Blount's disease

Blount's disease
Other names: Tibia vara
Blount's disease is inherited in an autosomal recessive manner (may be multifactorial as well).[1]

Blount's disease is a growth disorder of the tibia (shin bone) that causes the lower leg to angle inward, resembling a bowleg.[2] It is also known as "tibia vara".[3][2]

It is named after Walter Putnam Blount (1900–1992), an American pediatric orthopedic surgeon.[4][5] It has also been known as Mau-Nilsonne Syndrome, after C. Mau and H. Nilsonne, who published early case reports of the condition.[6][7] it is today considered an acquired disease of the proximal tibial metaphysis rather than an epiphyseal dysplasia or osteochondrosis.[8]

Signs and symptoms

The clinical presentation of this condition is as follows:[9]

  • Knee abnormality
  • Tibial bowing
  • Osteochondrosis
  • Osteochondritis dissecans

Diagnosis

Differential Diagnosis

Lower extremity deformities in Rickets can closely mimic those produced by Blount's disease. To differentiate between Rickets and Blount's disease it is important to correlate the clinical picture with laboratory findings such as calcium, phosphorus and alkaline phosphatase. Besides the X-ray appearance. Bone deformities in Rickets have a reasonable likelihood to correct over time, while this is not the case with Blount's disease. Nevertheless both disorders may need surgical intervention in the form of bone osteotomy or more commonly guided growth surgery.[10] Osteochondrodysplasias or genetic bone diseases can cause lower extremity deformities similar to Blount's disease. The clinical appearance and the characteristic radiographic are important to confirm the diagnosis.[11][12]

Treatment

Image before left and after right treatment (orthosis)

Children who develop severe bowing before the age of 3 may be treated with knee ankle foot orthoses.[13]

However, bracing may fail, or bowing may not be detected until the child is older. Bracing should be started by 3 years of age. In some cases, surgery may be performed.[14][2][8]

Prevalance

The frequency of this condition is not established.[15]

References

  1. ↑ "OMIM Entry 259200 - BLOUNT DISEASE, ADOLESCENT". omim.org. Archived from the original on 9 November 2021. Retrieved 7 November 2017.
  2. 1 2 3 Skinner, Harry B. (2006). Current Diagnosis & Treatment in Orthopaedics. New York: Lange Medical Books/McGraw-Hill. pp. 620–621. ISBN 0-07-143833-5.
  3. ↑ Clarke SE, McCarthy JJ, Davidson RS (March 2009). "Treatment of Blount disease: a comparison between the multiaxial correction system and other external fixators". J Pediatr Orthop. 29 (2): 103–9. doi:10.1097/BPO.0b013e3181982a62. PMID 19352232. S2CID 31733527.
  4. ↑ synd/1470 at Who Named It?
  5. ↑ W. P. Blount. Tibia vara: osteochondrosis deformans tibiae. Journal of Bone and Joint Surgery, Boston, 1937, 19: 1-29.
  6. ↑ Mau, C. (1923/24) Genu varum bedingt durch Tihiaepiphysendefekt bei Kartilaginärer Exostose. Z. orthop. Chir. 44, 383.
  7. ↑ Nilsonne, H. (1929) Genu varum mit eigentümlichen Epiphysenveränderungen. Acta chir. scand. 44, 187.
  8. 1 2 Canale, Terry S.; Beaty, James H. (2013). Campbell's Operative Orthopaedics (12th ed.). Philadelphia: Elsevier (Mosby). p. 1168. ISBN 978-0-323-07243-4.
  9. ↑ "Blount disease | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program". rarediseases.info.nih.gov. Archived from the original on 18 March 2021. Retrieved 8 November 2021.
  10. ↑ EL-Sobky, TA; Samir, S; Baraka, MM; Fayyad, TA; Mahran, MA; Aly, AS; Amen, J; Mahmoud, S (1 January 2020). "Growth modulation for knee coronal plane deformities in children with nutritional rickets: A prospective series with treatment algorithm". JAAOS: Global Research and Reviews. 4 (1): e19.00009. doi:10.5435/JAAOSGlobal-D-19-00009. PMC 7028784. PMID 32159063.
  11. ↑ EL-Sobky, TA; Shawky, RM; Sakr, HM; Elsayed, SM; Elsayed, NS; Ragheb, SG; Gamal, R (15 November 2017). "A systematized approach to radiographic assessment of commonly seen genetic bone diseases in children: A pictorial review". J Musculoskelet Surg Res. 1 (2): 25. doi:10.4103/jmsr.jmsr_28_17. S2CID 79825711.
  12. ↑ Solomon, Louis; Warwick, David; Nayagam, Selvadurai (2010). Appley's System of Orthopaedics and Fractures (9th ed.). London: Hodder Arnold. pp. 556–557. ISBN 978 0 340 942 086.{{cite book}}: CS1 maint: url-status (link)
  13. ↑ Alsancak, S; Guner, S; Kinik, H (2013). "Orthotic variations in the management of infantile tibia vara and the results of treatment". Prosthetics and Orthotics International. 37 (5): 375–83. doi:10.1177/0309364612471369. PMID 23344116. S2CID 24907234.
  14. ↑ McCarthy JJ, MacIntyre NR, Hooks B, Davidson RS (March 2009). "Double osteotomy for the treatment of severe Blount disease". J Pediatr Orthop. 29 (2): 115–9. doi:10.1097/BPO.0b013e3181982512. PMID 19352234. S2CID 21625248.
  15. ↑ RESERVED, INSERM US14-- ALL RIGHTS. "Orphanet: Blount disease". www.orpha.net. Archived from the original on 15 November 2017. Retrieved 8 November 2021.
Classification
External resources
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