eMedicine Specialties > Radiology > Pediatrics

Blount Disease: Multimedia

Author: Jugesh Cheema, MD, Consulting Staff, Department of Radiology, Brigham and Women's Hospital
Coauthor(s): H Theodore Harcke, MD, Chief of Imaging Research, Department of Medical Imaging, Alfred I DuPont Hospital for Children; Professor, Departments of Radiology and Pediatrics, Jefferson Medical College
Contributor Information and Disclosures

Updated: Nov 29, 2007

Multimedia

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Media file 1: Depiction of the 6 stages of the Langenskiold classification of tibia vara, as they would be seen on radiographs.

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Depiction of the 6 stages of the Langenskiold classification of tibia vara, as they would be seen on radiographs.

(Enlarge Image)

Media file 2: Infantile Blount disease. Radiograph in a 21-month-old boy shows bilateral bowing with definitive medial tibial beaking on the left. On the right, the appearance is consistent with physiologic bowing or early Blount disease. Follow-up radiographs were required.

[ CLOSE WINDOW ]

Infantile Blount disease. Radiograph in a 21-month-old boy shows bilateral bowing with definitive medial tibial beaking on the left. On the right, the appearance is consistent with physiologic bowing or early Blount disease. Follow-up radiographs were required.

(Enlarge Image)

Media file 3: Bilateral Blount disease. Radiograph in a 2.5-year-old girl with bowing, which is more severe on the left. The proximal left tibia shows a medial beaking deformity. The metaphyseal-diaphyseal angles are 24° on the left and 14° on the right.

[ CLOSE WINDOW ]

Bilateral Blount disease. Radiograph in a 2.5-year-old girl with bowing, which is more severe on the left. The proximal left tibia shows a medial beaking deformity. The metaphyseal-diaphyseal angles are 24° on the left and 14° on the right.

(Enlarge Image)

Media file 4: Blount disease scintigraphy. Bone scanning is used to assess growth-plate activity in a 10-year-old boy. Affected areas show increased physeal uptake until closure begins. At that time, activity decreases. The proximal tibial growth plate on the right has increased uptake throughout. On the left, the medial tibial physis has begun to close.

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Blount disease scintigraphy. Bone scanning is used to assess growth-plate activity in a 10-year-old boy. Affected areas show increased physeal uptake until closure begins. At that time, activity decreases. The proximal tibial growth plate on the right has increased uptake throughout. On the left, the medial tibial physis has begun to close.

(Enlarge Image)

Media file 5: Adolescent Blount disease. Coronal T1-weighted MRIs of the left knee in an 11-year-old boy show Blount disease affecting the entire tibial growth plate and the lateral part of the distal femoral plate. Signal intensity changes in the marrow of the metaphysis and epiphyseal flattening are evident in the medial portion of the tibia; this is the classic depiction.

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Adolescent Blount disease. Coronal T1-weighted MRIs of the left knee in an 11-year-old boy show Blount disease affecting the entire tibial growth plate and the lateral part of the distal femoral plate. Signal intensity changes in the marrow of the metaphysis and epiphyseal flattening are evident in the medial portion of the tibia; this is the classic depiction.

(Enlarge Image)

Media file 6: Adolescent Blount disease in a 12-year-old girl. Image shows mild changes in the medial tibia. The growth plate is widened and slightly depressed.

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Adolescent Blount disease in a 12-year-old girl. Image shows mild changes in the medial tibia. The growth plate is widened and slightly depressed.

(Enlarge Image)

Media file 7: Adolescent Blount disease. Moderate-to-severe changes in the proximal left tibia are demonstrated on this radiograph. Note the depression of the plateau, beaking, and metaphyseal sclerosis. The tibial growth plate is widened and irregular. Note that the distal femoral growth plate shows changes as well. Mild irregularity and slight widening are seen.

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Adolescent Blount disease. Moderate-to-severe changes in the proximal left tibia are demonstrated on this radiograph. Note the depression of the plateau, beaking, and metaphyseal sclerosis. The tibial growth plate is widened and irregular. Note that the distal femoral growth plate shows changes as well. Mild irregularity and slight widening are seen.

More on Blount Disease

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Imaging: Blount Disease

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References

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References

Erlacher, P. Deformierende Prozesse der Epiphysengegend bei Kindern. Archiv für orthopädische und Unfall-Chirurgie, München. 1922;20:81-96.
Blount WP. Tibia vara: osteochondrosis deformans tibiae. J Bone Joint Surg. 1937;19:1-29.
Harcke HT. In: Morrissy RT, Weinstein SL, eds. Lovell and Winter's Pediatric Orthopaedics. Vol 2. 4th ed. Philadelphia: Lippincott-Raven;1996:1055-7.
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].
Silve C, Jüppner H. Ollier disease. Orphanet J Rare Dis. 2006;1:37. [Medline].
Langenskiold A. Tibia vara. A critical review. Clin Orthop. Sep 1989;(246):195-207. [Medline].
Langenskiold A. Tibia vara: osteochondrosis deformans tibiae. Blount's disease. Clin Orthop. Jul-Aug 1981;(158):77-82. [Medline].
Langenskiold A. Tibia vara. Acta Chir Scand. 1952;103:9.
Ducou le Pointe H, Mousselard H, Rudelli A, et al. Blount''s disease: magnetic resonance imaging. Pediatr Radiol. 1995;25(1):12-4. [Medline].
Iwasawa T, Inaba Y, Nishimura G, et al. MR findings of bowlegs in toddlers. Pediatr Radiol. Nov 1999;29(11):826-34. [Medline].
Synder M, Vera J, Harcke HT, Bowen JR. Magnetic resonance imaging of the growth plate in late-onset tibia vara. Int Orthop. 2003;27(4):217-22. [Medline].
Mukai S, Suzuki S, Seto Y, et al. Early characteristic findings in bowleg deformities: evaluation using magnetic resonance imaging. J Pediatr Orthop. Sep-Oct 2000;20(5):611-5. [Medline].
Harcke HT, Mandell GA. Scintigraphic evaluation of the growth plate. Semin Nucl Med. Oct 1993;23(4):266-73. [Medline].
Andrade N, Johnston CE. Medial epiphysiolysis in severe infantile tibia vara. J Pediatr Orthop. Sep-Oct 2006;26(5):652-8. [Medline].
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].
Gordon JE, Heidenreich FP, Carpenter CJ, Kelly-Hahn J, Schoenecker PL. Comprehensive treatment of late-onset tibia vara. J Bone Joint Surg Am. Jul 2005;87(7):1561-70. [Medline].
Sabharwal S, Lee J Jr, Zhao C. Multiplanar deformity analysis of untreated Blount disease. J Pediatr Orthop. Apr-May 2007;27(3):260-5. [Medline].
Salenius P, Vankka E. The development of the tibiofemoral angle in children. J Bone Joint Surg Am. Mar 1975;57(2):259-61. [Medline].

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Keywords

tibia vara, congenital tibia vara, infantile tibia vara, juvenile tibia vara, adolescent tibia vara, infantile Blount disease, juvenile Blount disease, adolescent Blount disease

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Contributor Information and Disclosures

Author

Jugesh Cheema, MD, Consulting Staff, Department of Radiology, Brigham and Women's Hospital
Jugesh Cheema, MD is a member of the following medical societies: American College of Radiology, American Medical Association, American Roentgen Ray Society, Massachusetts Medical Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Coauthor(s)

H Theodore Harcke, MD, Chief of Imaging Research, Department of Medical Imaging, Alfred I DuPont Hospital for Children; Professor, Departments of Radiology and Pediatrics, Jefferson Medical College
Disclosure: Nothing to disclose.

Medical Editor

Fredric A Hoffer, MD, FAAP, FSIR, Professor of Radiology, University of Washington; Section Chief of Interventional Radiology, Department of Radiology, Seattle Children's Hospital and Regional Medical Center
Fredric A Hoffer, MD, FAAP, FSIR is a member of the following medical societies: American Academy of Pediatrics, American College of Radiology, Association of University Radiologists, Children's Oncology Group, Radiological Society of North America, Society for Pediatric Radiology, Society of Cardiovascular and Interventional Radiology, and Society of Interventional Radiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Marta Hernanz-Schulman, MD, FAAP, Professor, Radiology, Radiological Sciences, and Pediatrics, Director, Department of Pediatric Radiology, Radiologist-in-Chief, Director, Department of Diagnostic Imaging, Vanderbilt University Medical Center, Vanderbilt Children's Hospital
Marta Hernanz-Schulman, MD, FAAP is a member of the following medical societies: American Institute of Ultrasound in Medicine and American Roentgen Ray Society
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Felix S Chew, MD, MBA, EdM, Professor, Department of Radiology, Vice Chairman for Radiology Informatics, Section Head of Musculoskeletal Radiology, University of Washington
Felix S Chew, MD, MBA, EdM is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

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eMedicine Specialties > Radiology > Pediatrics

Blount Disease: Multimedia

Multimedia

Depiction of the 6 stages of the Langenskiold classification of tibia vara, as they would be seen on radiographs.

Infantile Blount disease. Radiograph in a 21-month-old boy shows bilateral bowing with definitive medial tibial beaking on the left. On the right, the appearance is consistent with physiologic bowing or early Blount disease. Follow-up radiographs were required.

Bilateral Blount disease. Radiograph in a 2.5-year-old girl with bowing, which is more severe on the left. The proximal left tibia shows a medial beaking deformity. The metaphyseal-diaphyseal angles are 24° on the left and 14° on the right.

Adolescent Blount disease in a 12-year-old girl. Image shows mild changes in the medial tibia. The growth plate is widened and slightly depressed.

More on Blount Disease

References

Further Reading

Keywords

Contributor Information and Disclosures

Author

Coauthor(s)

Medical Editor

Pharmacy Editor

Managing Editor

CME Editor

Chief Editor