Blount's disease
Clinical Condition
A 13-year-old patient presented with a pronounced right-sided O-B adjustment. The soccer player, who was very active in sports, reported increasing knee pain without recalling any particular incident.
At the first presentation in the ZEM-Germany the O-B-adjustment of the right leg was already so pronounced that a further sporting activity had to be advised against at first. At the level of the right knee joint, the load axis was shifted 105 mm medially, so that there was an acute risk of damage to the medial meniscus. There was also a moderate deviation of the loading axis of 24 mm on the left side. Due to the severe bending of the right leg, there was also a leg shortening of more than 2 cm on this side.
Diagnosis: suspected juvenile form of Blount's disease.
Initial presentation
LSR before treatment
Treatment
In order to use the residual growth for straightening, a temporary joint stapling was performed on the outer side of the right upper and lower leg in a first, small operation. However, there is only a small window of opportunity for such growth control procedures, which can avoid later, much more extensive operations. In this case, only a partial correction could be achieved due to the late initial presentation at ZEM-Germany.
Therefore, after completion of the length growth, the remaining deformities had to be surgically corrected as planned, first on the thigh and 3 months later also on the lower leg. At all times the boy was mobile with forearm crutches and was able to put 20kg of weight on his right leg until the bone had healed completely.
1st OP: 8-plates
2nd OP: supracondylar axis correction
3RD OP: HTO
Result
Measurement of the legs after consolidation and removal of the implants shows a centered, straight leg axis on the right side. The bone has healed completely and is stable under load again. The shortening of the leg is also compensated. The correction thus prevented possible consequential damage to the knee joint due to one-sided overloading and also a malposition of the spine. In the meantime, the young man can once again participate in sports without restrictions and is confident that he will one day become a famous professional soccer player.
Particularly in view of the intensive sporting activity, the O-B alignment of the left leg should also be corrected. Not an easy decision for the sports enthusiastic young man but a "must" because of his sporting ambitions.
Treatment completion
A straight right leg after surgical upper and lower leg corrections
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