Skip to main content
SpringerLink
Log in

Tibial bowing in children - what is normal? a radiographic study

  • Pediatric
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

To define osseous landmarks on tibia radiographs in order to establish age-related normal values characterizing physiological tibial bowing in children.

Materials and methods

Five hundred and twenty-six patients aged 0-17 years with normal radiographs of the lower legs were identified and retrospectively reviewed by two blinded radiologists. In anteroposterior (ap)/lateral (lat)-views, 3 lines defined tibial length and angulation. Line-A connecting proximal to distal corner of tibial metaphysic, lines B and C corresponding to corners of tibial metaphysis. Angle A/B defines proximal, A/C distal tibial-angulation. Tibial curvature is defined by distance of line-D parallel to A and tangential to tibial cortex. Normal values were calculated with linear-regression. Intra-/Interreader agreement were tested with a Bland-Altman-plot.

Results

Intrareader-agreement: Reader 1 showed a bias of -0.1, standard-deviation of bias was 1.9 and 95 %-limits-of-agreement -3.9- 3.7. Reader 2: -0.01, 2.4 and -4.7- 4.7. Interreader: 0.2, 1.6 and -2.9- 3.3. Angle-A/B ap was 80-100°, increasing with age (86.5-88); angle-AC ap was 82-107°(96.8-90.5), angle-AB lat was 81-107°(93.0-98.0); angle-AC lat was 76-102 (89.5-86.5); depth of curve ap was 0-11 % (8-3.5) and lat 2-13 %, (8.5-3.5).

Conclusion

Age dependent tibial bowing can be assessed with this new measurement system and age-related normal-values characterizing physiological tibial bowing in children is established.

Key Points

• Tibial Bowing is diagnosed on conventional radiographs.

• Existing Methods provide limited level of confidence.

• New methods provide easy to assess landmarks in all patient ages.

• Existing methods require higher radiation dose compared to new method presented.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12

Similar content being viewed by others

References

  1. Lovell WW, Winter RB, Morrissy RT, Weinstein SLV (eds) (1996) Lovell and Winter’s pediatric orthopaedics, 4th edn. Lippincott-Raven, Philadelphia, PA, pp 1047–1075

    Google Scholar 

  2. Caffey J (1947) Prenatal bowing and thickening of tubular bones, with multiple cutaneous dimples in arms and legs; a congenital syndrome of mechanical origin. Am J Dis Child 74(5):543–562, 1911

    Article  CAS  PubMed  Google Scholar 

  3. Hofmann A, Wenger DR (1981) Posteromedial bowing of the tibia. Progression of discrepancy in leg lengths. J Bone Joint Surg Am 63(3):384–388

    CAS  PubMed  Google Scholar 

  4. Hefti F, Bollini G, Dungl P, Fixsen J, Grill F, Ippolito E et al (2000) Congenital pseudarthrosis of the tibia: history, etiology, classification, and epidemiologic data. J Pediatr Orthop B 9(1):11–15

    Article  CAS  PubMed  Google Scholar 

  5. Lovell WW, Winter RB, Morrissy RT, Weinstein SLV (eds) (1996) Lovell and Winter’s pediatric orthopaedics, 4th edn. Lippincott-Raven, Philadelphia, PA, pp 305–344

    Google Scholar 

  6. Ablin DS (1998) Osteogenesis imperfecta: a review. Can Assoc Radiol J J Assoc Can Radiol 49(2):110–123

    CAS  Google Scholar 

  7. Lovell WW, Winter RB, Morrissy RT, Weinstein SLV (eds) (1996) Lovell and Winter’s pediatric orthopaedics, 4th edn. Lippincott-Raven, Philadelphia, PA, pp 137–201

    Google Scholar 

  8. Schmickel RD, Heidelberger KP, Poznanski AK (1973) The campomelique syndrome. J Pediatr 82(2):299–302

    Article  CAS  PubMed  Google Scholar 

  9. Jackson DW, Cozen L (1971) Genu valgum as a complication of proximal tibial metaphyseal fractures in children. J Bone Joint Surg Am 53(8):1571–1578

    CAS  PubMed  Google Scholar 

  10. Raney EM, Topoleski TA, Yaghoubian R, Guidera KJ, Marshall JG (1998) Orthotic treatment of infantile tibia vara. J Pediatr Orthop 18(5):670–674

    Article  CAS  PubMed  Google Scholar 

  11. Zionts LE, Shean CJ (1998) Brace treatment of early infantile tibia vara. J Pediatr Orthop 18(1):102–109

    CAS  PubMed  Google Scholar 

  12. McCarthy JJ, MacIntyre NR 3rd, Hooks B, Davidson RS (2009) Double osteotomy for the treatment of severe Blount disease. J Pediatr Orthop 29(2):115–119

    Article  PubMed  Google Scholar 

  13. Masrouha KZ, Sraj S, Lakkis S, Saghieh S (2011) High tibial osteotomy in young adults with constitutional tibia vara. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 19(1):89–93

    Article  Google Scholar 

  14. Putzeys P, Wilmes P, Merle M (2013) Triple tibial osteotomy for the correction of severe bilateral varus deformity in a patient with late-onset Blount’s disease. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 21(3):731–735

    Article  CAS  Google Scholar 

  15. Clarke SE, McCarthy JJ, Davidson RS (2009) Treatment of Blount disease: a comparison between the multiaxial correction system and other external fixators. J Pediatr Orthop 29(2):103–109

    Article  PubMed  Google Scholar 

  16. Bito H, Takeuchi R, Kumagai K, Aratake M, Saito I, Hayashi R et al (2009) A predictive factor for acquiring an ideal lower limb realignment after opening-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 17(4):382–389

    Article  Google Scholar 

  17. Saragaglia D, Nemer C, Colle P-E (2008) Computer-assisted double level osteotomy for severe genu varum. Sports Med Arthrosc Rev 16(2):91–96

    Article  Google Scholar 

  18. Kodkani PS (2007) Dome osteotomy of the proximal tibia for genu varum treated with a new fixation device. J Knee Surg 20(2):111–119

    PubMed  Google Scholar 

  19. Paley D, Tetsworth K (1992) Mechanical axis deviation of the lower limbs. Preoperative planning of multiapical frontal plane angular and bowing deformities of the femur and tibia. Clin Orthop 280:65–71

    PubMed  Google Scholar 

  20. Paley D, Tetsworth K (1992) Mechanical axis deviation of the lower limbs. Preoperative planning of uniapical angular deformities of the tibia or femur. Clin Orthop 280:48–64

    PubMed  Google Scholar 

  21. Levine AM, Drennan JC (1982) Physiological bowing and tibia vara. The metaphyseal-diaphyseal angle in the measurement of bowleg deformities. J Bone Joint Surg Am 64(8):1158–1163

    CAS  PubMed  Google Scholar 

  22. Paley D (2002) Principles of deformity correction. Springer, Berlin; New York, 806 p

    Book  Google Scholar 

  23. Cheema JI, Grissom LE, Harcke HT (2003) Radiographic Characteristics of Lower-Extremity Bowing in Children1. RadioGraphics 23(4):871–880

    Article  PubMed  Google Scholar 

  24. Salenius P, Vankka E (1975) The development of the tibiofemoral angle in children. J Bone Joint Surg Am 57(2):259–261

    CAS  PubMed  Google Scholar 

  25. Takatsu T, Itokazu M, Shimizu K, Brown TD (1998) The function of posterior tilt of the tibial component following posterior cruciate ligament-retaining total knee arthroplasty. Bull Hosp Jt Dis N Y N 57(4):195–201

    CAS  Google Scholar 

  26. Magerkurth O, Knupp M, Ledermann H, Hintermann B (2006) Evaluation of hindfoot dimensions: a radiological study. Foot Ankle Int Am Orthop Foot Ankle Soc Swiss Foot Ankle Soc 27(8):612–616

    Google Scholar 

Download references

Acknowledgments

The scientific guarantor of this publication is Olaf Magerkurth. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding by Pro UKBB Foundation. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, cross sectional study, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Radiology, University of Basel, Petersgraben 4, Basel, 4031, Switzerland

    Isabella Zbinden

  2. Department of Orthopedic Surgery, University Children’s Hospital, Spitalstrasse 33, Basel, 4056, Switzerland

    Erich Rutz

  3. Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5326, USA

    Jon A. Jacobson

  4. Department of Radiology, University Children’s Hospital, Spitalstrasse 33, Basel, 4056, Switzerland

    Olaf Magerkurth

  5. Department of Radiology, Kantonsspital Baden, Im Ergel 1, 5404, Baden, Switzerland

    Olaf Magerkurth

Authors
  1. Isabella Zbinden
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Erich Rutz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jon A. Jacobson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Olaf Magerkurth
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Olaf Magerkurth.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zbinden, I., Rutz, E., Jacobson, J.A. et al. Tibial bowing in children - what is normal? a radiographic study. Eur Radiol 25, 3459–3471 (2015). https://doi.org/10.1007/s00330-015-3785-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-015-3785-1

Keywords

Search

Navigation