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Observation, discontinuation of bracing
4%
142/3162
Observation, continuation of full-time bracing
15%
465/3162
Bilateral proximal tibial osteotomies
67%
2103/3162
Bilateral distal femur osteotomies
3%
95/3162
Bilateral proximal tibial medial hemiepiphysiodesis
11%
343/3162
Select Answer to see Preferred Response
The clinical scenario is consistent for a child with Infantile Blount’s disease who is < 3 year of age BUT has failed the first line of treatment which is bracing. At this time bilateral proximal tibial osteotomies is the most appropriate treatment. Infantile Blount’s disease is a pathologic type of tibia vara which develops in children 0-4 years of age. Bracing is indicated in patients < 3 years of age with Langenskiöld stage I-II disease, and is more effective in patients with unilateral disease. Surgery is indicated if varus secondary to Blount's disease persists at the age of 4 OR if bracing fails in 2-3 year olds after 12 months. Correction is achieved surgically with a proximal tibial realignment osteotomy. Feldman et al. discusses the two options of acute vs gradual correction of tibia vara. They concluded that gradual correction is a more accurate treatment in regards to correction of the limb length inequality, mechanical axis deviation, and medial proximal tibial angles. While there is literature to support the use of guided-growth in patients with adolescent Blount's, further investigation is required to see if similar results can be obtained in patients with infantile Blount's. Incorrect Answers: Answer 4: Incorrect because the pathology is in the tibia and not the femur in infantile blount’s. Answer 5: Incorrect because closing down the medial side will cause further varus.
3.8
(31)
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