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BLOUNT DISEASE

Dr. Andi Dhedie P.Sam, M.Kes, Sp.OT


Introduction

 First identified by Erlacher ( 1922 )

 Walter Blount ( Milwaukee, 1937 ) “ Blount


disease “
DEFENITION

Is a growth disorder involving the


medial portion of the proximal tibial
growth plate that produces a localized
varus deformity
ETIOLOGY ---> UNKNOWN

• Excessive force on the medial tibial


physis
• Children who are obese and walk
earlier
• Genetic predisposition such as
African-American
Epidemiologi

• 70 – 80 % cases  bilateral and symmetric

• More common in growing children

• Female >> male

• Etiology  controversial  most likely


secondary to a combination of hereditary and
developmental factors.
• Risk factors :
– Obesity
– Female gender
– Afro-american
– Start walking early
– Positive family history ( 9-43 % )

Obesity & early walking  causing


abnormal pressure to proximal tibial
growth plate.
PATHOLOGY
• Disruption of normal enchondral
osssification, disorganization, and
misalignment of the growth cartilage cell of
the physis  The medial tibial plateau is
depressed and deficient posteromedially.

• The degree of varus of the tibia is greater in


the infantile than in adolescent type, because
the ossification center of the partially ossified
epiphysis in the young child is more pliable.
Presentation
Physical exam
– Genu varum deformity
• usually bilateral in infants
– Often associated with internal tibial torsion
– Mild to moderate laxity of medial collateral
ligament
– Abnormal Gait
– Leg length discrepancies
– Pain is associated in 93% of the adolescent cases
Medial tibial epiphysis • Deficiency.

Medial tibial physis • Widening.

Medial tibial metaphysis • Beaking, irregularity & fragmentation.

Tibial diaphysis • Bowing & cortical thickening

Knee • Genu varum

Tibia • Lateral shift reatlive to the femur.

• Posterior shift relative to the tibia


Fibula • (superimposed fibula)
Classification

Blount’s disease devided into 3 types :

- Infantile type  age < 3 yo


- Juvenile type  between 4-10 yo
- Adolescens type  age > 11 yo

Some authors classified into 2 types :


- Infantile type  age < 8 yo
- Adolescens type  > 8 yo
Infantile type ( early onset ) :
- between 1-3 years
- bilateral, usually symmetrical  60 % cases

Juvenile type ( late onset ):


- between 4-10 years
- unilateral
- associated with a physeal bridge

Adolesence type ( late onset ):


- over 11 years
- same with juvenile type
Langenskiold ( 1964 )

- Classified Blount disease into 6


stages

- based on  progression of
epiphyseal changes and the
deformity
Radiology

- angulation "beaking" of the medial


cortical wall of the proximal tibial
metaphysis
- straight lateral wall of proximal tibial
metaphysis
- metaphyseal-diaphyseal angle > 11 degrees
( MDA = Drenann angle )
- tibio-femoral angle ( TFA ) ≥ 14 degrees
DIFFERENTIAL DIAGNOSIS

• Physiologic bowing of the lower limbs.


• Congenital medial bowing of the tibia
• Rickets
• Malunion fracture
• Osteomyelitis
• Focal fibrocartilaginous dysplasia
TREATMENT
Depends On :
1. the stage of the disease
2. the age of the patient and the growth
remaining
3. the degree of varus deformity
4. the health of the physis
5. structural intraarticular deformation of the
epiphysis
6. the degree of the epiphyseal-physeal slope
7. joint laxity
8. weight of the patient
9. social condition
 Complete regression can occur if orthotically
treated during stages I--IV using the
Lagenskiold –– Riska scale. The patient
should be three years of age or less

 Stages V--VI do not regress and usually


require surgical intervention. Surgery is
usually the course of action for patients >
than three years old
Operative

Indication
 By conservative Tx. no improvement, progressive
 Age > 3 years
 Advanced st II or III
 MDA > 140
 TFA > 150
 MEA > 300
Orthoses

The child is younger than 3 years of age and


the lesion is no greater than Langenskiöld
stage II, orthotic treatment is recommended
because 50% or more of these patients can
be successfully treated with braces,
especially if they have only unilateral
involvement
Conventional Orthotic Design

• Consists of a medial bar


• Thigh Cuff
• Foot plate
• Locked knee (or drop lock
knee joint)
• Medially directed force
strap at the knee joint
that pulls the knee
towards the medial bar
THANK YOU

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