Effectiveness of brace treatment in early infantile Blount's disease.

In an effort to determine whether bracing is effective in reversing early infantile Blount's disease, 27 patients with Langenskiold stage II disease were studied. Ten patients had bilateral disease (two of these patients had stage III disease affecting one side). Age at brace initiation averaged 2.1 years (range, 1.5-3.2). The duration of bracing averaged 9.7 months. Follow-up averaged 5.9 years. Successful outcomes (improved alignment without the need for osteotomy) were achieved in 19 (70%) patients, the majority of them having unilateral disease. Of the 37 affected extremities, 24 (65%) had successful outcomes. Eight patients (13 extremities) required tibial osteotomies and were classified as bracing failures. Of the 10 patients with bilateral involvement, seven (70%) required osteotomies for one or both extremities, whereas only one (6%) of 17 patients with unilateral involvement required osteotomy. Bracing appears to be effective in stage II infantile Blount's disease, particularly in those with unilateral involvement. Children with bilateral disease are most at risk for requiring subsequent corrective osteotomy.