Blount Disease

Tibia vara or Blount's disease is a familial disorder characterized by unusual growth disorganized ossification of the medial face of the Fizeau tibial proximal epiphysis and metaphysic. This is manifested by progressive deformity in varus angulation and internal rotation of the tibia in proximal metafizara region just below the knee. The natural evolution leads to irreversible pathological changes, particularly the medial portion of the proximal tibial epiphysis due to Fizeau underlying growth disorder.
Blount's disease can occur at any age children and is classified into two groups: early or late onset. Early onset under 3 years old is called infantile type. Late-onset form of disease include juvenile form in children 4-10 years and teens in over 11 years.
And osteochondrosis deformans tibia vara tibiae are other names used to describe Blount disease. The term of Blount disease is usually accepted in the medical community. But it does not identify the specific location of the fault and does not indicate etiology. The term osteochondritis deformans tibiae is not precisely describe the disorder as the primary or secondary ossification centers suffer avascular necrosis. Avascular necrosis was not found in any form of Blount disease. And tibia vara Blount disease continues to be the most accepted terms for this disease.
Blount's disease occurs in young children and teenagers. The cause is unknown but is believed to be due to the effects of increasing weight on the shelf. The inside of the tibia is not forcing me to develop normally bone angulation. The disease is progressive. It may affect one or both legs. It is a condition associated with obesity and early outpatient. There appear to be involved and genetic factors.
Treatment ranges from simple observation until the wearing of orthoses and surgery. Decision for treatment depends on the child's age, severity of disease. If it detects a moderate varus in children under 2 years indicate surveillance. In many cases varus will prove to be physiologically and will correct spontaneously. If varus worsens or if the child is detected in 2-4 years will be wearing orthopedic devices. In some cases the best treatment is surgery. The disease is always detected in adolescents treated by surgery. The surgery is osteotomy of the tibia and a portion is removed to realign fbula normal position of the foot. The realignment is maintained by external or internal fastening and metal rods. These will be removed at a certain period and replaced with Plasters.
PathogenesisBlount's disease is caused by the combination of excessive compressive forces on the medial proximal tibia metaphyses and abnormal bone formation endocrondral. It is unclear whether the deformation is caused by an intrinsic alteration of bone formation that is exacerbated by compressive forces or compressive forces that cause disruption to the normal formation of subchondral bone.Immobilization is necessary because the disease does occur in patients nonambulatori. The combination of mechanical and biological factors in influencing disease tibia vara in different ways.Physiological excessive bulging of the tibia is described in patients with infantile form of the disease. Compression is known to inhibit the growth of epiphyseal Fizeau and stimulates release of growth. It is known as cartilage is destroyed more slowly ossify.
The result is a progressive varus angulation below the knee in an increase in compressive forces on the tibia to change the direction of supporting forces perpendicular to the tibial apifiza Obilica.Skew forces tibial epiphysis tends to deviate laterally.Many researchers believe that this cycle progression is the result of increased disorder, and again varus deformity in bone growth disorder. Distal femoral valgus or varus deformation may occur with tibia vara. If these processes occur as compensatory mechanisms are due to factors intrinsic or Blount's disease is unknown. These deformities can be corrected at the same time as tibia vara.Causes and risk factors for Blount's disease:The cause of the disease remains controversial, but most likely is due to a combination of hereditary and developmental factors.Fizeau mechanical overload due to proximal tibial varus alignment in static and excessive body weight are involved in the etiology of infantile tibia vara. Medial compression forces on the front of the knee appear to cause growth suppression. Although similar processes may be involved in the development of adolescent tibia vara, the static varus alignment is not necessarily required.Dynamic weight variation diemnsiunilor secondary growth was suggested to be involved in the development of adolescent Blount disease.
Signs and symptomsClinical presentation of different types of tibia vara vary depending on age of onset. In infantile tibia vara children begin to walk early in the 9-10 months. At the onset infantile Blount's disease diferetierea between physiological and curved legs is difficult.Genu varum is physiologic frequency torsional deformation that occurs secondary normal position in the womb. Stretched posterior capsule of the hip cause internal rotation of the thigh at the hip. When combined with internal tibial torsion is a question results in varus deformity. This deformity usually resolves spontaneously physiologic until the age of 2 years. Unlike physiological genu varum, infantile Blount's disease may progress to severe deformity.
Infantile form is generally more prevalent in women, blacks and those with marked obesity. Metaphyses is associated with prominent beak, internal tibial torsion and limb discrepancy.Damage is bilateral in 80% of cases. Metaphyses bill may be palpable on the face of the proximal medial tibial condyle. Patients do not experience pain.Disease patients with an accused teenage girl medial knee pain.They are usually obese. Damage is unilateral in 80% of cases.Involved leg is shorter than the opposite 2-3 cm. degree of varus is not so severe as in individuals with infantile form and does not exceed 20 degrees.