Blount disease

Blount disease refers to a local disturbance of growth of the medial proximal tibial epiphysis that results in tibia vara. The condition is commonly bilateral. 

There is no recognised inheritance pattern. 

Clinically, the child often presents with leg bowing (tibia vara) with little or no associated pain.

A relative lack of growth of the medial proximal tibial physis occurs, likely secondary to an increase in compressive forces on the proximal tibial physis.

Subtypes

There are infantile, juvenile and adolescent forms. The infantile type is 5x more frequent than the others and is seen particularly in early walkers. It appears to be the result of abnormal compressive forces inhibiting growth at the medial growth plate and not from avascular necrosis

Grading

The condition can be graded into six stages according to the system proposed by Langenskiöld et al. 2.

Associations

Childhood obesity, in particular for the adolescent type 4.

The tibial shaft is in the varus position, and the epiphysis is wedge-shaped, fragmented or can appear absent. The adjacent metaphysis is also depressed and has a beak-like protuberance of rarified bone oriented medially. This causes the metaphyseal-diaphyseal angle of Drennan to increase (typically more than 11º). The lateral cortical wall of the upper tibial metaphysis remains notably straight.

Pre-operative MRI can be used to detect physeal bone bars.

Treatment depends on the subtype and stage. As a general rule:

  • infantile or early stage: often conservatively managed
  • adolescent or late stage: a proximal tibial osteotomy is often considered

It was first described by Blount in 1932.

For leg bowing consider: differential for leg bowing in children.

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Article Information

rID: 999
Section: Pathology
Tag: tibia
Synonyms or Alternate Spellings:
  • Blount syndrome
  • Osteochonrdrosis deformans tibiae
  • Blount's disease
  • Blount's syndrome

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