Blount's disease

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

Blount's disease
Other namesTibia vara
Blount's disease is inherited in an autosomal recessive manner (may be multifactorial as well).[1]
SpecialtyRheumatology Edit this on Wikidata

Signs and symptoms

Cause

Blount disease is a growth disorder of the shin bone which causes the lower leg to angle inward, resembling a bowleg. It can present in boys under 4-years in both legs, or in adolescents usually on one side. Causes are thought to be genetic and environmental, like obesity, African-American lineage, and early walkers.[4]

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.[5] 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.[6][7]

Staples for epiphysiodesis in the bone, Blount's disease treatment - rtg. snapshots and biomechanical experiments[8]

Treatment

Children who develop severe bowing before the age of 3 may be treated with knee ankle foot orthoses.[9] 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.[10][2][11][8]

Blount disease is one of the 8 severe comorbidities of severe obesity (BMI >35), which are an indication for bariatric surgery in children per a 2019 policy statement of the American Academy of Pediatrics. The other severe comorbidities are: obstructive sleep apnea (Apnea-Hypopnea Index > .5), Type2 Diabetes mellitus, idiopathic intracranial hypertension (IIH), nonalcoholic steatohepatitis, SCFE, GERD, and hypertension.[12]

Etymology

Blount disease is named after Walter Putnam Blount (1900–1992), an American pediatric orthopedic surgeon, who described it in 1937.[13][14] It has also been known as Mau-Nilsonne Syndrome, after C. Mau and H. Nilsonne, who published early case reports of the condition.[15][16] it is today considered an acquired disease of the proximal tibial metaphysis rather than an epiphyseal dysplasia or osteochondrosis.[11]

References
  1. "OMIM Entry 259200 - BLOUNT DISEASE, ADOLESCENT". omim.org. Retrieved 7 November 2017.
  2. 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. Dakshina Murthy T S. S; Alessandro De Leucio. Blount Disease Treasure Island (FL): StatPearls Publishing; 2022 January.
  5. 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.
  6. 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.
  7. 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.
  8. Frydrýšek, Karel; Čepica, Daniel; Halo, Tomáš; Skoupý, Ondřej; Pleva, Leopold; Madeja, Roman; Pometlová, Jana; Losertová, Monika; Koutecký, Jan; Michal, Pavel; Havlas, Vojtěch (January 2022). "Biomechanical Analysis of Staples for Epiphysiodesis". Applied Sciences. 12 (2): 614. doi:10.3390/app12020614. ISSN 2076-3417.
  9. 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.
  10. 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.
  11. Canale, Terry S.; Beaty, James H. (2013). Campbell's Operative Orthopaedics (12th ed.). Philadelphia: Elsevier (Mosby). p. 1168. ISBN 978-0-323-07243-4.
  12. Armstrong, Sarah C.; Bolling, Christopher F.; Michalsky, Marc P.; Reichard, Kirk W.; SECTION ON OBESITY, SECTION ON SURGERY; Haemer, Matthew Allen; Muth, Natalie Digate; Rausch, John Conrad; Rogers, Victoria Weeks; Heiss, Kurt F.; Besner, Gail Ellen (2019-12-01). "Pediatric Metabolic and Bariatric Surgery: Evidence, Barriers, and Best Practices". Pediatrics. 144 (6): e20193223. doi:10.1542/peds.2019-3223. ISSN 0031-4005. PMID 31656225. S2CID 204947687.
  13. synd/1470 at Who Named It?
  14. W. P. Blount. Tibia vara: osteochondrosis deformans tibiae. Journal of Bone and Joint Surgery, Boston, 1937, 19: 1-29.
  15. Mau, C. (1923/24) Genu varum bedingt durch Tihiaepiphysendefekt bei Kartilaginärer Exostose. Z. orthop. Chir. 44, 383.
  16. Nilsonne, H. (1929) Genu varum mit eigentümlichen Epiphysenveränderungen. Acta chir. scand. 44, 187.
  • Dakshina Murthy T S. S; Alessandro De Leucio. Blount Disease Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
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