DOI: 10.1148/rg.234025149
Radiographic Characteristics of Lower-Extremity Bowing in Children1
Jugesh I. Cheema, MD,
Leslie E. Grissom, MD and
H. Theodore Harcke, MD
1 From the Christiana Care Health System, Newark, Del (J.I.C.), and the Department of Medical Imaging, Nemours Children’s Clinic-Wilmington, Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19803 (L.E.G., H.T.H.). Presented as an education exhibit at the 2001 RSNA scientific assembly. Received September 27, 2002; revision requested December 13 and received January 28, 2003; accepted January 28. Address correspondence to L.E.G. (e-mail: lgrissom@nemours.org).
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Figure 1. Photograph shows a 2 -year-old girl with infantile Blount disease.
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Figure 2. Photograph shows an 11-year-old boy with adolescent Blount disease.
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Figure 3. Graph illustrates how normal varus angulation before 2 years of age changes to valgus angulation after 2 years of age (arrow). (Reprinted, with permission, from reference 2.)
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Figure 4a. Physiologic bowing in a 16-month-old boy. (a) Initial radiograph demonstrates physiologic bowing. (b) Follow-up radiograph obtained 7 months later shows mild metaphyseal beaking with improvement over time.
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Figure 4b. Physiologic bowing in a 16-month-old boy. (a) Initial radiograph demonstrates physiologic bowing. (b) Follow-up radiograph obtained 7 months later shows mild metaphyseal beaking with improvement over time.
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Figure 5. Congenital bowing in a 3-month-old girl. Anteroposterior (left) and lateral (right) radiographs demonstrate congenital bowing posteriorly and medially.
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Figure 6a. Infantile Blount disease in a 23-month-old boy. (a) Radiograph shows asymmetric depression of the proximal tibial metaphyses, particularly on the affected left side. (b) Radiograph obtained 7 months later demonstrates increased metaphyseal depression bilaterally and fragmentation of the medial tibial metaphysis on the left side. Black lines illustrate abnormally increased metaphyseal-diaphyseal angles measuring 13° and 26° on the right and left sides, respectively.
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Figure 6b. Infantile Blount disease in a 23-month-old boy. (a) Radiograph shows asymmetric depression of the proximal tibial metaphyses, particularly on the affected left side. (b) Radiograph obtained 7 months later demonstrates increased metaphyseal depression bilaterally and fragmentation of the medial tibial metaphysis on the left side. Black lines illustrate abnormally increased metaphyseal-diaphyseal angles measuring 13° and 26° on the right and left sides, respectively.
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Figure 7. Drawings illustrate the six stages of the Langenskiold classification system for Blount disease. Note the progressive depression, beaking, and fragmentation of the medial tibial metaphysis, also involving the epiphysis in the higher stages. (Reprinted, with permission, from reference 7.)
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Figure 8a. Adolescent Blount disease in a 12-year-old boy. (a) Radiograph shows metaphyseal changes in both the proximal tibia and the distal femur. Physeal widening is noted in the proximal tibia medially (arrow). (b) T1-weighted MR images show abnormal metaphyseal signal intensity in the distal femur and proximal tibia (arrowheads).
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Figure 8b. Adolescent Blount disease in a 12-year-old boy. (a) Radiograph shows metaphyseal changes in both the proximal tibia and the distal femur. Physeal widening is noted in the proximal tibia medially (arrow). (b) T1-weighted MR images show abnormal metaphyseal signal intensity in the distal femur and proximal tibia (arrowheads).
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Figure 9a. Neurofibromatosis in a 1-year-old girl. Anteroposterior (a) and lateral (b) radiographs demonstrate bowing with focal sclerosis and a notched medial cortex in the distal third of the tibia.
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Figure 9b. Neurofibromatosis in a 1-year-old girl. Anteroposterior (a) and lateral (b) radiographs demonstrate bowing with focal sclerosis and a notched medial cortex in the distal third of the tibia.
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Figure 10. Osteogenesis imperfecta in a 7-year-old girl. Anteroposterior (left) and lateral (right) radiographs demonstrate marked osteopenia, anterior and medial bowing, and focal sclerosis in the midshaft of the tibia due to prior fracture. Note also the thin, bowed fibula and posttraumatic changes in the distal femoral metaphysis.
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Figure 11. Vitamin D-resistant rickets in a 2-year-old girl. Radiograph shows metaphyseal changes and physeal widening.
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Figure 12a. Camptomelic dysplasia in a 5-month-old girl. Anteroposterior (a) and lateral (b) radiographs demonstrate thickened, dysmorphic long bones and bowing of both tibias and femurs.
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Figure 12b. Camptomelic dysplasia in a 5-month-old girl. Anteroposterior (a) and lateral (b) radiographs demonstrate thickened, dysmorphic long bones and bowing of both tibias and femurs.
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Figure 13. Achondroplasia in a 6-year-old boy. Radiograph shows short bones, metaphyseal flaring, and genu varum. The acetabula are squared, and the sacrosciatic notches are narrowed.
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Figure 14a. Blount disease in a 3-year-old girl who was treated with proximal tibial osteotomies. (a) Preoperative radiograph demonstrates bilateral metaphyseal deformity and marked left-sided metaphyseal depression and varus angulation. (b) Radiograph obtained 5 months after surgery shows improved angulation.
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Figure 14b. Blount disease in a 3-year-old girl who was treated with proximal tibial osteotomies. (a) Preoperative radiograph demonstrates bilateral metaphyseal deformity and marked left-sided metaphyseal depression and varus angulation. (b) Radiograph obtained 5 months after surgery shows improved angulation.
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Figure 15a. Adolescent Blount disease in a 12-year-old boy who was treated with tibial and fibular osteotomies. (a) Preoperative radiograph shows varus angulation and tibial metaphyseal depression. (b) On a radiograph obtained 2 years after surgery, these conditions have improved but have not been completely corrected.
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Figure 15b. Adolescent Blount disease in a 12-year-old boy who was treated with tibial and fibular osteotomies. (a) Preoperative radiograph shows varus angulation and tibial metaphyseal depression. (b) On a radiograph obtained 2 years after surgery, these conditions have improved but have not been completely corrected.
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Copyright © 2003 by the Radiological Society of North America.
