Abstract
Objective: This retrospective study evaluated treatment with individually contoured molded bracing at early stages of the disease. Methods: We evaluated the medical records of patients undergoing treatment of Blount's disease with molded orthoses for medial decompression between 2010 and 2014. The deformity angle (Drennan's metaphyseal-diaphyseal angle) and Langenskiöld classification were measured before and after treatment by a pediatric orthopedic surgeon with over 5 years of practice, blinded for the study and patients. Results: The mean age was 2.57 years old. Four patients were female and six male. Half of the total sample had bilateral disease. The average deformity angle showed a statistically significant reduction after treatment (p <0.001). Gender and laterality did not statistically influence the change of the deformity angle after treatment (p> 0.05). Conclusion: The nightly use of molded orthoses for medial decompression was effective in reducing the metaphyseal-diaphyseal angle in Blount's disease in children under 3 years of age, regardless of gender and bilateral disease. Patients over 3 years old did not benefit from bracing. Level of Evidence IV, Case Series.
Highlights
The difficulties encountered by researchers include: 1) lack of standardization of orthotic devices; 2) difficulty of regulating the treatment regimen; 3) absence of control groups; and 4) the differentiation between Blount’s disease and physiological genu varum.[19,23]
Half of the total sample had bilateral disease. (Table 1) The patients deformity angle showed statistically significant average reduction after treatment (p
The use of orthoses was effective in reducing Drennan's metaphyseal-diaphyseal angle, with statistical significance. (Figures 4 and 5) Only three tibiae (20% of the total sample) showed no reduction of the deformity angle and two of them (13%) were from patients older than three years
Summary
Blount’s disease, identified and described by Blount in 19371 and initially reported by Erlacher[2] in 1922 is a condition of unknown etiology, characterized by varus deformity[3] of the proximal tibia in previously healthy children, usually between two and five years old.[2,4] Due to the risk of evolving with progressive angular deformity, many cases come to require surgical treatment for correction and re-establishment of lower limb alignment.[5,6,7,8,9,10,11,12,13,14] In the early stages of the disease, several authors have proposed treatment with orthotics.[7,10,11,15,16,17,18,19,20,21] The indications include children under the age of three years and unilateral disease Langenskiöld stage I or II.[22,23] Patients over four years old, with weight to age percentile > 90, presenting bilateral disease or progressive deformity did not show good performance with nonsurgical treatment. The indication of conservative treatment is based on papers published in the late 90s,19-21 mainly guided by Richards’ study,[20] as explained by Birch in the latest review on the subject, published in the Journal of the American Academy of Orthopaedic Surgeons.[22] In our service, we have been using a new orthosis that is clinically efficient. This retrospective study aimed to evaluate treatment with this type of individually molded orthosis in children presenting early stages of the disease
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