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The deformity will likely resolve by the age of 10 but he will likely require future surgery to correct his leg length
13%
209/1556
The deformity will likely resolve by the age of 5 but he will likely require future surgery to correct his leg length
36%
567/1556
The deformity will not resolve and he will require limb reconstruction to correct the deformity
199/1556
The deformity will likely resolve by the age of 5 and he is unlikely to require any future surgery
33%
509/1556
The deformity will not resolve but he is unlikely to require any future surgery
4%
58/1556
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The clinical presentation is consistent with congenital posteromedial bowing of the tibia (CPMBT). The bowing deformity is likely to resolve by the age of 5 (~80% of patients) but more than 50% of patients will require future surgery for residual leg length difference (LLD) CPMBT is thought to be a result of intrauterine positioning which usually involves the middle and distal third of the tibia. It is commonly associated with calcaneovalgus foot, another intrauterine positioning condition. CPMBT is treated with observation for the bowing deformity which usually spontaneously corrects by the age of 5 (~80% of patients). However, patients need to be monitored long-term since the majority of patients have a residual LLD of 2-5 cm. Greater than 50% of patients will require surgery at some point in the future to address the leg length difference. Shah et al. retrospectively reviewed 20 children with CPMBT to determine the pattern of correction of the bowing and the role of surgical intervention in CPMBT. Two distinct mechanisms seem to be responsible for the resolution of the deformity in CPMBT; one involves physeal realignment and the other involves diaphyseal remodeling which progressively resolves in the first year of life. They noted that 80% of patients had a resolution of the deformity by the age of 5. The authors recommend that all children with CPMBT be followed until skeletal maturity, to identify cases with residual bowing, ankle deformity, muscle weakness, and LLD, as surgical intervention may be needed to correct these problems. Pappas et al. reviewed the patterns of growth and development of 33 patients with CPMBT. The authors noted that the bowing is accompanied by shortening of the tibia and fibula and a decrease in ankle motion that does not improve with age. The authors noted that the greater the initial bowing, the greater the ultimate LLD. They also noted that the proportionate length differences between the normal and the bowed tibia remained stable after the age of 12 months. Wright et al. reviewed the initial deformity and subsequent remodeling of 38 patients with CPMBT to determine the likelihood of limb reconstruction. Patients were followed up for an average of 78 months. The authors noted that 20 of the 38 patients (53%) were indicated and/or underwent limb reconstruction due to leg length difference and/or residual deformity. Figure A and B: AP and lateral of the tibia showing characteristic findings of posteromedial tibial bowing. Incorrect Answers: Answer 1: The posteromedial bowing deformity is expected to resolve by the age of 5-7 in the majority of cases. Answer 3: The posteromedial bowing deformity is expected to resolve by the age of 5-7 and in the majority of cases, will not require surgical intervention. This is contrary to the LLD, which will in most cases require surgical intervention at a later date. Answer 4: While the patient's deformity is likely to resolve, greater than 50% of patients go on to needing surgery at some point for LLD Answer 5: The posteromedial bowing deformity is expected to resolve in the majority of cases
2.6
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