Tibia bowing
PRESENTED BY QUTAIBH ALOTAIBI PGY 2
MODERATED BY [Link] SAMARAH
Tibia bowing
TIBIA BOWING
DEFENTION
defined by the apex of the tibial curve being
directed posteriorly medially laterally .
Tibia
bowing
Anterio lateral
Anterio medial
Postero medial
Posterio medial
Unknown intrauterine #.
Developing failure in embryonic
period in distal tibial physis Intrauterine
malposition
typically presents with a
calcaneovalgus foot deformity and leg
length discrepancy.
Psoterio
medial
anatomy
Post.& medial
angulation between
middle and distal 1/3 of
T& F
Genetics
no known genetic
association
Clinical
features
Calcaneus position of the
foot,
Dorsiflexion contracture of
the ankle,
Calcaneo valgus foot,
Limited plantar flexion of
foot,
Small Calf.
Clinical
features
Shortining
due to
inhibition at
distal tibia
epiphysis
Clinical features
Recurvatum (Kyphosis) of
tibia
Xray finding
Normal looking medulla
Narrow, may be
obliterated
Cortical thickening on
concave surface, a
response to stress.
Clinical features
No increased risk of fracture
• With growth >> bowing decrease.
• By age of 3 >> 50% of angular
deformity is corrected
• [Link] deformity improves.
Treatment
Nonoperative
observation
indications
observation >> usually spontaneously corrects
over 5-7 years
follow clinically to monitor for leg length
discrepancy
associated calcaneovalgus foot treated with
observation and parental stretching
Case-1
One year 2.5 Y
5Years 9Years
Treament
Operative
age-appropriate epiphysiodesis of long
limb
indications
projected leg length discrepancy
> 50% of patients end up requiring surgical
intervention for LLD
2-Anteriolateral
Anterolateral
Bowing of the Tibia are
congenital conditions,
most commonly associated with
Neurofibromatosis Type 1, that present
with a bowing deformity of the tibial.
Anteriolateral
anterolateral bowing of congenital pseudarthrosis of tibia
tibia
Anteriolateral
clinical features
Symptoms
majority present with bowing in the first year of life
Physical exam
deformity careful skin examination for cafe-au-lait
spots and other signs of neurofibromatosis
X ray
finding
Bowing at middle-
Lower 1/3 junction.
Narrow medulla,
with normal bone
texture
X ray
finding
Tratment
Nonoperative
bracing in clamshell orthosis or patellar tendon
bearing (PTB) orthosis
indications >> children of ambulatory age (weight
bearing) >> without pseudarthrosis or fracture
goal >> prevent further bowing + fractures
osteotomy for bowing alone is #
technique maintained until skeletal maturity
Tratment
operative
surgical fixation
indications bowing with pseudarthrosis or fracture
amputation
indications
multiple failed surgical attempts at union
severe limb length discrepancy
dysfunctional angular deformity
Method- Syme or Boyd amputation
3-anteromedial
fibula hemimelia
Its is a congenital disorder >> partial or
complete absence of the fibula.
most common deficiency of long bones,
spectrum of anomalies from mild fibular
shortening with LLD to bilateral involvement
with associated defects of the femur, tibia,
ankle and [Link]
3-anteromedial
clinical features
Associated anomalies
Ankle instability
equinovalgus deformities
Tarsal coalition
Diaphyseal tibia angular
deformity apex anteromedial.
Hypoplasia of the lateral
femoral condyle or patella
Knee instability – ACL
insufficiency
3-anteromedial
Classification
Achterman and Kalamchi
Classification
3-anteromedial
treatment
• The goals of management are to achieve
a. normal weight bearing
b. normal gait
c. equal limb length
3-anteromedial
treatment
epiphysiodesis
epiphysiodesis limb amputati
lengthening on
3-anteromedial
treatment
3-anteromedial
treatment
Operative
contralateral epiphysiodesis alone
indications mild projected LLD (<5cm or <10%)
stable, plantigrade foot
limb lengthening procedure alone
indications plantigrade, functional foot with a stable
ankle LLD < 10% technique involves resection of
fibular anlage to avoid future foot problem
3-anteromedial
treatment
Operative
contralateral epiphysiodesis + limb
lengthening procedure
indications moderate LLD (10-30%)
Syme amputation (preferred to Boyd
amputation)
Boyd is more bulbous and only about 1cm longer
indications nonfunctional, deformed, unstable foot
LLD > 30% unable to cope psychologically with
multiple limb lengthening procedures cosmesis
3-anteromedial
treatment
Achterman and Kalamchi
Classification
