https://www.ijmhr.org/ijpr.html editor_physiotherapy@hotmail.com
ISSN:       2321-1822 (E) 2321-8975 (P)

IJPR.2019.155

DOWNLOAD PDF
Table of Contents

Type of Article:  Case Report

Volume 7; Issue 4 (August 2019)

Page No.: 3188-3196

DOI: https://dx.doi.org/10.16965/ijpr.2019.155

A CASE REPORT OF BLOUNT’S DISEASE IN PHYSIOTHERAPEUTIC PERSPECTIVE

Rajani Cartor Medidi *1, Mallireddy Raja Rajeswari 2.

*1 Professor and Principal, VAPMS College Of Physiotherapy, Visakhapatnam, Andhra Pradesh, India.

2 VAPMS College Of Physiotherapy, Visakhapatnam, Andhra Pradesh, India.

Address for correspondence: Prof Dr  Rajani Cartor Medidi  MPT Ortho, MIAP, DHA, Principal, VAPMS College Of Physiotherapy, Visakhapatnam, Andhra Pradesh, India. E-Mail: rajani.cartor@gmail.com

ABSTRACT

Background: This report on Blount’s disease after evaluation and sessions of exercises has shown the difficulties of obese patient in performing exercises with post surgical weakness. 

Case Summary: Blount Disease (Tibia Vara) Idiopathic tibia vara, or Blount disease, is the most common pathologic disorder producing a progressive genu varum deformity. It is characterized by abnormal growth of the medial aspect of the proximal tibial epiphysis, resulting in a progressive varus angulation below the knee. Tibia vara can occur at any age in a growing child. It is classified according to the age: infantile (1 to 3 years), juvenile (4 to 10 years), and adolescent (great than 11 years). The infantile group is the most common. The degree of deformity is measured by the distance between the two medial femoral condyles when the patient is lying. Multiple factors such as ethnicity, genetics, and mechanical stress are thought to be contributing elements to this disease. Diagnostic radiography is the method of choice in diagnosing Blount’s disease in children, and common radiographic manifestations include a rounded, dome – like tibial metaphysis with fracturing or change in size of the epiphysis. During the earliest stage of infantile Blount disease, bracing has been utilized in an attempt to correct the varus angle of the proximal tibia.

Intervention: When performing osteotomies or with pin insertion, nerves as well as the anterior tibial artery and its recurrent branch, are at risk.  With acute correction of the varus deformity, medial-side structures are at risk for stretch injury. Compartment syndrome is a risk particularly with acute correction of tibial deformity. Both through the surgical and/or  conservative management, Physical therapy care should be continued to prevent muscle wasting, correct malalignment, strengthening the muscles, promote healing, weight reduction…etc

Conclusion: Obesity being one of the prime barrier to overcome and complete the exercises, use of aquatic therapy is favourable. Weakness of muscles have to be checked right from the time condition was diagnosed. Proper bracing and strengthening exercises along with moral support and gaining confidence are key for better prognosis.

KEY WORDS: Case Report, Blount’s Disease, Congenital, Epiphyseal.

REFERENCES

  1. OMIM Entry – 259200 – BLOUNT DISEASE, ADOLESCENT”. org. Retrieved 7 November2017.
  2. Clarke SE, McCarthy JJ, Davidson RS. Treatment of Blount disease: a comparison between the multiaxial correction system and other external fixators. J Pediatr Orthop. 2009; 29(2): 103–9. doi:1097/BPO.0b013e3181982a62. PMID19352232.
  3. synd/1470at Who Named It?
  4. P. Blount. Tibia vara: osteochondrosis deformans tibiae. Journal of Bone and Joint Surgery, Boston, 1937;19: 1-29.
  5. Mau, C. Genu varum bedingt durch Tihiaepiphysendefekt bei Kartilaginärer Exostose. Z. orthop. Chir. 1923;24(44):383.
  6. Nilsonne, H. Genu varum mit eigentümlichen Epiphysenveränderungen. Acta chir. scand. 1929;44:187.
  7. Bathfield ca,Beighton blount disease.a review of etiological factors in 110patient clin orthop relat res. 1978;135:29-80.
  8. Bradway Jk, Klassen Ra. Peterson ha.blount disease:a review of the english literature.j pediatric orthopedics.1987jul-aug;7(4):472-80.
  9. Brooks Wc, Gross Rh. Genu varum in children diagnosis and treatment. J am acad orthop surg.1995 nov;3(6):326-335.
  10. Sanjeev Sabharwal, J Bone Joint Surg Am. 2009;91:1758-1776.doi:10.2106/JBJS.H.01348,
  11. Davids Jr, Huskamp M, Bagley Am. A dynamic biomechanical analysis of the etiology of adolescent tibia vara .j pediatr orthop 1996 jul- aug;16(4):461-8.
  12. Orthobullets infantile blount disease tibia vara. aug 2014;30. http; //www.orthbullets .com/pediatrics/4050/infantile-blount disease.
  13. Ayla Güven, MD, Suna Hancılı, MD, L İhsan Kuru, Obesity and Increasing Rate of Infantile Blount Disease, clin pediatr.2014jan 13;53 (6) :539-543.
  14. Gordon je Hughes ms, Shephered k, szymanski da schoenecker pl,parker l. obstruction sleepapnoea syndrome in morbidly obese children with tibia vara. j bone joint surg br.2006jan;88(1):100-3.
  15. Hofmann a, Jones re Herring ja blounts disease after skeletal maturity. j bone joint surg am.1982 sep;64 (7):1004-9.
  16. McCarthy JJ, MacIntyre NR, Hooks B, Davidson RS. Double osteotomy for the treatment of severe Blount disease.  J Pediatr Orthop.  2009;29(2):115–9. doi:10.1097/BPO.0b013e3181982512. PMID 19352234.
  17. Doyle bs,volk ag Smith; infantile blount disease :long –term follow –up of surgically treatment patients at skeletal maturity j pediatr orthop 1996 jul –aug;16(4)469-76.
  18. Eamsobhana p, Kaewpornsawan k, Yusuwank. Do we need to do overcorrection in blount disease int orthop 2014;8(38):1661-4.
  19. Alsancak, S; Guner, S; Kinik. Orthotic variations in the management of infantile tibia vara and the results of treatment. Prosthetics and Orthotics International. 2013; 37 (5): 375–83. doi:10.1177/0309364612471369. PMID 23344116.
  20. Richards bs, katz de Sims jb. Effectiveness of brace treatment in early infantile blount disease. J Pediatr Orthop 1998 may –june;18(3):374-80.

Cite this article: Rajani Cartor Medidi, Mallireddy Raja Rajeswari. A CASE REPORT OF BLOUNT’S DISEASE IN PHYSIOTHERAPEUTIC PERSPECTIVE. Int J Physiother Res 2019;7(4):3188-3196. DOI: 10.16965/ijpr.2019.155
Post Views: 0