Blount disease

Case contributed by Dr Hani Makky Al Salam

Presentation

Leg bowing but otherwise asymptomatic, in particular no history of pain

Patient Data

Age: 4 years
Gender: Male
X-ray

Typical appearances of Blount disease.

The tibiae demonstrate varus positioning with abnormal triangular epiphyses. The metaphyses show the typical medially-oriented beak-like osteopenic exostoses.

Case Discussion

Findings are consistent with Blount disease (also known as tibia vara) which refers to a local disturbance of growth of the medial proximal tibial epiphyses. It is usually bilateral.

The tibiae demonstrate varus positioning with abnormal epiphyses, which maybe of triangular morphology, fragmented, or even completely lacking. The affected metaphysis tend to be depressed with a medially-oriented beak-like demineralized exostosis.

This results in an increased metaphyseal-diaphyseal angle of Drennan (commonly >11º). The lateral cortical wall of the upper tibial metaphysis remains notably straight.

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