Presentation
[…] is 2 y/o or more, as opposed to physiologic bowing which should be improving by 2 y/o Pain is frequently the presenting symptom Pain and tenderness often present over the medial prominence of the proximal tibia Deformity is slight but slowly progressive [orthopaedicsone.com]
Slight tenderness was present in the region of the proximal tibial epiphyseal cartilage, medially. A slight degree of inward torsion of the tibia was present. The leg lengths were equal. [pubs.rsna.org]
It can also be present when the medial proximal tibial growth plate has been disturbed by injury or disease. Mild presentations of tibial varum can be physiologically normal in individual cases. [cascadedafo.com]
This represents the degree of deformity that is present in the upper inner portion of the lower leg bone (tibia). Changes indicative of growth plate disturbances may be seen. [southfloridasportsmedicine.com]
Anterior or antero-lateral bowing of the tibia may occur in neurofibromatosis with fractures, and may be complicated by pseudoarthrosis. bowleg Genu varum Orthopedics External deviation of the knee(s); a certain degree is normally present in infants, [medical-dictionary.thefreedictionary.com]
Entire Body System
- Weight Loss
Obese individuals who have undergone weight loss, however, require 10% to 15% fewer calories to maintain weight stability than a “non–weight-reduced” person of similar body composition and weight. 26 Further weight loss results in further decline in total [oncohemakey.com]
If Blount’s disease in your child has been attributed to excess body weight in relation to your child’s age, your physiotherapist at Advantage Physiotherapy will discuss strategies for weight loss including tips to encourage your child to be more active [advantagephysiotherapy.com]
If Blount’s disease in your child has been attributed to excess body weight in relation to your child’s age, your physiotherapist at Physiocare Physiotherapy & Rehab Centre will discuss strategies for weight loss including tips to encourage your child [physiocarephysiotherapy.com]
If Blount’s disease in your child has been attributed to excess body weight in relation to your child’s age, your physiotherapist at Scott Anderson & Associates Physiotherapy will discuss strategies for weight loss including tips to encourage your child [andersonphysiotherapysask.ca]
If Blount’s disease in your child has been attributed to excess body weight in relation to your child’s age, your Physical Therapist at FYZICAL Pine Bluffs will discuss strategies for weight loss including tips to encourage your child to be more active [fyzical.com]
- Short Stature
Idiopathic short stature (50% of cases) [ 8 ] includes familial short stature, non‐familial short stature and constitutional growth and puberty delay. [intechopen.com]
Discussion: - most commonly presents at 14 to 36-months; - bowleg deformity in children w/ short stature & may indicate skeletal dysplasia; - developmental knee alignment: - normal knee alignment progresses from 10-15 deg of varus at birth to maximal [wheelessonline.com]
short stature - may have coxa vara as well Focal fibrocartilagenous dysplasia - generalised abnormality or focal deformity in tibia OI Trauma Infection Tumor NHx Progresses to severe OA by early adulthood - metaphyseal-diaphyseal angle >11° --> likely [52.62.202.235]
- Disability
This causes complications and significant disability in these patients. [jims.mui.ac.ir]
[…] secondary to the eccentric compressive forces A bony bridge may be evident (especially if secondary to trauma) Treatment Based on the age of the patient and the Langenskiold staging Stage 1 + 2 Long leg bracing (KAFO) Try night bracing first, as it does not disable [orthopaedicsone.com]
Search Clinics Resources Many valuable resouces are avalable to help you find the specific information to help your children with limb loss or orthopedic disabilities. Join in! Track down sports clubs and organizations that meet your child's needs. [acpoc.org]
Conditions that support considering a surgical approach include: Child is older than eight years of age Severe deformity that creates significant cosmetic and functional disability Anteversion in excess of 50 degrees Deformity more than three standard [footclinic.wordpress.com]
- Swelling
[…] due to excess fluid in tissues accumulation of protein rich fluid in an area nosebleed fibrous membrane that covers, supports, and separates muscles edema swelling due to excess fluid in tissues Exudate accumulation of protein rich fluid in an area - [quizlet.com]
Swelling (2): Note whether the swelling extends beyond the limits of the joint cavity, suggesting infection (of the joint, femur or tibia), tumour or major injury. 10.3. Lumps: Note presence of localized swellings, e.g. [arthritisresearch.us]
The lesions cause stiffness, pain, and swelling in the joint. Often, the affected joint feels like it catches or locks during movement. [malacards.org]
Case 7.11 Simple Bone Cyst CLINICAL HISTORY A 16-year-old girl with leg swelling. FIGURE 7.11A FIGURE 7.11B FIGURE 7.11C FINDINGS A, B. [radiologykey.com]
There is SPNBF and soft tissue swelling (short arrows). [clinicalgate.com]
- Collapse
The second thing you may notice is that he has more midfoot collapse on this same side. You would think that with that much midfoot collapse he would get his first ray to the ground but that’s obviously not the case. [thegaitguys.com]
Avoiding and Managing Problems In active patients tibial fracture through a pin hole is a concern as is collapse of the newly formed regenerate bone. [hss.edu]
The client on the right has imploded deep into the frontal plane via rigid pes planus foot collapse and genu valgum. These will both affect your physical screenings for these clients. [wikigait.wordpress.com]
[…] storage disorders, infiltrative, impaired outflow, and biliary tract disorders Genitourinary Buried penis Suprapubic fat accumulation leading to the appearance of a shortened penile shaft Trapped penis, webbed penis, and micropenis 12 Musculoskeletal Gait Collapse [pediatrics.aappublications.org]
Gastrointestinal
- Failure to Thrive
Skeletal deformities may include dolichocephalic skull and enlarged joints.Other common features are signs of intracranial hypertension and failure to thrive. [findzebra.com]
- Abdominal Pain
In May, 1937, she had had an appendectomy performed elsewhere because of recurrent attacks of abdominal pain with vomiting. [pubs.rsna.org]
Musculoskeletal
- Knee Pain
Abstract The correction of genu varum for patients with medial compartment osteoarthritis is a well established treatment with the goals of reducing knee pain and slowing the progression of knee arthritis. [hss.edu]
Knee version associated with anterior knee pain. Clin Orthop Relat Res 1997; (339) 152-155 23 Meister K, James SL. Proximal tibial derotation osteotomy for anterior knee pain in the miserably malaligned extremity. [thieme-connect.com]
"Association between knee alignment and knee pain in patients surgically treated for medial knee osteoarthritis by high tibial osteotomy. A one year follow-up study". BMC Musculoskeletal Disorders. 10 (1): 154. doi : 10.1186/1471-2474-10-154. [en.wikipedia.org]
- Severe Short Stature
Since puberty the girl attained very short stature associated with bilateral tibia vara. Clinical examination at the age of 17-years showed severe short stature of –3SD, her OFC was around the 50 percentile as well as her weight. [journals.eco-vector.com]
Short stature is observed usually secondary to the pathologic bone and its deformities. There are several clinical forms of osteogenesis imperfecta, with different degree of severity. [intechopen.com]
- Joint Deformity
Bone and joint deformities that occur in the front plane include : Varus/valgus: These deformities occur mainly at the level of the knee. [leg-limb-stature-lengthening-taller-height-increase-cosmetic.eu]
Conclusion: DLTO correct bow leg deformity in the point of alignment of limb and paralleling of knee and ankle joint more effectively. [ncbi.nlm.nih.gov]
Neurologic
- Waddling Gait
gait, knee pain and elbow pain. [malacards.org]
As it becomes more severe, the patient may exhibit lateral knee thrust and a waddling gait. There may be associated in-toeing and secondary effects on the hip and ankle. [emedicine.medscape.com]
[…] with bilateral involvement have a waddling gait and increased lumbar lordosis (similar to that seen in bilateral DDH) PHYSICAL EXAM: prominent and elevated greater trochanter positive Trendelenburg test limb-length inequality (usually less that 2.5 cm [gait.aidi.udel.edu]
Despite a dysplastic (but not dislocated) left hip, crawling and walking were not delayed; however at 2 years of age she developed a waddling gait, and at 2 years 5 months a dislocated left hip was diagnosed. [jmg.bmj.com]
- Seizure
A two-month-old infant with osteopetrosis and hypocalcemic seizures. A, AP radiograph of the chest shows diffuse increased bone density. [clinicalgate.com]
His disease was very well controlled in the past with valproate, and he was seizure-free for 18 months. The pain is mild and suprapubic and does not radiate. The patient looks tired and moderately uncomfortable. [thebakersfieldfox.com]
Signs of hypocalcemia: Carpopedal muscular spasms, cramping, numbness and tetany, as well as generalized seizures, when the calcium deficit is severe. Paraesthesias affecting the lips, fingers or toes are common early symptoms. [posterng.netkey.at]
None of them presented alopecia, myopathy, seizures, or aminoaciduria. [findzebra.com]
Orthotics (braces) are used to: Help muscle growth keep up with bone growth Prevent foot and knee damage Help support weak muscles Protect the muscles after surgery Medications may be prescribed to control or prevent seizures and/or to reduce spasticity [shrinershospitalsforchildren.org]
Workup
Probably needs a metabolic workup to r/o rickets. Also get x rays of the remaining joints of upper extremity. Regards, Sanjeev Sabharwal Pediatric Orthopedics E-mail: [email protected] FROM: K I. [orthopaedicsone.com]
Workup Laboratory Studies When an underlying syndrome is suggested by the physical findings and history, consultation with a geneticist and an appropriate workup are warranted. [emedicine.medscape.com]
Treatment
Genu varum in children: diagnosis and treatment. J Am Acad Orthop Surg 1995; 3(6): 326-35. Shim JS, Lee SH, Jung HJ, Lee HI. High tibial open wedge osteotomy below the tibial tubercle: clinical and radiographic results. [jims.mui.ac.ir]
Case Report: ‘Z’ osteotomy - a novel technique of treatment in Blount’s disease [version 1; peer review: 2 approved]. [f1000research.com]
Treatment What treatment options are available? Treatment depends on the age of the child and the stage of the disease. Between ages birth and two, careful observation or a trial of bracing (also called orthotics may be done. [concordortho.com]
PMID: 6676350 Tibia vara or Blount's disease: pathogenesis, clinical features and treatment E Ippolito et al. Ital J Orthop Traumatol. 1983 Dec. [pubmed.ncbi.nlm.nih.gov]
Prognosis
If closure of the growth plate takes place at an early age prognosis for the deformity is poor. If surgery is delayed until after the age of 4 there is a high rate of recurrence of the bowlegged deformity. [southfloridasportsmedicine.com]
Osteotomy indicated if there is : Severe deformity Severe joint depression In osteotomy aim to correct to 10° valgus Use of an opening wedge may obviate the need for operative correction of LLD Need to warn parents of risk of recurrence post surgery Prognosis [orthopaedicsone.com]
Genu Varum Prognosis The prognosis of the disorder is considered to be very good. Generally, patients encounter any problem during walking. However, in severe cases, sufferers often experience discomfort while walking. [hxbenefit.com]
The prognosis in the infantile form of Blount disease must be considered separately from that in the adolescent form. Infantile tibia vara has a good prognosis, and recurrence rates of deformity are low when treated at a young age and early stage. [emedicine.medscape.com]
If not treated early enough, the condition worsens quickly. [3] Prognosis In most cases persisting after childhood, there is little or no effect on the ability to walk. [medbox.iiab.me]
Etiology
Various etiological theories have been proposed. [journals.lww.com]
Factors such as injury or infection of the physis have been suspected to play an etiologic role; however, most patients have no history of trauma or infection, leading many authors to discount them as the only possible causes. [13, 16, 17] Etiology The [emedicine.medscape.com]
Other studies have found no evidence of an inherited condition and have concluded that the etiology is multifactorial. III) ANATOMY The tibia and fibula are the bones of the leg. [docgo.net]
Epidemiology
Yet, the two share a significant number of features related to their epidemiology and histology. The two diseases differ most in their radiographic appearance. It does not, however, necessarily follow that their etiologies cannot be similar. [pubmed.ncbi.nlm.nih.gov]
Epidemiology, Classification and Treatment, RS Kuo, JF Keating, CM Court-Brown Orthopaedic Research Forum, Edinburgh, UK November 11th, 1992 Combined Fractures of the Tibia and Fibula. Epidemiology, Classification and Treatment. [drroderickkuo.com.au]
secondary to abnormality of medial upper tibial physis - localised varus & internal rotation deformity Infantile form - onset 1-3 years / bilateral Adolescent form - onset > 6 years / unilateral - 5 times less common - M:F - presents 8 - 14 years Epidemiology [52.62.202.235]
Epidemiology The epidemiology of Blount disease is not well documented. Large series of patients with Blount disease indicates the estimated prevalence is less than 1% [21] in the United States. [emedicine.medscape.com]
Pathophysiology
The pathophysiologic manifestations of many of these disorders differ from analogous adult problems because of the added dimension of growth. [accessmedicine.mhmedical.com]
Fibrocartilaginous dysplasia o Skeletal dysplasias Metaphyseal dysostosis Mucopolysaccharoidosis long term effect of blounts o Progressive Varus Deformity o Epiphyseal Distortion o Limb Length Inequality In Unilateral Cases o Meniscal Tears o Degenerative Arthritis Pathophysiology [quizlet.com]
[…] of the radius Schaefer disease Distal epiphysis of the ulna Burns disease Medial humeral condyle Froelich disease Lateral humeral condyle Froelich disease Capitellum of the humerus Panner disease Humeral head Hass disease Clavicle Friedrich disease Pathophysiology [boneandspine.com]
It is important to distinguish that there is controversy as whether the two forms of the disease have similar pathophysiology. Some literature supports their similarities, while other authors consider them separate entities. [emedicine.medscape.com]
Prevention
Page 46 - I have less than 2 hours of sleep. ( ) Pain prevents me from sleeping at all. [books.google.com]
Seite 46 - I have less than 2 hours of sleep. ( ) Pain prevents me from sleeping at all. [books.google.de]
This deformity prevents full range of motion. For example, a flexor deformity of a joint prevents full extension. At the bone level. [leg-limb-stature-lengthening-taller-height-increase-cosmetic.eu]