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A comparative evaluation of tibial metaphyseal-diaphyseal angle changes between physiologic bowing and Blount disease

 Byoung Kyu Park  ;  Kun Bo Park  ;  Yoon Hae Kwak  ;  Seokhwan Jin  ;  Hyun Woo Kim  ;  Hoon Park 
 MEDICINE, Vol.98(17) : e15349, 2019 
Journal Title
Issue Date
Bone Diseases, Developmental/diagnostic imaging* ; Bone Diseases, Developmental/physiopathology ; Child ; Child, Preschool ; Diaphyses/diagnostic imaging ; Diaphyses/growth & development ; Diaphyses/physiopathology ; Disease Progression ; Female ; Follow-Up Studies ; Genu Varum/diagnostic imaging* ; Genu Varum/physiopathology ; Humans ; Infant ; Male ; Osteochondrosis/congenital* ; Osteochondrosis/diagnostic imaging ; Osteochondrosis/physiopathology ; Retrospective Studies ; Tibia/diagnostic imaging* ; Tibia/growth & development ; Tibia/physiopathology
The purpose of this study was to estimate the rate of spontaneous improvement in tibial metaphyseal-diaphyseal angle (TMDA) in physiologic bowing in comparison to that in Blount disease and to provide reference values of TMDA for monitoring patients with highly suspected to have Blount disease.We retrospectively reviewed patients with physiologic bowing meeting the following criteria:(1) TMDA greater than 9° before 36 months of age at initial evaluation;(2) two or more standing long bone radiographs available; and(3) follow-up conducted up to resolution of deformity.Patients with Blount disease had(1) more than 2 standing long bone radiographs obtained before 36 months of age and(2) underwent no treatment during the period in which these images were obtained.TMDA measurements were obtained from 174 patients with physiologic bowing and 32 patients with Blount disease. Rates of TMDA improvement were adjusted by multiple factors using a linear mixed model, with sex and laterality as fixed effects and age and individual patients as the random effects.In the physiologic bowing group, TMDA improved significantly, by 3° per 6 months and by 6° per year. Changes in TMDA were not significant in the Blount disease group.Knowing the rate of TMDA change can be helpful for physicians seeking to monitor infants with suspected as having Blount disease with a high TMDA and to avoid unnecessary repeat radiographic evaluations.
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1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Yoon Hae(곽윤해) ORCID logo https://orcid.org/0000-0002-0596-1228
Kim, Hyun Woo(김현우) ORCID logo https://orcid.org/0000-0001-8576-1877
Park, Kun Bo(박건보) ORCID logo https://orcid.org/0000-0002-8839-4870
Park, Hoon(박훈) ORCID logo https://orcid.org/0000-0002-8063-3742
Jin, Seokhwan(진석환)
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