BLOUNT DISEASE

By;

Nurul Sylvana Shoraya C 111 06 001

Advisor:

dr. Andresanto Lengkong dr. A. Dhedie Prasatia Sam Supervisor: dr. Muhammad Sakti, S .!" !rhto edi# dan "raumatology $a#ulty o% Medi#ine &niversitas 'asanuddin Makassar (011

Description

Bowing of the legs normal stage of growth for infants and toddlers.

This phase called physiologic bowing and resolves by spontaneously

approximately 2 years of age

'lassification:

Infantile form: at 0 ! years old

" uvenile form: at # ! $ years

%dolescent form: years old # &0

Infantile (orm

Incidence

Prevalece

Infantile tibia vara most common cause of pathologic bowing in young

The infantile form is more common in girls.

The )uvenile or adolescent form is more common in boys.

The )uvenile form is much less common

The disorder is more common in %frican %merican children than those of other races

*is+ (actors

%frican %merican ethnicity ,besity -arly age of wal+ing

-tiology

Decreased growth of the proximal medial tibial growth plate .physis/ varus angulation .bowing/.

,verweight may cause disturbance growth plate Internal rotation of the proximal tibia

Pathophysiology The growth plate islands of densely pac+ed cartilage cells with more hypertrophy than normal0 islands of almost acellular fibrous cartilage0 1 abnormal groups of capillaries

3igns and 3ymptoms

%dolescent 1 Infantile tibia vara 2 &! 1 !0 months of age increasingly bowed legs .usually bilateral involvement/.

%dolescent presentation varus deformity .bowing/2 but many of the patient also have medial +nee pain .unilateral/

If untreated0 the infantile form severe The )uvenile and adolescent forms severe 3ome internal tibial torsion usually is present along with the bowing

Imaging

*adiography

%ppropriate radiographs: % long leg %4 view The metaphyseal diaphyseal angle differentiates Blount disease and physiologic varus:

5 &&6 is physiologic varus. # &70 indicates Blount disease. 8alues between &&6 and &76 signify a ris+ of potential Blount disease.

*eveals a medial physeal bar

4hysical -xam

*ecord : height0 weight The finding 2 short stature suggests ric+ets 9a s+eletal dysplasia :ote the location of any pain. *ecord the gap : the medial sides of the +nees0 chec+ +nee *,; %ssessment tibial torsion *outine +nee examination0 observe gait0 1 measure the foot progression angle

Treatment

Differential Diagnosis

Brace Illustrations:

'omplications

*ecurrence of deformity abnormal limb alignment 1degenerative arthritis. <imb length ine=uality 4ost osteotomy neurovascular complications

4rognosis
&.

2.

the *ecurrence rate Treated after ! years old .>0 >?@/ than in patients treated before ! years old .20 A0@/ -arly osteotomy .before ! yo/ if bracing is not successful. 4atients with late treatment or incomplete treatment 2 ris+ of arthritis of the +nee.

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