Tibial Bowing Research Articles

Posteromedial bowing of the tibia. Progression of discrepancy in leg lengths.

Thirteen children with posteromedial bowing of the tibia were followed clinically and radiographically for a mean of four years from the time of original diagnosis. At follow-up, the discrepancy in leg lengths as determined by scanograms ranged from 1.9 to 5.6 centimeters, with a mean of 3.1 centimeters; usually there was progression of the discrepancy. Nine of the thirteen children had a discrepancy of more than 2.5 centimeters. There appeared to be a direct relationship between the degree of initial tibial bowing and the severity of the subsequent leg-length discrepancy.

The Campomelic Syndrome

The radiographic and clinical findings of the campomelic syndrome are described. Radiographically, it is characterized by bony and cartilaginous growth disturbances manifested by bowing of the femurs and tibiae, hypoplasia of the vertebral bodies, scapulae, and pelvis, and dislocation of the hips, knees, and elbows. These findings clearly differentiate this entity from other short-limbed dwarfisms. Clinically, these infants are short-limbed with tibial and femoral bowing, with dimpling over the tibial bow. Generally there is cleft palate, macrocephaly, hypertelorism, micrognathia, hypotonia, and laryngotracheal malacia. Most patients with this syndrome die in infancy, usually of respiratory disorders.

The natural history of metaphyseal dysostosis

This study of metaphyseal dysostosis in 24 related patients and 2 sporadic cases demonstrated wide variation in the severity of expression in this inherited nonrachitic abnormality of osseous development. Twenty-five of the patients were short of stature. Most of them had pain in the legs during childhood and frequent findings were broad metaphyses, tibial bowing, waddling gait, flaring of the lower rib cage, and inability to fully extend the fingers. Roentgenographic studies revealed wide irregular metaphyses at the ankles, knees, wrists and shoulders, with normal epiphyses and diaphyses. The natural course of this form of metaphyseal dysostosis has been one of symptomatic and radiographic improvement beginning as early as 3 years of age. Because spontaneous improvement occurs in most cases orthopedic operation is indicated only for the unusual instance of severe disability.

Congenital Absence of the Fibula

A limb with an absent fibula is truly a limb dysplasia, with serious anomalies in the foot, the tibia, and the femur. Tibial bowing is not affected by weight-bearing and braces. It may regress spontaneously, but will not progress. Tibial osteotomies will unite. The treatment required must be specific for each patient. It is suggested, however, that amputation should be performed early whenever shortening of more than three inches is anticipated. Every effort should be made to perform a Syme type of amputation because the heel pad provides a durable stump which lengthens with growth.

Congenital Absence of the Fibula

A limb with an absent fibula is truly a limb dysplasia, with serious anomalies in the foot, the tibia, and the femur. Tibial bowing is not affected by weight-bearing and braces. It may regress spontaneously, but will not progress. Tibial osteotomies will unite. The treatment required must be specific for each patient. It is suggested, however, that amputation should be performed early whenever shortening of more than three inches is anticipated. Every effort should be made to perform a Syme type of amputation because the heel pad provides a durable stump which lengthens with growth.

Familial Osteochondritis Dissecans with Associated Tibia Vara

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