Blount's disease

INTRODUCTION

Blount’s disease or infantile tibia vara is a developmental disorder of growth that affects the medial aspect of the proximal tibial physis. Children with infantile tibia vara have no apparent abnormality at birth; they are generally healthy, and early growth of the legs is within normal limits. Infantile tibia vara is found frequently in black populations with preponderance among female obese children who start walking at an early age. Almost all cases of Blount’s disease associated with obesity appear to be of infantile onset. The increased stress on the young bone, resulting from excessive adiposity, may act on an underlying physiological varus deformity to produce changes characteristic of Blount’s disease. The mechanism by which Blount’s disease occurs is still largely unresolved. Mechanical effects alone may not fully explain the manifestation of this condition. An in-depth biochemical exploration may be contributory.

A common bone disorder, which shows clinical presentations similar to Blount’s disease in our environment, is burnt-out rickets, which is basically a vitamin-D-deficiency disease characterized by overproduction and deficient calcification of osteoid tissue, with associated skeletal deformities. Although the prevalence of Blount’s disease in most countries in Africa is not readily available, an epidemiological survey of bone and joint disorders in a rural African Negro population in the Western Travaal of South Africa documented the incidence of Blount’s disease to three per 1,000 children. In Nigeria, the rate of referral of infants with Blount’s disease to tertiary healthcare centers is relatively low because of the perceived healthy look of the children and the belief that the disorder will be corrected as the child grows older. All these factors probably explain the unavailability of accurate information on the prevalence rate of Blount’s disease in our community.
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Bathf ield and Beighton reported that the results of routine laboratory investigations in patients suffering from Blount’s disease were usually within normal limits. In particular, the serum calcium canadian, phosphorus, hemoglobin concentrations, the white blood cell counts, and erythrocyte sedimentation rates, as well as alkaline phosphatase activity were not significantly altered compared with corresponding control values.

Although the importance and phosphate metabolism in bone disorders is well recognized, antioxidant micronutrients—such as zinc, copper, and manganese—also play important roles in normal bone homeostasis, bone health and bone metabolism. The deficiency of these micronutrients may contribute to bone disorders. There has been no previous study in the English literature on these antioxidant micronutrients in Blount’s disease (in addition to the traditional bone profile evaluation) in Nigeria.

The present study was therefore designed to evaluate the biochemical profiles in patients suffering from Blount’s disease in our community where the diets are mainly carbohydrate-based and low in protein as well as micronutrients. An attempt to ascertain any possible role of antioxidant micronutrients in the etiology of Blount’s disease in Nigeria was explored using standardized biochemical assessments.