Girl with Bilateral varus deformity

Saturday, April 24, 2010
This is the Xray showing both knee joints of  a 4 1/2 year old  female who was brought to the orthopedic clinic by her mother complaining of  a 1 1/2 year history of episodic left knee pain, worsening over the past 6 months, especially when walking.
On examiantion there was Bilateral varus deformity of lower extremities which was more prominent in the left side than the right side.





Identify this Xray ?



ANSWER

Blount's disease
Xray Findings
  • Bilateral depression and deformity of medial aspect of proximal tibial epiphysis and metaphysis
  • Beaking of proximal tibial metaphysis bilaterally


Differential Diagnosis:
1) Mild rickets
2) A physiological bow legs


Blount disease is a growth disorder of the tibia characterized by disordered ossification of the medial aspect of the proximal tibial physis, epiphysis, and metaphysis. This progressive deformity is manifested by varus angulation and internal rotation of the tibia in the proximal metaphyseal region immediately below the knee.


Blount disease most likely is caused by a combination of excessive compressive forces on the proximal medial metaphysis of the tibia and altered endochondral bone formation


Two main types
Infantile Blount disease - tends to be bilateral and occurs in children less than 3 years.The infantile form is generally more common in females and children generally start to walk early, usually when aged 9-10 months.
Juvenile Blount disease - usually unilateral seen in children aged 4-10 years


Diagnosis
Xray Features
  • The medial epiphyseal line demonstrates irregularity
  • Abnormal sloping of the medial tibial epiphysis
  • The metaphyseal portion of the plate demonstrates irregular beaking


Treatment: Children can be treated by bracing, epiphyseal stapling, osteotomies, or in extreme cases, by intra-epiphyseal corrective realignment.

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20 comments

  1. Ahmed Aref Says:
  2. Active Rickets

     
  3. Anonymous Says:
  4. arthritis

     
  5. dr g murtaza Says:
  6. rikets

     
  7. Anonymous Says:
  8. Ricket it is!

     
  9. RICKETS

     
  10. Anonymous Says:
  11. most probably rickets

     
  12. Anonymous Says:
  13. rickets
    sadaf

     
  14. Gity Says:
  15. Blount disease.

     
  16. Anonymous Says:
  17. rickets

     
  18. Anonymous Says:
  19. Rickets

     
  20. Anonymous Says:
  21. RICKETS

     
  22. RICKETS

     
  23. Anonymous Says:
  24. osteomalacia

     
  25. Anonymous Says:
  26. itz congenital...

     
  27. Anonymous Says:
  28. i accept with blount's disease
    because in rickets it is more symmetrical
    dr.winzo

     
  29. drnjenga2001 Says:
  30. Njenga Mburu
    Classical of Blount's disease. Rickets is a distant DDX.

     
  31. drnjenga2001 Says:
  32. Blount's disease. Rickets is a distant DDX.

     
  33. Ahmad Says:
  34. Blount

     
  35. Ahmad Says:
  36. if episodic then cit is a hemophilic arthritis

     
  37. Anonymous Says:
  38. classis blount disease
    D/D Syphilis

     

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