswijayanti R

    ADVISORS :dr. Rangga Ariezadr. Denal Bato Tampakdr. Herbert Yurianto

    SUPERVISOR :Dr. Notinas Horas Sp.OT

  • DEFINITIONProgressive bow-leg deformity associated with abnormal growth of the posteromedial part of the proximal tibia. Blount characterized the deformity as an abrupt angulation just below the proximal physisAn irregular physeal line and a wedge-shaped epiphysis with a beak at the medial metaphysis. Apparent lateral subluxation of the proximal end of the tibia is often present.

    Miller MD, Brinker MR. Pediatric Orthopaedics. 3rd Ed. Review of Orthopaedics; 2006.John Anthony Herring, MD. Chapter 22: Disorder of the Leg. In: Tachdjian's Pediatric Orthopaedics 4th edition; Elsevier Saunders; 2008

  • ETIOLOGY Miller MD, Brinker MR. Pediatric Orthopaedics. 3rd Ed. Review of Orthopaedics; 2006.John Anthony Herring, MD. Chapter 22: Disorder of the Leg. In: Tachdjian's Pediatric Orthopaedics 4th edition; Elsevier Saunders; 2008

  • Netters Concise Orthopaedic Anatomy, 2nd Edition, Chapter, Leg/KneeANATOMY

  • Development of the tibiofemoral angle during growth.Salenius&Vankka GraphNormal children show maximal varus at 6 to 12 months of ageNeutral alignment by 18 to 24 monthsMaximal genu valgum at 4 yearsGradual decrease in genu valgum age of 11 yearsJohn Anthony Herring, MD. Chapter 22: Disorder of the Leg. In: Tachdjian's Pediatric Orthopaedics 4th edition; Elsevier Saunders; 2008PHYSIOLOGY

  • Evolution of lower limb alignment from varus to valgus to normal alignment.Normal transition from varus alignment at 14 months to neutral position at 25 months to valgus tibiofemoral alignment at 39 monthsJohn Anthony Herring, MD. Chapter 22: Disorder of the Leg. In: Tachdjian's Pediatric Orthopaedics 4th edition; Elsevier Saunders; 2008

  • John Anthony Herring, MD. Chapter 22: Disorder of the Leg. In: Tachdjian's Pediatric Orthopaedics 4th edition; Elsevier Saunders; 2008PATHOPHYSIOLOGY

  • ANAMNESISJohn Anthony Herring, MD. Chapter 22: Disorder of the Leg. In: Tachdjian's Pediatric Orthopaedics 4th edition; Elsevier Saunders; 2008

  • PHYSICAL EXAMINATIONJohn Anthony Herring, MD. Chapter 22: Disorder of the Leg. In: Tachdjian's Pediatric Orthopaedics 4th edition; Elsevier Saunders; 2008

  • Physical AppearanceBlounts Disease is characterized the deformity as an abrupt angulation just below the proximal physisNetters Concise Orthopaedic Anatomy, 2nd Edition, Chapter, Leg/Knee

  • Langenskiold classification based on the degree of metaphyseal-epiphyseal changes

  • RADIOGRAPHIC FINDINGSAbrupt angulation at the epiphysealmetaphyseal junction and medial metaphyseal radiolucency and beaking.Tibiofemoral angle (TFA) >20Tibial metaphysealdiaphyseal angle (MDA) > 11John Anthony Herring, MD. Chapter 22: Disorder of the Leg. In: Tachdjian's Pediatric Orthopaedics 4th edition; Elsevier Saunders; 2008

  • MANAGEMENT

  • PROGNOSIS

  • DIFFERENTIAL DIAGNOSISJohn Anthony Herring, MD. Chapter 22: Disorder of the Leg. In: Tachdjian's Pediatric Orthopaedics 4th edition; Elsevier Saunders; 2008

  • COMPLICATIONSJohn Anthony Herring, MD. Chapter 22: Disorder of the Leg. In: Tachdjian's Pediatric Orthopaedics 4th edition; Elsevier Saunders; 2008

  • THANK YOU

  • 1. Hukum Heuter-Volkmann Pengaruh tekanan (pressure) pada GP : pressure bertambah, pertumbuhan akan terlambat2. Hukum Delpech ; pengaruh tarikan (distraksi) pada GP: distraksi merangsanGgP menyebabkan percepatan pertumbuhan Hubungan G.Pd engan pressurep ada G.P : pressure bertambah, pertumbuhan akan terhambat (pelan). Pressure berkurang (distrakspie) rtumbuhan bertambah. Gaya (stress) yang tidak simetri pada G.Pm enyebabkan angulassi,t ress torsi (torque) paralepla da G.P menyebabkan deformitatosr sional 3. Hukum dari Wolff Hukum Wolff sering disingkat 3F : Form Follows Function. Perubahan-perubabentuk dan stress pada tulangd iikuti oleh perubahan- perubahan internal (arsitektur) dan bentuk (form) eksternal, sesuaid engan mathematicrualle s.

  • **The normal knee alignment at birth is 10 to 15 degrees of varus, which remodels to a neutral femoral-tibial alignment at approximately 14 months of age Levine and Drennan (51) have defined physiologic bowing radiographically as more than 10 degrees of bilateral femoral-tibial varus noted after the age of 18 months.*The following is the normal growth and development for children, from infancy to the age of 10:From infancy to 18 months, a childs legs are initially bowlegged (varus), causing toddlers to often walk with their feet wide apart.When the child is between 1 1/2 and 2 1/2 years, the legs have usually straightened.By 3 to 4 years, the childs legs typically grow into a knock-knee (valgus) position.Finally, by age 8 to 10 years, the childs legs have settled in to what will likely be their adult alignment.

    **Intoeing- when the child walk or run the feet turn inward instead of pointing straight ahead reffered to as being pigeon toedLateral trust gait - lateral compartment joint line opening which occurs at foot strike*1-blunting2- sloping3- depress4-inclined5- double6-fusion*Measuring the metaphyseal-diaphyseal (MD) angle of both the proximal tibia and distal femur further helps to identify the specific location and relative severity of varus deformity (51,56,57). Although an absolute MD angle is not diagnostic, it does serve as a guide in differentiating Langenskild stage I infantile Blount disease from physiologic bowing (50,53) (Fig. 28.9). Measurement can be affected by limb position (58). A study of the proximal tibial MD angle in patients with bowing (physiologic bowing or Blount disease) identified two distinct populations with considerable overlap (56) (Fig. 28.10). On the basis of this study by Feldman and Schoenecker, when the MD angle is less than 10 degrees, there is a 95% probability that the diagnosis is physiologic bowing. Conversely, if the MD angle is greater than 16 degrees, then there is a 95% probability that the diagnosis is Blount disease. For those patients with an MD angle between 10 and 16 degrees, follow-up for at least 1 to 2 years is necessary to determine whether the metaphyseal changes resolve (physiologic bowing) or progress (Blount disease). In a recent report, Bowen et al. (54) noted that all children with a tibial MD angle greater than 16 degrees showed progression of the varus deformity.*The locked KAFO counteracts the pathologic medial compressive forces, allowing resumption of more normal growth and correction of the genu varum. The bowleg deformity typically improves over the ensuing months. The pathologic radiographic changes at the proximal medial tibial metaphysis, physis, and epiphysis are slow to remodel. Brace treatment is continued until the bony changes in the proximal medial tibia resolve; typically, this takes 1 to 2 years of brace treatment (72,73,74). Sustained, successful correction with nonoperative treatment requires that correction be achieved before 4 years of age. Appropriate alignment means that the mechanical axis of the lower extremity passes through the center of the knee *Children older than 3 years with Blount disease, who are either noncompliant or not good candidates for brace treatment because of obesity or bilateral involvement, should be treated with a varus-correcting osteotomy (50,72). The proximal tibial varus should decrease within 12 months in those children who are compliant with bracing. The radiographic appearance of the medial epiphysis and metaphysis should normalize by 5 years of age. If such improvement does not occur, varus-correcting osteotomy should be recommended. Early surgery to realign the leg (that is, osteotomy performed by 4 years of age) is necessary to prevent progression to stage IV disease, which is the formation of a physeal bar. The osteotomy unloads the medial compartment of the knee and facilitates growth of the proximal medial physis. Restoration of normal growth in the medial tibial physis is less likely to occur if surgery is delayed *Physiologic genu varum, Nonphysiologic causes of genu varumskeletal dysplasias (metaphyseal chondrodysplasia, spondyloepiphyseal dysplasia, multiple epiphyseal dysplasia, achondroplasia)metabolic diseases (renal osteodystrophy, vitamin Dresistant rickets) post-traumatic deformity postinfectious sequelae, proximal focal fibrocartilaginous dysplasia.

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