HSS spring Blount's Disease

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Author:
shmvii
ID:
216710
Filename:
HSS spring Blount's Disease
Updated:
2013-04-29 22:40:54
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HSS spring Blount Disease
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HSS spring Blount's Disease
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  1. normal LE varus dev
    • newborn: pronounced varus of 10-15 degrees
    • 12-18 months: gets to neutral thanks to wt bearing
    • 3-4 yrs: vagus begins
    • 5-7 yrs: reaches normal mild valgus of 5-9 degrees
  2. Blounts disease
    • genu varum (bow legged) > 2 yrs old
    • it's affects only the tibia ... so there's an in-toeing gait pattern
    • these kids aren't born w congenital abnormalities
    • Blount's affects the medial proximal tibial physis
  3. risk factors for blount's
    • obesity
    • early walking
    • fam hx
  4. diffy diag for blount's
    • trauma
    • OI
    • rickets
    • osteochondroma - dysplasia of growth plate
    • metaphyseal chondrodysplasia - inherited disorder of bone growth
  5. 2 classifications of blount's, and basic differences
    • infantile: < 5 y/o, most get it bilatterally, hits females more than males
    • adolescent or late onset: 5-10 y/o, unilat, obese, boys > girls
  6. gait w blount's?
    • in-toe
    • internal tibial torsion
    • lateral knee thrust
  7. blount's x-ray
    • wedge shaped epipysis (varus angulation)
    • irregular physeal line
    • increased tibial-fem angle (the acute angle formed by drawing a line thru these bones)
    • increased metaphyseal-diaphyseal (MD) angle -- >11 degrees is risky, >20 is confermed tibia vara
  8. non-op tx for infantile blount's
    • KAFO w medial strap (50-80% success)
    • no good if MD anlge is >16
    • useful only up to 3 yo
  9. operative tx for infantile blount's
    • >3 y/o
    • proximal tibial osteotomy
    • epipysidesis (growth plate obliteration)
  10. tx for adolescent blount's
    • non-op if it's not progressing
    • if deformity's worsening -- proximal tibial osteotomy, epiphysiodesis, external fixation
  11. external fixation for blount's?
    • gives angular correction ni any plane
    • corrects distal tib deformities
    • allows limb lenghtening for LLD
    • stable fram allows WBAT
    • shortened hospital stay
  12. goals of PT for blount's
    • edema control
    • stim bone grownt & healing
    • ROM
    • strenghtening
    • nrom gait & function
    • edu for pt and parents
  13. post op blount's
    • NWB for 6-8 wks w cast
    • transfer training
    • gait training
  14. 5 phases of limb lenghtening for blounts w external fixator
    • I: inpatient - fram application and latency period
    • II: home - lengthening
    • III: home - consolidation
    • IV: inpatient - frame removal
    • V: home - post fram removal, bone maturation
  15. 4 complications of external fixator for blounts
    • neurovascular compromise
    • compartment syndromes
    • infection
    • fracture
  16. what can PT do during phase I?
    • knee extension positioning
    • kne and ankle AAROM and strenghtening - lifts, quad sets, press into towel
  17. phase II PT
    • optimize ROM, anti and then against gravity
    • open and closed chain work for strenght
    • optimize gait
    • wt shift on a balance toy
    • gait training and stairs, WBAT
  18. phase III PT
    • full ROM in all jts
    • do lunges, squats, SLS
    • indep gait, noAD
    • indep functional mobility & play
  19. phase IV PT
    ROM, strenght, gait, crutch-training, edu
  20. phase V PT
    • PWB w crutches for 2 weeks
    • AAROM gently and slowly
    • after 4-6 weeks, WBAT w/o AD

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