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Pediatrics
Diagnosis
Musculoskeletal
Congenital Anomalies
Tibial Bowing
Tibial Bowing
Arthur B. Meyers, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Diagnostic Checklist

        TERMINOLOGY

        • Definitions

          • Tibial bowing refers specifically to (typically unilateral) congenital or infantile tibial diaphyseal deformity characterized by direction of apex
            • Posteromedial: Typically physiologic & secondary to intrauterine positioning
            • Anteromedial: Associated with fibular hemimelia
            • Anterolateral: High association with neurofibromatosis type 1 (NF1)
          • Beyond these specific circumstances, lower limb bowing deformities have broader differential diagnostic considerations for underlying conditions that may have degrees of tibial bowing
            • Such deformities are not typically primary or centered at diaphysis

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • MR Findings

                • Ultrasonographic Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          CLINICAL ISSUES

                          • Presentation

                            • Natural History & Prognosis

                              DIAGNOSTIC CHECKLIST

                              • Image Interpretation Pearls

                                Selected References

                                1. Kesireddy N et al: Current treatment of congenital pseudarthrosis of the tibia: a systematic review and meta-analysis. J Pediatr Orthop B. 27(6):541-50, 2018
                                2. Bedoya MA et al: Common patterns of congenital lower extremity shortening: diagnosis, classification, and follow-up. Radiographics. 35(4):1191-207, 2015
                                3. Zbinden I et al: Tibial bowing in children - what is normal? A radiographic study. Eur Radiol. 25(12):3459-71, 2015
                                4. Oberc A et al: Fibular hemimelia - diagnostic management, principles, and results of treatment. J Pediatr Orthop B. 22(5):450-6, 2013
                                5. Kaufman SD et al: Limb lengthening in congenital posteromedial bow of the tibia. Strategies Trauma Limb Reconstr. 7(3):147-53, 2012
                                6. Shah HH et al: Congenital posteromedial bowing of the tibia: a retrospective analysis of growth abnormalities in the leg. J Pediatr Orthop B. 18(3):120-8, 2009
                                7. Stevenson DA et al: Analysis of radiographic characteristics of anterolateral bowing of the leg before fracture in neurofibromatosis type 1. J Pediatr Orthop. 29(4):385-92, 2009
                                8. Schindeler A et al: Recent insights into bone development, homeostasis, and repair in type 1 neurofibromatosis (NF1). Bone. 42(4):616-22, 2008
                                9. Stevenson DA et al: The use of anterolateral bowing of the lower leg in the diagnostic criteria for neurofibromatosis type 1. Genet Med. 9(7):409-12, 2007
                                10. Cheema JI et al: Radiographic characteristics of lower-extremity bowing in children. Radiographics. 23(4):871-80, 2003
                                Related Anatomy
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                                Related Differential Diagnoses
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Terminology

                                  • Imaging

                                    • Diagnostic Checklist

                                      TERMINOLOGY

                                      • Definitions

                                        • Tibial bowing refers specifically to (typically unilateral) congenital or infantile tibial diaphyseal deformity characterized by direction of apex
                                          • Posteromedial: Typically physiologic & secondary to intrauterine positioning
                                          • Anteromedial: Associated with fibular hemimelia
                                          • Anterolateral: High association with neurofibromatosis type 1 (NF1)
                                        • Beyond these specific circumstances, lower limb bowing deformities have broader differential diagnostic considerations for underlying conditions that may have degrees of tibial bowing
                                          • Such deformities are not typically primary or centered at diaphysis

                                      IMAGING

                                      • General Features

                                        • Radiographic Findings

                                          • CT Findings

                                            • MR Findings

                                              • Ultrasonographic Findings

                                                • Imaging Recommendations

                                                  DIFFERENTIAL DIAGNOSIS

                                                    PATHOLOGY

                                                    • General Features

                                                      • Gross Pathologic & Surgical Features

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Natural History & Prognosis

                                                            DIAGNOSTIC CHECKLIST

                                                            • Image Interpretation Pearls

                                                              Selected References

                                                              1. Kesireddy N et al: Current treatment of congenital pseudarthrosis of the tibia: a systematic review and meta-analysis. J Pediatr Orthop B. 27(6):541-50, 2018
                                                              2. Bedoya MA et al: Common patterns of congenital lower extremity shortening: diagnosis, classification, and follow-up. Radiographics. 35(4):1191-207, 2015
                                                              3. Zbinden I et al: Tibial bowing in children - what is normal? A radiographic study. Eur Radiol. 25(12):3459-71, 2015
                                                              4. Oberc A et al: Fibular hemimelia - diagnostic management, principles, and results of treatment. J Pediatr Orthop B. 22(5):450-6, 2013
                                                              5. Kaufman SD et al: Limb lengthening in congenital posteromedial bow of the tibia. Strategies Trauma Limb Reconstr. 7(3):147-53, 2012
                                                              6. Shah HH et al: Congenital posteromedial bowing of the tibia: a retrospective analysis of growth abnormalities in the leg. J Pediatr Orthop B. 18(3):120-8, 2009
                                                              7. Stevenson DA et al: Analysis of radiographic characteristics of anterolateral bowing of the leg before fracture in neurofibromatosis type 1. J Pediatr Orthop. 29(4):385-92, 2009
                                                              8. Schindeler A et al: Recent insights into bone development, homeostasis, and repair in type 1 neurofibromatosis (NF1). Bone. 42(4):616-22, 2008
                                                              9. Stevenson DA et al: The use of anterolateral bowing of the lower leg in the diagnostic criteria for neurofibromatosis type 1. Genet Med. 9(7):409-12, 2007
                                                              10. Cheema JI et al: Radiographic characteristics of lower-extremity bowing in children. Radiographics. 23(4):871-80, 2003