title: Answer please. Blount's disease: tibia vara.
abstract: Infantile tibia vara, although uncommon compared to normal physiologic bowing, is significant due to the resultant progressive deformities if not diagnosed early. The key radiographic finding is medial tibial metaphyseal beaking and fragmentation. Although the etiology is unclear, it appears to be an acquired growth disturbance of the proximal medial tibial epiphysis, ossification center, and metaphysis rather than any type of avascular necrosis. The Langenskiöld six-stage classification is useful for the diagnostic, prognostic, and treatment staging of the disease. The adolescent form is less common and less severe with only slight irregular thickening of the physis present on radiograph. The MDA appears to be the most reproducible method for measuring angular deformities in both variants of the disease. Treatment of the infantile stages I or II consists of observation and bracing. Stage III or IV disease in children over age 3 years with more than 5 degrees of varus angulation should be treated with corrective valgus osteotomy. Stages V or VI may require repeated surgical treatment with multiple osteotomies and possible contralateral epiphysiodesis. The adolescent form frequently requires surgery when there is significant physical impairment related to the severe genu varum.
authors.affiliation: Department of Orthopedic Surgery, Hahnemann University, Philadelphia, PA 19102-1192.
authors.forename: J M
authors.initials: JM
authors.lastname: Marine
authors.forename: R E
authors.initials: RE
authors.lastname: DiSimone
authors.forename: M J
authors.initials: MJ
authors.lastname: Clancy
mesh_terms: D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D010007:Osteochondritis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D010027:Osteotomy; D011859:Radiography; D013977:Tibia