O slideshow foi denunciado.
Utilizamos seu perfil e dados de atividades no LinkedIn para personalizar e exibir anúncios mais relevantes. Altere suas preferências de anúncios quando desejar.
BLOUNTS DISEASE
Dr Imran Jan
Definition
It is an disorder of the proximal
medial tibial growth plate
causes progressive varus
alignment of the knees (b...
synonyms
 Infantile tibia vara
 Erlacher`s disease
 Blount-barber disease
 Subepipyseal osteochondropathy
 Non rachit...
BLOUNTS DISEASE
 Erlacher first description of
tibia vara and internal tibial torsion
(1922)
 Blount (1937) described ti...
 Prevalence
<1% of all bow legs
 The infantile form is more common in girls.
 The juvenile or adolescent form is more
...
ETIOLOGY
 Current concept is tibia vara is
An acquired disease of the
proximal tibial metaphysis of
unknown cause
 Encho...
Suggested causative factors include
infection
trauma
osteonecrosis
latent form of rickets
although none of these has been ...
 The relationship of early walking
and obesity to Blount disease
has been clearly documented.
 Rarely seen in non ambula...
BLOUNTS DISEASE
COMPONENTS OF DEFORMITY
 Varus
 Internal torsion of tibia
 Recurvatum
 LLD
 Femoaral varus late
 MSC...
PATHOLOGY
 islands of densely packed chondrocytes with
hypertr0phy
 areas of almost acellular cartilage
 Intraphyseal o...
CLASSIFICATON
 Infantile:
before 8 years of age
 bilateral in 60%
 Adolescent more than 8Yrs till
skeletal fusion
 1 ...
Clinical features
Bowing of legs -
progressive
Metaphyseal spike
Knee pain +/-
Radiology
 medial half of the epiphysis as seen on
radiographs is short, thin, and wedged
 the physis is irregular in co...
Radiological Features
Metaphyseal
beak
Tibio Femoral Angle Metaphysio Diaphysial angle
(Levin and Drennen)
MD
angle
MDA ANGLE
 MDA < 11: normal
physiologic bowing
 MDA 11-15: equivocal
 MDA >15: Blount’s
Langenskiold classification
(1952)
 I - irregular metaphyseal ossification combined with medial and distal
protrusion of ...
Work up findings
No specific blood marker
Tests to R/o Infection and
Rickects
CT scan in 5yrs + to detect
physeal bar
Differential Diagnosis
 Physiologic genu varum
 Skeletal dysplasias (Metaphysial
chondrodysplasia, SED, MED, Achondropla...
Treatment
 Treatment choices and
prognosis depend greatly on
the age of the patient and
radiographic stage at the time
of...
Rx - Orthotics
 Recommended for patients < 3 years of age and <
stage II disease
 Rainey et al recommended LOCKED KAFO t...
Corrective osteotomy options
Metaphyseal
Epiphyseal – metaphyseal
Intra epiphyseal
 Fibula &Bony bar resection
Rx – Corrective Osteotomy…
 Rab
 proximal tibial oblique
metaphyseal osteotomy in which
single plane oblique cut allows ...
RAB’S OBLIQUE PROX. TIBIAL
OSTEOTOMY
Rx – Corrective Osteotomy…
Greene
 Chevron open- closing wedge osteotomy in
which opening and closing wedges can be
made...
GREEN CHEVRON
Rx – Corrective Osteotomy…
 In children older than 9 years with more severe
involvement, osteotomy alone, with bony bar
r...
Rx – Corrective Osteotomy…
 Schoenecker et al – elevation of medial tibial
plateau with metaphysial wedge osteotomy
 Gre...
SIFFERT’S I E OSTEOTOMY
ILLIZARROV’S TECHNIQUE
Rx in a nut shell
AGE STAGE Rx
< 2 1-11 observation
2-3 1-11 Modified locked KAFO
3-8 11-111 Oblique / chevron o-y
9 + 1v ...
COMPLICATIONS
Common peroneal nerve
palsy
Compartment syndrome
Anterior tibial artery
occlusion
Recurrence
Not yet over
CONGENITAL METATARSUS
ADDUCTUS
 Definition
 Metatarsus adductus is a congenital
foot deformity consists of adduction
of ...
Transverse crease along medial
border of foot
Widening of 1st web space
CONGENITAL METATARSUS ADDUCTUS
 It can occur as an isolated
anomaly or in association with
clubfoot.
 Among individuals ...
 Metatarsus adductus may be
seen as a residual deformity in
patients previously treated
surgically or nonsurgically for
c...
CONGENITAL METATARSUS ADDUCTUS
 BLECK classified as
 mild
 moderate
 severe
 In the mild form, the forefoot can be cl...
Diagnosis
Clinical and radiologic
Treatment
 MILD
 mild deformities resolve
 Reassurance
 Observation
 Serial stretching and casting can be tried
 MODERATE - SEVEREtype
 Serial stretching and casting
for 2-3 months
Rx SURGICAL
 INDICATIONS
 severe deformity uncorrected
by conservative treatment
 pain
 Objectionable appearance
 Dif...
SURGICAL OPTIONS
 Less 4 yrs of age
Tarsometatarsal capsulotomies
 (Heyman, Herndon, and Strong)
 Beyond 4 yrs of age
...
BERMAN GARTLAND
TECHNIQUE
DOUBLE OSTEOTOMY
Hold on!!!!
5 more
minutes
Congenital
Calcaneovalgus
foot
CCV foot
 Ccv presents
 Marked dorsiflexion at ankle
 Hind foot valgus
 Dorsum of foot against anterior
surface of dis...
CCV foot - causes
Uterine packing
Oligohyraminos
Primipara
Twin/triplets
Ccv Foot Rx
Spontaneous recovery
with 2-3 months
Stretching advisable
Serial casting +/-
Allay parental anxiety
THANK YOU
Blounts disease
Blounts disease
Blounts disease
Blounts disease
Blounts disease
Blounts disease
Blounts disease
Próximos SlideShares
Carregando em…5
×

Blounts disease

ppt about blounts disease

  • Seja o primeiro a comentar

Blounts disease

  1. 1. BLOUNTS DISEASE Dr Imran Jan
  2. 2. Definition It is an disorder of the proximal medial tibial growth plate causes progressive varus alignment of the knees (bowed legs) in children or adolescents .
  3. 3. synonyms  Infantile tibia vara  Erlacher`s disease  Blount-barber disease  Subepipyseal osteochondropathy  Non rachitic bow legs  Ostetis deformans tibia
  4. 4. BLOUNTS DISEASE  Erlacher first description of tibia vara and internal tibial torsion (1922)  Blount (1937) described tibia vara as  “an osteochondrosis similar to coxa plana and Madelung's deformity but located at the medial side of the proximal tibial epiphysis.”  .
  5. 5.  Prevalence <1% of all bow legs  The infantile form is more common in girls.  The juvenile or adolescent form is more common in boys.  The disorder is more common in African American children than those of other races.
  6. 6. ETIOLOGY  Current concept is tibia vara is An acquired disease of the proximal tibial metaphysis of unknown cause  Enchondral ossification seems to be altered.
  7. 7. Suggested causative factors include infection trauma osteonecrosis latent form of rickets although none of these has been proved A combination of hereditary and developmental factors is the most likely cause
  8. 8.  The relationship of early walking and obesity to Blount disease has been clearly documented.  Rarely seen in non ambulant children
  9. 9. BLOUNTS DISEASE COMPONENTS OF DEFORMITY  Varus  Internal torsion of tibia  Recurvatum  LLD  Femoaral varus late  MSC hypertrophy
  10. 10. PATHOLOGY  islands of densely packed chondrocytes with hypertr0phy  areas of almost acellular cartilage  Intraphyseal ossification centers  abnormal groups of capillaries.  Extension of noncalcified cartilaginous bars into the proximal epiphysis and distal metaphyses
  11. 11. CLASSIFICATON  Infantile: before 8 years of age  bilateral in 60%  Adolescent more than 8Yrs till skeletal fusion  1 with a cause  2 obese , black
  12. 12. Clinical features Bowing of legs - progressive Metaphyseal spike Knee pain +/-
  13. 13. Radiology  medial half of the epiphysis as seen on radiographs is short, thin, and wedged  the physis is irregular in contour and slopes medially.   The proximal metaphysis forms a projection medially  . According to Smith, however, medial metaphyseal fragmentation is pathognomonic for the development of a progressive tibia vara.
  14. 14. Radiological Features Metaphyseal beak
  15. 15. Tibio Femoral Angle Metaphysio Diaphysial angle (Levin and Drennen) MD angle
  16. 16. MDA ANGLE  MDA < 11: normal physiologic bowing  MDA 11-15: equivocal  MDA >15: Blount’s
  17. 17. Langenskiold classification (1952)  I - irregular metaphyseal ossification combined with medial and distal protrusion of the metaphysis  II, III, IV - evolves from a mild depression of the medial metaphysis to a step-off of the medial metaphysis  V - increased slope of medial articular surface and a cleft separating the medial and lateral epicondyle  VI - bony bridge across the physis  Depending on degree of metaphysial and epiphysial changes on radiograph – 6 progressive stages with increasing age
  18. 18. Work up findings No specific blood marker Tests to R/o Infection and Rickects CT scan in 5yrs + to detect physeal bar
  19. 19. Differential Diagnosis  Physiologic genu varum  Skeletal dysplasias (Metaphysial chondrodysplasia, SED, MED, Achondroplasia)  Metabolic diseases (Renal OD,Vit D resistant rickets)  Post-traumatic deformity  Post-infective sequelae  Proximal focal fibrocartilaginous dysplasia
  20. 20. Treatment  Treatment choices and prognosis depend greatly on the age of the patient and radiographic stage at the time of diagnosis
  21. 21. Rx - Orthotics  Recommended for patients < 3 years of age and < stage II disease  Rainey et al recommended LOCKED KAFO that produced a valgus force by three point pressure  23 HRS /DAY  Full weight bearing  Risk for failure included ligamentous instability, patient weight above 90th percentile and late initiation of bracing
  22. 22. Corrective osteotomy options Metaphyseal Epiphyseal – metaphyseal Intra epiphyseal  Fibula &Bony bar resection
  23. 23. Rx – Corrective Osteotomy…  Rab  proximal tibial oblique metaphyseal osteotomy in which single plane oblique cut allows simultaneous correction of varus and internal rotation and permits postoperative cast wedging if necessary to obtain appropriate position.
  24. 24. RAB’S OBLIQUE PROX. TIBIAL OSTEOTOMY
  25. 25. Rx – Corrective Osteotomy… Greene  Chevron open- closing wedge osteotomy in which opening and closing wedges can be made so that the limb length deformity present in moderate to severe tibia vara will not be increased. He prefers a crescent shaped osteotomy using one half lateral closing wedge and using the graft medially in an opening wedge to maintain length.
  26. 26. GREEN CHEVRON
  27. 27. Rx – Corrective Osteotomy…  In children older than 9 years with more severe involvement, osteotomy alone, with bony bar resection, or with epiphysiodesis of the lateral tibial and fibular physes may be indicated  For older children in whom bracing and tibial osteotomy have failed to prevent progressive deformity, Ingram, Siffert and others have suggested an intraepiphyseal osteotomy to correct severe joint instability and a valgus metaphysial osteotomy to correct the varus angulation
  28. 28. Rx – Corrective Osteotomy…  Schoenecker et al – elevation of medial tibial plateau with metaphysial wedge osteotomy  Gregosiewics – double elevating osteotomies; intraepiphyseal and metaphyseal  Zayer – hemicondylar tibial osteotomy through the epiphysis into the tibial intercondylar notch  Bell, Coogan – recommended Ilizarov’s technique  Uniplanar external fixator for isolated frontal one plane deformity
  29. 29. SIFFERT’S I E OSTEOTOMY
  30. 30. ILLIZARROV’S TECHNIQUE
  31. 31. Rx in a nut shell AGE STAGE Rx < 2 1-11 observation 2-3 1-11 Modified locked KAFO 3-8 11-111 Oblique / chevron o-y 9 + 1v + Resection of bony / physeal bar +osteotomy+ epiphyseal elevaton +/-lateral tibial epiphyseodesis
  32. 32. COMPLICATIONS Common peroneal nerve palsy Compartment syndrome Anterior tibial artery occlusion Recurrence
  33. 33. Not yet over
  34. 34. CONGENITAL METATARSUS ADDUCTUS  Definition  Metatarsus adductus is a congenital foot deformity consists of adduction of the forefoot in relation to the midfoot and hindfoot presenting as in-toeing in children.
  35. 35. Transverse crease along medial border of foot Widening of 1st web space
  36. 36. CONGENITAL METATARSUS ADDUCTUS  It can occur as an isolated anomaly or in association with clubfoot.  Among individuals with metatarsus adductus, 1% to 5% also have developmental dysplasia of the hip or acetabular dysplasia
  37. 37.  Metatarsus adductus may be seen as a residual deformity in patients previously treated surgically or nonsurgically for congenital clubfoot.  This residual metatarsus adductus can be rigid, indicating fixed positioning of the forefoot on the midfoot and hindfoot, or it can be dynamic, caused by imbalance of the anterior tibial tendon during gait.
  38. 38. CONGENITAL METATARSUS ADDUCTUS  BLECK classified as  mild  moderate  severe  In the mild form, the forefoot can be clinically abducted to the midline of the foot and beyond  The moderate form has enough flexibility to allow abduction of the forefoot to the midline only  In rigid metatarsus adductus, the forefoot cannot be abducted at all.
  39. 39. Diagnosis Clinical and radiologic
  40. 40. Treatment  MILD  mild deformities resolve  Reassurance  Observation  Serial stretching and casting can be tried
  41. 41.  MODERATE - SEVEREtype  Serial stretching and casting for 2-3 months
  42. 42. Rx SURGICAL  INDICATIONS  severe deformity uncorrected by conservative treatment  pain  Objectionable appearance  Difficulty in fitting shoes
  43. 43. SURGICAL OPTIONS  Less 4 yrs of age Tarsometatarsal capsulotomies  (Heyman, Herndon, and Strong)  Beyond 4 yrs of age  Multiple metatarsal osteotomies  (Berman and Gartland)  Medial cuneiform, lateral cuboid double osteotomy
  44. 44. BERMAN GARTLAND TECHNIQUE
  45. 45. DOUBLE OSTEOTOMY
  46. 46. Hold on!!!! 5 more minutes
  47. 47. Congenital Calcaneovalgus foot
  48. 48. CCV foot  Ccv presents  Marked dorsiflexion at ankle  Hind foot valgus  Dorsum of foot against anterior surface of distal leg  Ankle ROM till neutral or lessat birth with a dramatic
  49. 49. CCV foot - causes Uterine packing Oligohyraminos Primipara Twin/triplets
  50. 50. Ccv Foot Rx Spontaneous recovery with 2-3 months Stretching advisable Serial casting +/- Allay parental anxiety
  51. 51. THANK YOU

    Seja o primeiro a comentar

    Entre para ver os comentários

  • SowmyaAkash

    May. 13, 2020
  • raj1251

    Jun. 10, 2020
  • abebawdesta

    Jun. 21, 2020
  • vidyasagarko

    Jul. 11, 2020
  • VikrantChauhan37

    Jul. 21, 2020
  • praveen29007

    Aug. 4, 2020
  • ramkrish94

    Aug. 31, 2020
  • PapaKojoArthur

    Oct. 19, 2020
  • AlbertAnnan

    Oct. 25, 2020
  • ZakariyyaYusuf

    Nov. 18, 2020
  • madhavanmaddymadhan

    Nov. 29, 2020
  • AliSobhy1

    Dec. 13, 2020
  • ShorifZaman

    Jan. 5, 2021
  • AAshuMishra

    Jan. 18, 2021
  • SattamAlMalki

    Mar. 3, 2021
  • VictorFabunmi

    Mar. 14, 2021
  • RebbyErasmo

    Mar. 20, 2021
  • YomiIpinera

    May. 6, 2021
  • PrabhuVj1

    May. 10, 2021
  • OluwatomiwaIdowu

    May. 18, 2021

ppt about blounts disease

Vistos

Vistos totais

13.702

No Slideshare

0

De incorporações

0

Número de incorporações

60

Ações

Baixados

1

Compartilhados

0

Comentários

0

Curtir

118

×