Diaphysis (Long Bones): Bowing


Diaphysis (Long Bones): Bowing

Bowing may be congenital or acquired. The direction of bowing of the tibia may suggest the etiology. Anterolateral bowing of the tibia is associated with neurofibromatosis, tibial fractures, and congenital pseudarthrosis of the tibia. Posteromedial tibial bowing is an isolated finding not associated with other conditions.

Table 5.57 Diaphysis: bowing




Physiologic bowling of toddlers

Femur and tibia are mildly bowed.

Predilection for the first 2 y of life. Corrected within 6 mo of walking. Reaches adult pattern of mild valgus by 6–7 y.

Plastic/bowing fracture

Bowing of radius or ulna are the most common sites.

If the radius is fractured, the accompanying bone (ulna) may be fractured (and vice versa).


Fig. 5.90

(see Table 5.42 )

Widening of the medial aspect of the growth plate in older children with an ossified distal femoral epiphysis. The weight-bearing part is always the widest.

Recurrent fracture with malposition

Bowing of fragile bones after repeated fractures.

Occurs in all bone disorders with increased bone fragility (e.g., osteogenesis imperfecta and other intrinsic sclerotic bone dysplasias).

Fibrous dysplasia

Fig. 5.91a, b, p. 558

Expansile and lucent lesion with a ground-glass matrix.

Typically restricted to the polyostotic variety. Medial bowing of the proximal femur (Shepherd crook deformity).

Intrauterine malposition/congenital bowing of the tibia

Unilateral bowing, mostly involving the tibial diaphysis. Lateral and posterior bowing. Fibula is also bowed.

Believed to result from an abnormal intrauterine position. Usually heals in the neonatal period.


Fig. 5.92a, b, p. 558

Anterolateral bowing.

Ten percent of patients with neurofibromatosis will have pseudarthrosis of the tibia.

Tibia vara (Blount disease)

Fig. 5.43, p. 524

Varus angulation of the proximal tibia.

Changes in the posteromedial proximal tibial epiphysis that lead to growth suppression. Any varus angulation at the knee in children > 2 y is considered abnormal.

Pseudarthrosis of the tibia

Anterolateral bowing.

Almost always unilateral. Associated with neurofibromatosis (40%–50% of pseudarthroses of the tibia).

Other syndromes and dysplasias

Fig. 5.93, p. 559

Fig. 5.94, p. 559

Fig. 5.95a, b, p. 559

Osteogenesis imperfecta, achondroplasia, and camp-omelic dysplasia, for example.

Fig. 5.90 Rickets. Hypophosphatemic rickets and bowing of both femurs.
Fig. 5.91a, b Fibrous dysplasia with ground-glass matrix producing anterolateral bowing of the tibia.
Fig. 5.92a, b Neurofibromatosis with anterolateral bowing of the tibia.
Fig. 5.93 Unknown congenital syndrome with congenitally bowed femurs and dislocated hips.
Fig. 5.94 Osteogenesis imperfecta with a bowed left femur and a contralateral fracture.
Fig. 5.95a, b Osteogenesis imperfecta. Anteromedial bowing of the tibia in a 4-year-old with osteogenesis imperfecta.

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Jul 12, 2020 | Posted by in PEDIATRIC IMAGING | Comments Off on Diaphysis (Long Bones): Bowing

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