Approach to Blount’s Disease (Infantile Tibia Vara)
First – make sure you are actually dealing with Blount’s disease and not some weird skeletal dysplasia or rickets!
Assess the x-rays
– note the metaphyseal diaphyseal angle and the medial physeal slope
– note the Langenskiold staging (I to VI)
– I and II have mild varus with no major sloping of the tibial physis
– III and IV have some tilting over of the physis
– VI and VI have a significant angulation of the physis
– consider a bony bar in anything from III to VI (most commonly IV, V, VI)
Decision Making – you want the legs to be normal by the age of FOUR – this significantly influences what you do
General Indications for Bracing
– first time visit 36 months of age – you have no time to waste before the age of 4 to be fucking around with bracing.
– documented progression in the KAFO at any age
– metaphyseal diaphyseal angle of 60 or more at any age
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