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Fulltext Gradual correction of proximal tibia deformity for Blount disease in adolescent and young adults

Saw A, Phang ZH, Alrasheed MK, Gunalan R, Albaker MZ, Shanmugam R

J Orthop Surg (Hong Kong), 2019 9 19;27(3):2309499019873987.
PMID: 31530084 DOI: 10.1177/2309499019873987

PURPOSE: Management of Blount disease in adolescents and young adults is complex and associated with high risk of morbidities. Gradual correction with external fixator can minimize soft tissue injury and allow subsequent adjustment in degree of correction. This study investigates the surgical outcome and complication rate of gradual correction of neglected Blount disease through single-level extra-articular corticotomy.
METHODS: Patients treated for Blount disease using external fixator from 2002 to 2016 were recruited for the study. We used Ilizarov and Taylor Spatial Frame (TSF) external fixator to perform simultaneous correction of all the metaphyseal deformities without elevating the tibia plateau. Surgical outcome was evaluated using mechanical axis deviation (MAD), tibial femoral angle (TFA), and femoral condyle tibial shaft angle (FCTSA).
RESULTS: A total of 22 patients with 32 tibias have been recruited for the study. The mean MAD improved from 95 ± 51.4 mm to 9.0 ± 37.7 mm (medial to midpoint of the knee), mean TFA improved from 31 ± 15° varus to 2 ± 14° valgus, and mean FCTSA improved from 53 ± 14° to 86 ± 14°. Mean duration of frame application is 9.4 months. Two patients developed pathological fractures over the distracted bones, one developed delayed consolidation and other developed overcorrection.
CONCLUSIONS: Correction of Blount disease can be achieved by gradual correction using Ilizarov or TSF external fixator with low risk of soft tissue complication. Longer duration of frame application should be considered to reduce the risk of pathological fracture or subsequent deformation of the corrected bone.

Matched MeSH terms: Bone Diseases, Developmental/diagnosis*; Bone Diseases, Developmental/surgery
Remodelling of Humeral Fracture in a Child with Osteopetrosis Tarda following Conservative Management - A 7-year Follow-up: A Case Report

Erkus S, Turgut A, Kose O, Kalenderer O

Malays Orthop J, 2019 Jul;13(2):42-44.
PMID: 31467651 DOI: 10.5704/MOJ.1907.008

Osteopetrosis (OP) is a rare hereditary sclerosing bone dysplasia characterised by generalised hard and brittle bone secondary to defective osteoclastic function. Osteopetrotic bone is brittle, thus these subjects are prone to frequent fractures, particularly of the long bones. Due to defective osteoclastic function, remodeling is also defective in OP. This report is a case of humeral fracture in a 9 years old girl who was followed seven years. The fracture had remodeled totally similar to healthy bone at the final follow-up. Conservative treatment should be kept in mind in the management of fractures in children with OP, and fractures within acceptable angulations and/or translations should be treated conservatively without hesitation.

Matched MeSH terms: Bone Diseases, Developmental
Optic disc swelling in acromicric and geleophysic dysplasia

Moey LH, Flaherty M, Zankl A

Am J Med Genet A, 2019 09;179(9):1898-1901.
PMID: 31228225 DOI: 10.1002/ajmg.a.61268
Matched MeSH terms: Bone Diseases, Developmental/drug therapy*; Bone Diseases, Developmental/genetics; Bone Diseases, Developmental/pathology
Tibia vara and slipped upper femoral epiphysis: is there an association?

Jamil K, Abdul Rashid AH, Ibrahim S

J Pediatr Orthop B, 2015 Jan;24(1):46-9.
PMID: 25192368 DOI: 10.1097/BPB.0000000000000101

Tibia vara and slipped upper femoral epiphysis (SUFE) share a common risk factor, but their relationship is unclear. In both conditions, the patients are usually obese. To the best of our knowledge, there have been only two previous reports in the literature that have described the occurrence of tibia vara and SUFE in three patients. We report a child who was treated for bilateral tibia vara at the age of 3 years and subsequently developed a SUFE at the age of 13 years.

Matched MeSH terms: Bone Diseases, Developmental/complications*
Fulltext Tibia vara in Asians: Myth or fact? Verification with three-dimensional computed tomography

Ho JPY, Merican AM, Ayob KA, Sulaiman SH, Hashim MS

J Orthop Surg (Hong Kong), 2021 2 27;29(1):2309499021992618.
PMID: 33632009 DOI: 10.1177/2309499021992618

BACKGROUND: There is a common perception among surgeons that Asian tibiae are significantly more varus compared to non-Asians, contributed both by an acute medial tibial proximal angle (MPTA) and diaphyseal bowing. Insight into the normative morphology of the tibia allows generation of knowledge towards disease processes and subsequently planning for corrective surgeries.
METHODS: Computed tomography (CT) scans of 100 normal adult knees, aged 18 years and above, were analysed using a 3-dimensional (3D) analysis software. All tibiae were first aligned to a standard frame of reference and then rotationally aligned to the tibial centroid axis (TCAx) and the transmalleolar axis (tmAx). MPTA was measured from best-fit planes on the surface of the proximal tibia for each rotational alignment. Diaphyseal bowing was assessed by dividing the shaft to three equal portions and establishing the angle between the proximal and distal segments.
RESULTS: The mean MPTA was 87.0° ± 2.2° (mean ± SD) when rotationally aligned to TCAx and 91.6° ± 2.7° when aligned to tmAx. The mean diaphyseal bowing was 0.1° ± 1.9° varus when rotationally aligned to TCAx and 0.3° ± 1.6° valgus when aligned to tmAx. The mean difference when the MPTA was measured with two different rotational alignments (TCAx and tmAx) was 4.6° ± 2.3°. No statistically significant differences were observed between males and females. Post hoc tests revealed statistically significant difference in MPTA between different ethnic sub-groups.
CONCLUSION: The morphology of the proximal tibiae in the disease-free Asian knee is inherently varus but not more so than other reported populations. The varus profile is contributed by the MPTA, with negligible diaphyseal bowing. These implications are relevant to surgical planning and prosthesis design.

Matched MeSH terms: Bone Diseases, Developmental/ethnology*
Femoral-facial syndrome

Samuel, K.F., Rasat, R.

Malaysian Journal of Paediatrics and Child Health, 1998;10(2):59-61.
MyJurnal

A Malay baby boy with the femoral-facial syndrome is presented. The phenotype included bilateral femoral hypoplasia, short nose with a broad nasal tip, long philtrum with a thin upper lip, micrognathia, bilateral cryptorchidism and hypoplastic penis.

Matched MeSH terms: Bone Diseases, Developmental