eMedicine Specialties > Orthopedic Surgery > Knee

Blount Disease: Multimedia

Author: Matthew J DeOrio, MD, Staff Physician, Department of Orthopedic Surgery, Mayo Clinic of Rochester
Coauthor(s): James K DeOrio, MD, Director of Foot and Ankle Fellowship Program, Assistant Professor of Orthopedic Surgery, Orthopedic Surgery, St Lukes Hospital, Jacksonville, Florida
Contributor Information and Disclosures

Updated: Nov 18, 2008

Multimedia

A 10-year-old boy with Blount disease. Marked obe...
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Media file 1: A 10-year-old boy with Blount disease. Marked obesity and bilateral genu varum is present. Courtesy of S. Standard, MD.
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A 10-year-old boy with Blount disease. Marked obe...

A 10-year-old boy with Blount disease. Marked obesity and bilateral genu varum is present. Courtesy of S. Standard, MD.

Anteroposterior radiograph of the knee demonstrat...
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Media file 2: Anteroposterior radiograph of the knee demonstrating the medial plateau depression and prominent metaphyseal beaking (Langenskiöld stage II-III) typical of infantile genu varum regardless of age of presentation.
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Anteroposterior radiograph of the knee demonstrat...

Anteroposterior radiograph of the knee demonstrating the medial plateau depression and prominent metaphyseal beaking (Langenskiöld stage II-III) typical of infantile genu varum regardless of age of presentation.

Anteroposterior radiograph representing important...
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Media file 3: Anteroposterior radiograph representing important angles for staging typical for the adolescent form. Obvious varus deformity in the proximal tibia with no sloping or bar formation is present (bars do not occur in the adolescent form). A: Tibiofemoral angle. B: Metaphyseal-diaphyseal angle. C: Metaphyseal-epiphyseal angle.
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Anteroposterior radiograph representing important...

Anteroposterior radiograph representing important angles for staging typical for the adolescent form. Obvious varus deformity in the proximal tibia with no sloping or bar formation is present (bars do not occur in the adolescent form). A: Tibiofemoral angle. B: Metaphyseal-diaphyseal angle. C: Metaphyseal-epiphyseal angle.

Diagram depicting the radiographic changes observ...
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Media file 4: Diagram depicting the radiographic changes observed in the infantile form of Blount disease and their development with increasing age.
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Diagram depicting the radiographic changes observ...

Diagram depicting the radiographic changes observed in the infantile form of Blount disease and their development with increasing age.

A: Anteroposterior radiograph of the knee in a 10...
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Media file 5: A: Anteroposterior radiograph of the knee in a 10-year-old boy demonstrating use of an external fixator (Taylor Spatial Frame; Smith & Nephew) in correction of tibia vara. B: 6-month postoperative anteroposterior radiograph of correction. Contributed by S. Standard, MD.
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A: Anteroposterior radiograph of the knee in a 10...

A: Anteroposterior radiograph of the knee in a 10-year-old boy demonstrating use of an external fixator (Taylor Spatial Frame; Smith & Nephew) in correction of tibia vara. B: 6-month postoperative anteroposterior radiograph of correction. Contributed by S. Standard, MD.

More on Blount Disease

Overview: Blount Disease
Workup: Blount Disease
Treatment: Blount Disease
Follow-up: Blount Disease
Multimedia: Blount Disease
References
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References

  1. Hofmann A, Jones RE, Herring JA. Blount''s disease after skeletal maturity. J Bone Joint Surg Am. Sep 1982;64(7):1004-9. [Medline].

  2. Andrade N, Johnston CE. Medial epiphysiolysis in severe infantile tibia vara. J Pediatr Orthop. Sep-Oct 2006;26(5):652-8. [Medline].

  3. Wilson NA, Scherl SA, Cramer KE. Complications of high tibial osteotomy with external fixation in adolescent Blount's disease. Orthopedics. Oct 2007;30(10):848-52. [Medline].

  4. Accadbled F, Laville JM, Harper L. One-step treatment for evolved Blount's disease: four cases and review of the literature. J Pediatr Orthop. Nov-Dec 2003;23(6):747-52. [Medline].

  5. Blount WP. Tibia vara, osteochondrosis deformans tibiae. J Bone Joint Surg. 1937;19:1.

  6. Bradway JK, Klassen RA, Peterson HA. Blount disease: a review of the English literature. J Pediatr Orthop. Jul-Aug 1987;7(4):472-80. [Medline].

  7. Wenger DR, Mickelson M, Maynard JA. The evolution and histopathology of adolescent tibia vara. J Pediatr Orthop. Jan 1984;4(1):78-88. [Medline].

  8. Davids JR, Blackhurst DW, Allen BL Jr. Radiographic evaluation of bowed legs in children. J Pediatr Orthop. Mar-Apr 2001;21(2):257-63. [Medline].

  9. Henderson RC, Kemp GJ Jr, Greene WB. Adolescent tibia vara: alternatives for operative treatment. J Bone Joint Surg Am. Mar 1992;74(3):342-50. [Medline].

  10. Schoenecker PL, Meade WC, Pierron RL, et al. Blount''s disease: a retrospective review and recommendations for treatment. J Pediatr Orthop. Mar-Apr 1985;5(2):181-6. [Medline].

  11. Sevastikoglou JA, Eriksson I. Familial infantile osteochondrosis deformans tibiae. Idiopathic tibia vara. A case report. Acta Orthop Scand. 1967;38(1):81-7. [Medline].

  12. Davids JR, Huskamp M, Bagley AM. A dynamic biomechanical analysis of the etiology of adolescent tibia vara. J Pediatr Orthop. Jul-Aug 1996;16(4):461-8. [Medline].

  13. Golding JS, McNeil-Smith JD. Observations on the etiology of tibia vara. J Bone Joint Surg. 1963;45B:320.

  14. Grover JP, Vanderby R, Leiferman EM, Wilsman NJ, Noonan KJ. Mechanical behavior of the lamb growth plate in response to asymmetrical loading: a model for Blount disease. J Pediatr Orthop. Jul-Aug 2007;27(5):485-92. [Medline].

  15. Cook SD, Lavernia CJ, Burke SW, et al. A biomechanical analysis of the etiology of tibia vara. J Pediatr Orthop. Sep 1983;3(4):449-54. [Medline].

  16. Arkin AA, Katz JF. The effects of pressure on epiphyseal growth: the mechanism of plasticity of growing bone. J Bone Joint Surgery Am. 1956;38:1056-76.

  17. Langenskiöld A. Tibia vara. Osteochondrosis deformans tibiae. A survey of 23 cases. Acta Chir Scand. 1952;103:1.

  18. Tachdjian MO, ed. The foot and leg: tibia vara. In: Pediatric Orthopedics. Vol 4. Philadelphia:. WB Saunders Co;1990:2835-50.

  19. Gordon JE, King DJ, Luhmann SJ, Dobbs MB, Schoenecker PL. Femoral deformity in tibia vara. J Bone Joint Surg Am. Feb 2006;88(2):380-6. [Medline].

  20. de Pablos J, Alfaro J, Barrios C. Treatment of adolescent Blount disease by asymmetric physeal distraction. J Pediatr Orthop. Jan-Feb 1997;17(1):54-8. [Medline].

  21. Langenskiöld A. Tibia vara: osteochondrosis deformans tibiae. Blount''s disease. Clin Orthop. Jul-Aug 1981;(158):77-82. [Medline].

  22. Langenskiöld A. Tibia vara. A critical review. Clin Orthop. Sep 1989;(246):195-207. [Medline].

  23. Lavelle WF, Shovlin J, Drvaric DM. Reliability of the metaphyseal-diaphyseal angle in tibia vara as measured on digital images by pediatric orthopaedic surgeons. J Pediatr Orthop. Sep 2008;28(6):695-8. [Medline].

  24. Zionts LE, Shean CJ. Brace treatment of early infantile tibia vara. J Pediatr Orthop. Jan-Feb 1998;18(1):102-9. [Medline].

  25. Doyle BS, Volk AG, Smith CF. Infantile Blount disease: long-term follow-up of surgically treated patients at skeletal maturity. J Pediatr Orthop. Jul-Aug 1996;16(4):469-76. [Medline].

  26. Dietz FR, Weinstein SL. Spike osteotomy for angular deformities of the long bones in children. J Bone Joint Surg Am. Jul 1988;70(6):848-52. [Medline].

  27. Rab GT. Oblique tibial osteotomy for Blount''s disease (tibia vara). J Pediatr Orthop. Nov-Dec 1988;8(6):715-20. [Medline].

  28. Birch JG, Buech MF, Roach JW. Lateral tibia epiphysiodesis for adolescent Blount's disease. Orthop Trans. 1992;16:14.

  29. Coogan PG, Fox JA, Fitch RD. Treatment of adolescent Blount disease with the circular external fixation device and distraction osteogenesis. J Pediatr Orthop. Jul-Aug 1996;16(4):450-4. [Medline].

  30. Price CT, Scott DS, Greenberg DA. Dynamic axial external fixation in the surgical treatment of Blount disease. J Pediatr Orthop. 1985;15:236-243.

  31. Stanitski DF, Dahl M, Louie K, Grayhack J. Management of late-onset tibia vara in the obese patient by using circular external fixation. J Pediatr Orthop. Sep-Oct 1997;17(5):691-4. [Medline].

  32. Henderson RC. Tibia vara: a complication of adolescent obesity. J Pediatr. Sep 1992;121(3):482-6. [Medline].

  33. Feldman DS, Madan SS, Ruchelsman DE, Sala DA, Lehman WB. Accuracy of correction of tibia vara: acute versus gradual correction. J Pediatr Orthop. Nov-Dec 2006;26(6):794-8. [Medline].

  34. Schoenecker PL, Johnston R, Rich MM, Capelli AM. Elevation of the medical plateau of the tibia in the treatment of Blount disease. J Bone Joint Surg Am. Mar 1992;74(3):351-8. [Medline].

  35. Ganel A, Heim M, Farine I. Asymmetric epiphyseal distraction in treatment of Blount's disease. Orthop Rev. Apr 1986;15(4):237-40. [Medline].

  36. Golding JS. Tibia vara. J Bone Joint Surg. 1962;44B:216.

  37. Pirpiris M, Jackson KR, Farng E, Bowen RE, Otsuka NY. Body mass index and Blount disease. J Pediatr Orthop. Sep-Oct 2006;26(5):659-63. [Medline].

  38. Sabharwal S, Zhao C, McClemens E. Correlation of body mass index and radiographic deformities in children with Blount disease. J Bone Joint Surg Am. Jun 2007;89(6):1275-83. [Medline].

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Further Reading

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Keywords

Blount's disease, Blount disease, osteochondrosis deformans tibiae, tibia vara, idiopathic tibia vara, infantile tibia vara, juvenile tibia vara, adolescent tibia vara, knee pain

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Contributor Information and Disclosures

Author

Matthew J DeOrio, MD, Staff Physician, Department of Orthopedic Surgery, Mayo Clinic of Rochester
Matthew J DeOrio, MD is a member of the following medical societies: American Medical Association and Florida Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

James K DeOrio, MD, Director of Foot and Ankle Fellowship Program, Assistant Professor of Orthopedic Surgery, Orthopedic Surgery, St Lukes Hospital, Jacksonville, Florida
James K DeOrio, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society, Florida Medical Association, and German Society of Neurology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Thomas M DeBerardino, MD, Associate Professor of Orthopaedic Surgery, University of Connecticut Health Center
Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, and American Orthopaedic Society for Sports Medicine
Disclosure: Arthrex, Inc. Grant/research funds Other; Arthrex, Inc. Honoraria Speaking and teaching; Genzyme Biosurgery. Inc. Grant/research funds Other; Musculoskeletal Transplant Foundation Grant/research funds Other; Histogenics Grant/research funds None; Arthrex, Inc. Consulting fee Speaking and teaching

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Carlos J Lavernia, MD, FAAOS, Adjunct Clinical Professor, Department of Orthopedic Surgery, University of Miami School of Medicine; Medical Director, Orthopedic Institute at Mercy Hospital
Carlos J Lavernia, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, Arthritis Foundation, Biomedical Engineering Society, Florida Orthopaedic Society, and Orthopaedic Research Society
Disclosure: Zimmer Stock Implant Designer

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