Blaunt's disease (the disease of Erlakhera-Blaunta-Biyezinya, Barber's syndrome deforming the osteochondrosis of a tibial bone deforming epifizit a tibial bone) – a disease at which the tibial bone is bent in the top part, owing to what varusny (Au-shaped) deformation of a tibial bone develops. Valgusny (H-shaped) deformation is in some cases observed. The reason of development of a disease – damage of an epifizarny cartilage in the field of condyles of a tibial bone. Usually the internal condyle suffers, external is more rare. The disease develops or in 2-3 years, or age 6 years are more senior. It is shown by visible deformation of the top third of a shin. The diagnosis is exposed on the basis of clinical and radiological signs. Treatment in most cases surgical.
Blaunt's disease – the deformation of the top third of a shin caused by damage of an epifizarny cartilage of a tibial bone. Opinions concerning prevalence of a disease differ. In most of the medical managements this pathology is carried to number seldom meeting, however some orthopedists believe that easy forms of a disease often are not diagnosed or considered as rakhitopodobny deformations. Girls suffer more often than boys.
Reasons and pathogenesis
The causes of a disease of Blaunt are not finalized. It is supposed that violation of development of an epifizarny cartilage is caused by a local osteochondropathy or a hondrodisplaziya. The disease can be combined with other congenital anomalies of development, the family nature of inheritance is not excluded. The excess body weight, the early beginning of walking and violation of endocrine balance are considered as the contributing factors. The starting moment is the overload of unprepared bone and muscular system in combination with a certain anatomic option of a structure of the lower extremity.
Varusny installation of a shin becomes the reason of an overload of an internal or external condyle of a tibial bone owing to what the epifizarny zone extends, mown, displaced inside and from top to bottom. Because of uneven distribution of loading not only bones, but also soft fabrics are exposed to elevated pressure that leads to emergence of neurodystrophic frustration. As a result function of an extremity is even more broken, pathological changes in an epifiza are aggravated. Process of ossification is broken, cartilaginous cages or turn into a bone tissue more slowly, than normal, or are transformed to the defective bone incapable to maintain usual loadings. The condyle grows at an angle, in the field of a metafiz there is a beak-shaped ledge, and the curvature is formed below. In the lower departments the shin remains almost direct, foot rotirutsya knutr.
Allocate two forms of a disease of Blaunt:
- Infantile. The first symptoms of a disease appear at the age of 2-3 years. Symmetric damage of both shins is characteristic.
- Teenage. Symptoms of a disease arise aged 6 years are more senior. Usually one shin is surprised.
Taking into account a type of deformation distinguish:
- Varusny curvature of shins (Au-shaped legs). Arises in most cases.
- Valgusny curvature of shins (X-shaped legs). Comes to light seldom.
Taking into account extent of deformation allocate four options of a disease of Blaunt:
- Potential. The corner of a curvature does not exceed 15 degrees, the regional sclerosis (usually from the inside, less often – with external) in the top part of a tibial bone comes to light.
- Moderately expressed. A corner of a curvature of 15-30 degrees, destruction and fragmentation of a proximal epifiz of a tibial bone are defined.
- Progressing. Extensive fragmentation and expansion of a proximal epifiz in a middle part comes to light.
- Quickly progressing. The Rostkovy zone in medial department is closed, there is a bone bridge between metafizy and epifizy.
Symptoms of a disease of Blaunt usually appear at the age of 2-3 years. The curvature of shins connected with the beginning of walking becomes the first manifestation. In the subsequent deformation of extremities gradually increases. The child quickly gets tired, there is lameness. The clumsy "duck" gait caused as directly by a curvature of shins, and looseness of ligaments of knee joint is characteristic. At bilateral defeat there is noticeable a disproportion in length of the top and lower extremities after a while – legs are rather shortened owing to a curvature therefore hands look unnaturally long. In some cases fingers of hands can reach knee joints.
Patients have growth below age norm because of relative shortening of the lower extremities. At external survey the shtykoobrazny curvature of shins in the top department in combination with a direct diaphysis comes to light. In the top departments of a tibial bone the beak-shaped ledge is found. The head of a low-tibial bone will stand. Shins of a rotirovana of a knutra, extent of rotation can fluctuate in wide limits (from 20 to 85 degrees). Also flat-footedness, an atrophy and decrease in a tone of muscles of a shin is defined.
The diagnosis is exposed on the basis of a characteristic clinical and radiological picture. On a X-ray analysis of knee joints the following changes come to light:
- The tibial bone is bent in the top part of a metafiz or practically on border of a metafiz and epifiz. The bone in the field of a curvature acts in the form of a beak.
- The articulate surface of a tibial bone has evenly concave form and is slanted at an angle. Height of internal department of an epifiz is 2-3 times less than norm. Often signs of the raised mineralization are defined, regional fragmentation is sometimes observed.
- The zone of growth is from the inside expanded, bone and switching plates have indistinct contours. At children of advanced age premature closing of rostkovy zones can come to light.
- The Kortikalny layer on the internal surface of a tibial bone is thickened.
- Because of twisting of a shin of a shadow of a low-tibial and tibial bone in a picture accumulate at each other.
Differential diagnostics usually is not required. For a detailed research of a condition of bone and cartilaginous tissue in the top departments of a tibial bone KT of a knee joint, for assessment of a condition of myagkotkanny structures – MRT of a knee joint can be appointed.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
All patients with suspicion of Blaunt's disease, even at the minimum curvature of a shin, have to be observed constantly at the children's orthopedist. At insignificant deformations (potential degree) appoint the massage and the LFK complex including corrective exercises and training in corrective poses. The child is directed to GBO-therapy, paraffin and mud applications. If necessary carry out stimulation of muscles with use of special medicines. To patients with flat-footedness recommend to wear orthopedic shoes and to carry out special exercises.
The moderated and expressed deviation of a tibial bone at Blaunt's disease can become the reason of development of the deforming arthrosis therefore at identification of similar deformations early prevention is carried out. At younger age landmark plaster bandages and special orthopedic products in combination with the all-strengthening therapy and UF-radiation are used. If deformation was not eliminated on reaching 5-6-year age, the child is sent to office of orthopedics for surgical elimination of deformation.
The most effective technique is imposing of the device of Ilizarov in combination with corrective high osteotomiy a tibial bone. In some cases in addition carry out a low osteotomiya of a low-tibial bone. Sometimes between bone fragments after an osteotomiya establish bone allotransplantata. At the expressed instability of a knee joint at the same time carry out plasticity of sheaves.
The forecast at Blaunt's disease depends on expressiveness of deformation, extent of defeat of a rostkovy plate, a timely initiation of treatment and terms of performing surgeries.