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Year |
2001 |
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Question Number |
185. |
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Category |
Select |
Question
A 6-year-old girl has a right genu varum that has progressed over the last 6 months. Plain radiographs of the knee reveal a sloping medial joint line with an obvious bony bar at the medial proximal tibial physis. A CT scan shows that this bar involves about 20% of the physis. Treatment at this time should include
1- epiphyseodesis of the proximal tibial physis.
2- corrective osteotomy of the tibia and fibula.
3- corrective osteotomy of the tibia and epiphyseodesis of the left proximal tibial physis.
4- proximal tibial physeal bar resection and corrective osteotomy of the tibia and fibula.
5- elevating osteotomy of the proximal tibial medial plateau.
Figures
Answer (click for answer)
Answer – 4
Blount’s disease is considered to be a developmental condition, which affects the proximal medial tibial physis, resulting in a progressive varus deformity. The precise etiology is not known, although disordered endochondral ossification has been identified. Infantile Blount’s affects those children younger that 3 years of age. The adolescent form affects those older than 8 years of age, and some authors describe a middle or juvenile group between these two. The infantile form is bilateral 60% of the time.
The treatment of Blount’s disease is determined by the age of the child and the severity of the condition. If progressive deformity is identified, tibial osteotomy is indicated.
Since this patient is only six and has significant remaining growth, any answer involving epiphyseodesis is wrong. Answer 2 addresses the deformity, but leaving the bar in place will guarantee recurrence in this skeletally immature child. Answer 4 is the only correct answer because it addresses the bar and the angular deformity. An elevating osteotomy of the proximal tibial medial plateau is a useful procedure in skeletally mature children with significant deformity at the joint line.
Reference: OKU-Pediatrics 1st edition 1996