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Management of Hip Instability in Children

Volume 10 | Issue 2 | May-August 2024 | Page: 18-23 | Parmanand Gupta, Deepak Kumar DOI- https://doi.org/10.13107/ijpo.2024.v10.i02.186 Submitted: 02/06/2024; Reviewed: 26/06/2024; Accepted: 16/07/2024; Published: 10/08/2024 Authors: Parmanand Gupta MS Ortho [1], Deepak Kumar MS Ortho [1] [1] Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India. Address of Correspondence Dr. Parmanand Gupta, Department […]

Blount’s Disease: Review Article

Volume 10 | Issue 2 | May-August 2024 | Page: 24-33 | Yashwant Singh Tanwar, Sirazul Haque Malik, Karolina Siwicka, Nando Ferreira, Pieter Herman Maré DOI- https://doi.org/10.13107/ijpo.2024.v10.i02.188 Submitted: 02/05/2024; Reviewed: 29/05/2024; Accepted: 21/06/2024; Published: 10/08/2024 Authors: Sudhanshu Yashwant Singh Tanwar MS Ortho., DNB, MRCS [1], Sirazul Haque Malik MS Ortho. [2], Karolina Siwicka MD, PhD […]

Management of Hip Instability in Children

Blount’s Disease: Review Article

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Management of Hip Instability in Children

Volume 10 | Issue 2 | May-August 2024 | Page: 18-23 | Parmanand Gupta, Deepak Kumar

DOI- https://doi.org/10.13107/ijpo.2024.v10.i02.186

Submitted: 02/06/2024; Reviewed: 26/06/2024; Accepted: 16/07/2024; Published: 10/08/2024

Authors: Parmanand Gupta MS Ortho [1], Deepak Kumar MS Ortho [1]

[1] Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India.

Address of Correspondence

Dr. Parmanand Gupta,
Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India.
E-mail: drpgupta123@gmail.com

Abstract

Post septic resorption and neglected hip dislocation due to hip dysplasia are the common causes of hip instability in children. The goal in such cases is to create a joint which is stable, painless and mobile hip and mimics the function of the original hip. Hip arthrodesis takes away the mobility of the hip whereas excision arthroplasty of the femoral head only addresses pain but not instability. Pelvic Support Osteotomy overcomes these limitations and addresses pain, instability as well as limp. A big drawback of this procedure remains failure to address limb length discrepancy as well as valgus at the knee. Adding a second osteotomy to the distal femoral shaft region addresses the problem of shortening as well as valgus malalignment of the limb resulting from the pelvic support osteotomy component. This procedure should preferably be performed in a child older than 12 years as doing it prior to this age often results in remodeling at the osteotomy site, thereby leading to less than optimal results with passage of time.
Keywords: Hip instability, Pelvic support osteotomy, Ilizarov HipConstruction

References

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How to Cite this Article: Gupta P, Kumar D | Management of Hip Instability in Children| International Journal of Paediatric Orthopaedics | May-August 2024; 10(2): 18-23. https://doi.org/10.13107/ijpo.2024.v10.i02.186

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Blount’s Disease: Review Article

Volume 10 | Issue 2 | May-August 2024 | Page: 24-33 | Yashwant Singh Tanwar, Sirazul Haque Malik, Karolina Siwicka, Nando Ferreira, Pieter Herman Maré

DOI- https://doi.org/10.13107/ijpo.2024.v10.i02.188

Submitted: 02/05/2024; Reviewed: 29/05/2024; Accepted: 21/06/2024; Published: 10/08/2024

Authors: Sudhanshu Yashwant Singh Tanwar MS Ortho., DNB, MRCS [1], Sirazul Haque Malik MS Ortho. [2], Karolina Siwicka MD, PhD (T & O) [3], Nando Ferreira FC Orth (SA), MMed (Orth), PhD [3], Pieter Herman Maré FC Orth (SA), PhD [4]
[1] Department of Orthopedics, Indraprastha Apollo Hospital, New Delhi, India.
[2] Department of Orthopedics, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jollygrant, Uttarakhand, India.
[3] Division of Orthopedics, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, 7505, South Africa.
[4] Paediatric Orthopaedics Unit, Grey’s Hospital, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa.

Address of Correspondence

Dr. Yashwant Singh Tanwar
Department of Orthopedics, Indraprastha Apollo Hospital, New Delhi, India.
E-mail: tanwar_yashwant@yahoo.co.in

Abstract

Blount’s disease, or non-physiological idiopathic tibia vara, is a growth disturbance affecting the medial proximal tibial physis, leading to a progressive three-dimensional deformity characterized by varus, procurvatum, and internal rotation. While its precise etiology remains unclear, the condition has been closely linked to obesity, mechanical stress, and potential genetic predisposition. Infantile Blount’s typically presents between one and three years of age, often bilaterally, whereas late-onset forms occur in juveniles (4–10 years) or adolescents (>10 years) and are more commonly unilateral. Early differentiation from physiological bowing is essential, as untreated disease results in progressive deformity and joint instability.
Radiographic evaluation is critical in confirming the diagnosis and planning treatment. Key parameters, including the meta-diaphyseal (Drennan) angle, medial metaphyseal beak angle, and mechanical tibiofemoral axis deviation, provide objective measures to distinguish Blount’s disease from other causes of genu varum. Medial tibial plateau depression, best assessed using an arthrogram, is a key determinant in surgical planning, particularly in advanced cases.
Management strategies depend on the stage and severity of the disease. In early stages, guided growth using tension-band plating may modulate physeal development and prevent progression. However, in advanced or recurrent cases, surgical correction is required. Metaphyseal osteotomy, with or without internal fixation, remains the mainstay of treatment. In cases with significant medial plateau depression, a medial hemiplateau elevation osteotomy is indicated to restore joint congruency and knee stability. Severe or late-presenting cases may necessitate double osteotomy techniques, combining joint line realignment with metaphyseal correction. Acute correction methods, including oblique and dome osteotomies, are effective but carry risks of neurovascular compromise. In cases of complex multiplanar deformity, gradual correction using circular external fixation offers precise correction while minimizing complications.
Despite surgical intervention, recurrence remains a concern, particularly in cases with persistent medial physeal slope abnormalities. Strategies such as prophylactic lateral tibial and fibular epiphysiodesis, as well as controlled overcorrection, have been proposed to minimize recurrence risk. Perioperative considerations, including prophylactic fasciotomy and careful fibular osteotomy placement, play a role in preventing complications such as compartment syndrome and peroneal nerve palsy.
Blount’s disease is a progressive condition requiring early diagnosis and timely intervention to prevent long-term morbidity. A structured approach, incorporating clinical assessment, radiographic analysis, and stage-specific management, is essential to optimize outcomes. While current surgical techniques provide reliable correction, ongoing research into the pathophysiology and treatment of Blount’s disease remains essential to improving long-term prognosis.
Keywords: Blount’s disease, Infantile tibia vara, Adolescent tibia vara

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How to Cite this Article: Tanwar YS, Malik SH, Siwicka K, Ferreira N, Maré PH | Blount’s Disease: Review Article | International Journal of Paediatric Orthopaedics | May-August 2024; 10(2): 24-33. https://doi.org/10.13107/ijpo.2024.v10.i02.188

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Management of Hip Instability in Children

Blount’s Disease: Review Article

Management of Hip Instability in Children

Blount’s Disease: Review Article

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Management of Hip Instability in Children

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Blount’s Disease: Review Article

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