Adolescent Tibia Vara

Abstract

In recent years voluminous literature has appeared in medical publications on osteochondritis of various epiphyses in the body. With careful search a report of abnormal development in almost every epiphysis will be found recorded. From time to time lesions in heretofore rarely recognized locations are described and among these is osteochondrosis deformans tibire, or tibia vara, as suggested by Blount (1). Blount, in January, 1937, presented an excellent review of the previously described cases of tibia vara and added 13 new ones, making a total of 28 reported cases of this condition. It is not the purpose of this paper to reiterate the excellent description or discussion of Blount but, rather, to add one more case of the so-called adolescent type of tibia vara to the medical literature. Case Report.—M. K., white, female, aged 10 years, was brought to the clinic on Jan. 20, 1939, because of bowing of the left leg and pain in the left knee. The father and mother were alive and well, as were two brothers and one sister. There was no history of tuberculosis. The patient had had none of the contagious diseases of childhood and her general health had been good. The developmental history was negative. In May, 1937, she had had an appendectomy performed elsewhere because of recurrent attacks of abdominal pain with vomiting. Seven days following the operation she developed phlebitis in the left leg and, subsequent to discharge from the hospital, was in bed one month at home. She was then permitted to be up and allowed to go back to school. About January, 1938, she first noted pain in the left knee and some bowing and deformity of the lower left leg. She continued in school but because of pain in the knee frequently missed days in school. Heat applications gave her relief. In December, 1938, a knee cast was applied in another clinic; it was removed after a few weeks. Following the appendectomy, she gained considerable weight. The mother stated that bowing of the leg had become more marked in the last few months. Examination showed the weight to be 85 pounds (38.6 kg.) and the height 52.75 inches (130 cm.). The normal average weight was 68 pounds (30.9 kg.). The adipose tissue was fairly well distributed. The tonsils were medium sized and infected. Some dental decay was present. The examination was otherwise negative except for the left leg. The left femur seemed straight but just below the left knee there was angulation of the tibia, giving the clinical appearance of genu varum. Slight tenderness was present in the region of the proximal tibial epiphyseal cartilage, medially. A slight degree of inward torsion of the tibia was present. The leg lengths were equal. The circumference at the calves of both legs showed the left leg to be one-half inch greater than the right.