Скачать или смотреть Infantile tibia vara

Infantile tibia vara is the early-onset form of Blount’s disease, a growth disorder affecting the proximal tibial physis (upper shin bone growth plate), leading to progressive genu varum (bow-legged deformity).


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Key Features

Age of onset: Usually less than 4 years (infantile type).

Laterality: Often bilateral but can be asymmetric.

Etiology:

Exact cause unknown; thought to be due to abnormal growth of the medial portion of the proximal tibial physis.

Risk factors: early walking, obesity, African ancestry, and possible genetic predisposition.




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Pathology

Medial growth plate disturbance → asymmetric growth of proximal tibia.

Medial metaphysis becomes beaked and depressed, lateral side grows normally → progressive varus deformity.



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Clinical Features

Genu varum deformity that is:

Progressive (not improving with age, unlike physiological bow legs in toddlers).

Often associated with medial knee thrust during walking.


Short stature may be present.

No signs of systemic disease.



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Radiological Features

X-ray:

Depression and fragmentation of the medial proximal tibial epiphysis.

Medial metaphyseal happening (most characteristic).

Widened epiphyseal plate medially.

Drennan’s angle is more than 11° (measured between the metaphyseal line and a line perpendicular to the tibial shaft) → predictive of progression.




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Differential Diagnosis

Physiological genu varum (self-resolving by age 2–3).

Rickets.

Skeletal dysplasias.

Post-traumatic deformity.



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Treatment

Conservative:

Bracing (KAFO – knee-ankle-foot orthosis) if age less than 3 years and deformity is mild/moderate.


Surgical:

Indicated if:

Child more than 3 years.

Severe deformity.

Failure of bracing.


Options:

Proximal tibial osteotomy (valgus-producing).

Growth modulation (guided growth with plates/screws).





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💡 Exam Tip:

Infantile tibia vara worsens with growth, whereas physiological bow legs improve by 3 years.

Medial metaphyseal beaking is a buzzword in orthopaedics MCQs.

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