Deformity Reconstruction Surgery for Blount’s Disease

Abstract

Blount’s disease is an idiopathic developmental abnormality affecting the medial proximal tibia physis resulting in a multi-planar deformity with pronounced tibia varus. A single cause is unknown, and it is currently thought to result from a multifactorial combination of hereditary, mechanical, and developmental factors. Relationships with vitamin D deficiency, early walking, and obesity have been documented. Regardless of the etiology, the clinical and radiographic findings are consistent within the two main groups. Early-onset Blount’s disease is often bilateral and affects children in the first few years of life. Late-onset Blount’s disease is often unilateral and can be sub-categorized as juvenile tibia vara (ages 4–10), and adolescent tibia vara (ages 11 and older). Early-onset Blount’s disease progresses to more severe deformities, including depression of the medial tibial plateau. Additional deformities in both groups include proximal tibial procurvatum, internal tibial torsion, and limb length discrepancy. Compensatory deformities in the distal femur and distal tibia may occur. When non-operative treatment fails the deformities progress through skeletal maturity and can result in pain, gait abnormalities, premature medial compartment knee arthritis, and limb length discrepancy. Surgical options depend on the patient’s age, weight, extent of physeal involvement, severity, and number of deformities. They include growth modulation procedures such as guided growth for gradual correction with hemi-epiphysiodesis and physeal closure to prevent recurrence and equalize limb lengths, physeal bar resection, physeal distraction, osteotomies with acute correction and stabilization, gradual correction with multi-planar dynamic external fixation, and various combinations of all modalities. The goals of surgery are to restore normal joint and limb alignment, equalize limb lengths at skeletal maturity, and prevent recurrence. The purpose of this literature review is to delineate basic concepts and reconstructive surgical treatment strategies for patients with Blount’s disease.

Epidemiology of Genu Varum in Pediatric Patients in Dr. Soetomo General Academic Hospital Surabaya 2010-2018: A Retrospective Study

“…Bilateral abnormalities are common, especially in early-onset Blount disease. 11 Based on the study from Birch, this classification's weakness is the extremity's position, which can affect the appearance of the coronal plane on the radiographic image. 29 Moreover, according to Janoyer, these six Langenskiold levels have significant variability between observers, as well as limited relevance to non-white populations in North America and the Caribbean.…”

“…8 Osteotomy performed at the age above four years old will increase the recurrence rate due to decreasing the healing of the physis (growth plate). 8,11 Complications of surgery that can occur are compartment syndrome, delayed union, nonunion, hardware failure, vascular injury, infection, peroneal nerve palsy, and recurrence. 11 The limitation of the study includes the condition of medical records at the Polyclinic of Dr. Soetomo General Academic Hospital, where the long-term control status of the patients was not archived aptly.…”

“…8,11 Complications of surgery that can occur are compartment syndrome, delayed union, nonunion, hardware failure, vascular injury, infection, peroneal nerve palsy, and recurrence. 11 The limitation of the study includes the condition of medical records at the Polyclinic of Dr. Soetomo General Academic Hospital, where the long-term control status of the patients was not archived aptly. The records only used a status book, were written manually, and then archived in the storage room.…”

“…Thompson and Carter further classified late-onset Blount disease as juvenile type (onset at 4-10 years of age) and adolescent type (onset after ten years old). 10,11 Blount disease can affect children in their infancy and can be classified into two based on the age of first complaint, namely early-onset or infantile and late-onset or adolescent. Langenskiold described six stages of progressive radiographic changes in the epiphyses and proximal tibial metaphysis of children in the early-onset Blount disease.…”

A Predictive Score for Infantile Blount Disease Recurrence After Tibial Osteotomy

“…All Blount disease patients who met the indications, including the age older than 3 years, Langenskiöld stage 3, and failure of conservative treatment 15,16 were scheduled for surgery. We performed a proximal tibial valgus osteotomy below the tibial tubercle using a dome or closewedged osteotomy.…”