Review Question - QID 8454

This patient has left knee early-stage infantile Blount disease. After age 2, physiologic genu varum should be resolving. By age 3+ affected children have physiologic genu valgum, so observation is not appropriate because her medial physeal disturbance will progress to later-stage Blount disease with a bony bar. Infantile Blount disease is believed to be a mechanical disorder and does not need endocrine workup; also, the radiographs show no signs of rickets (physeal widening/cupping). Braces can be used, but they are associated with success rates of 50% to 70% if worn appropriately and are most effective for children younger than age 3. To be effective, bracing is best worn full time, and has not been shown effective when worn fewer than 12 hours per day. Because recurrence rates after surgery are much higher in later-stage Blount disease and in children older than age 4, a hemiepiphysiodesis should be done now. Lateral hemiepiphysiodesis in Blount disease can be successful if done during the early stage and is minimally invasive. Corrective osteotomy also would be a reasonable choice for treatment.