Q. What can cause painless swelling in a baby's tibia bone?

Answered by
Dr. Chirag Ashok Berry
and medically reviewed by iCliniq medical review team.
Published on Apr 06, 2016 and last reviewed on: Jan 10, 2020

Hi doctor,

My 8 month old baby boy has swelling in tibia bone. He does not have any pain or irritation over the swelling. He started standing by his 6 months onwards. What is the reason for this swelling?

Dr. Chirag Ashok Berry

Orthopedics And Traumatology Spine Health Spine Surgery
#

Hi,

Welcome to icliniq.com.

  • It looks like your child has a painless bump on the tibia or leg.
  • Can you describe where exactly you see this swelling or bump, either upper, mid or lower tibia? Has this been evaluated by a doctor with x-rays?
  • There can be numerous causes for such a swelling. My most common suspicion would be bow legs which may be normal in kids of that age.
  • Early standing is usually not correlated with any skeletal problems. But early walking has been correlated with Blount's disease (growth variant of tibia).
  • If the swelling or bump is in the lower half of tibia, it could be a congenital pseudoarthrosis, which is pretty rare.
  • Tumors, infection, etc., are other rare causes.
  • I would be able to give more accurate information if you could send me some pictures of your kid's legs. If x-rays have been done, you could attach those too.

Revert back with the photos to an orthopaedician and traumatologist online --> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist


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Hi doctor,

I have attached the x-rays here. He is walking with support now. We supplied him with a walker too.

Dr. Chirag Ashok Berry

Orthopedics And Traumatology Spine Health Spine Surgery
#

Hi,

Welcome back to icliniq.com.

Thank you for attaching the x-rays (attachment removed to protect patient identity) and for giving me an opportunity to assist you.

  • From the x-ray, it looks like he has a thickening of the anterior cortex (outer shell of bone). Few reason for this thickening are,
  1. Osteofibrous dysplasia (OFD).
  2. Adamantinoma.
  3. Simply anterolateral bowing of tibia as a precursor of pseudoarthrosis.
  • There may be other rarer possibilities too which only a biopsy may help rule out. Adamantinoma is the least likely one since it usually does not occur at such a young age.
  • Has he been diagnosed with any particular syndrome? Have you noticed any skin patches anywhere in the body?
  • The latter could be a sign of a condition called Neurofibromatosis (NF-1). There is an association of anterolateral bowing of tibia and pseudoarthrosis with NF-1.
  • While a biopsy of this lesion may give us a tissue diagnosis, I would not recommend starting with that for now. The reason being, for both OFD and anterolateral bowing, the initial treatment is observation (wait and watch).
  • If the swelling keeps on worsening, it may be prudent to do serial x-rays to see if the appearance changes.
  • Right now, there are no cystic changes (dark cavities within the thickening) on the x-rays. If these cysts appear in near future, it would indicate weakening of the bone, and possibility of a fracture.
  • If the bowing worsens, and the deformity becomes asymmetric from the other leg, he may need a brace to prevent a fracture and possible pseudoarthrosis. If no fracture occurs, he may not need any surgery till his adolescence. Even at that time, the surgery would be just to realign the deformed tibia if needed.
  • I know this is a lot of information and can be overwhelming. I would suggest reading about congenital pseudoarthrosis of tibia over the internet, if possible, to know more about this condition.
  • I would also strongly suggest seeing an orthopedic surgeon with expertise in pediatric orthopedic problems to evaluate this swelling.
  • You may be advised a biopsy or other imaging studies like CT or MRI to further evaluate this swelling. If it turns out to be OFD or anterolateral bowing, there is about 10-30% chances of fracture and pseudoarthrosis in future.
  • I do not think being an early stander or walker has caused this problem. However, there is a chance that the deformity may worsen in him because he is at an age where the normal (physiological) bowing at the knee can stress his tibia more than usual.

Investigations to be done:

Biopsy or CT or MRI at the discretion of an orthopedic surgeon.

Differential diagnosis:

1. Osteofibrous dysplasia (OFD).
2. Adamantinoma.
3. Anterolateral bowing of tibia as a precursor of pseudoarthrosis.

Probable diagnosis:

Anterolateral bowing of tibia.

Treatment plan:

1. Wait and watch
2. Maintain follow up with an orthopedic surgeon.

Regarding follow up:

For further information consult an orthopaedician and traumatologist online.---> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist


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