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Elewee A, Mayo W, Mirali B, Alaktaa ME, Hmaidy O. A case report of Gollop-Wolfgang complex in 12 years old boy. Int J Surg Case Rep 2023; 106:108223. [PMID: 37094418 PMCID: PMC10149289 DOI: 10.1016/j.ijscr.2023.108223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/07/2023] [Accepted: 04/08/2023] [Indexed: 04/26/2023] Open
Abstract
INTRODUCTION The Gollop-Wolfgang Complex (GWC) was initially described by Gollop et al. and is a rare congenital limb anomaly disorder characterized by the association of distal bifid femur and tibial agenesis. CASE PRESENTATION This study presents a case of a 12-year-old boy with Gollop-Wolfgang Complex (GWC), a rare congenital limb anomaly disorder characterized by the association of distal bifid femur and tibial agenesis. The patient did not have any VACTERL abnormalities and had a normal level of intelligence. Examination revealed coxa valga in both hips and upper limbs on both sides, a shortened left leg with a palpable bony protuberance and absence of the patella, and a shortened right leg with a palpable fibula lateral to the knee and absent tibia with severe knee varus deformity on both sides. Both feet revealed equinovarus deformity with ectrodactyly. The patient underwent through-knee amputation and was fitted with two prostheses to provide enhanced functional support. CLINICAL DISCUSSION The etiology of GWC is still unknown, but errors in the complex genetic control of limb development are believed to be related. CONCLUSION Treatment choice depends on the deformity type, with through-knee amputation recommended for cases with observed flexion contracture, bifid femur, and tibial hemimelia, followed by modern prosthesis fitting for optimal outcomes. This case illustrates the efficacy of this surgical management and highlights the need for ongoing follow-up care.
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Affiliation(s)
- Ahmad Elewee
- Department of Orthopedic Surgery, Damascus Hospital, Damascus, Syria
| | - Wafik Mayo
- Faculty of Medicine, Aleppo University, Aleppo, Syria.
| | - Bashar Mirali
- President of Department of Orthopedic Surgery, Damascus Hospital, Damascus, Syria
| | | | - Osama Hmaidy
- Department of Urologic Surgery, Faculty of Medicine, Damascus University, Damascus, Syria
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Tankam CS, Peterson MR, Tachie-Baffour Y, Zammar S, Rizk EB. Fatty filum terminale and low-lying conus medullaris in Gollop-Wolfgang complex: a case report and review of literature. Childs Nerv Syst 2023; 39:517-526. [PMID: 36155841 DOI: 10.1007/s00381-022-05679-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/15/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND/IMPORTANCE Gollop-Wolfgang complex is a rare skeletal dysplasia with only 200 cases reported in the literature. This disorder is usually associated with several extraosseous anomalies. This report describes the first case of a fatty filum terminale and a low-lying conus medullaris in a patient with this complex. A review of the current literature of the Gollop-Wolfgang complex accompanies this case, highlighting the documented extraosseous anomalies seen in this complex. CLINICAL PRESENTATION We report a case of an 18-month-old patient with Gollop-Wolfgang complex who underwent cord untethering with release of the filum terminale after extensive workup showed the presence of a dyssynergic bladder and radiological evaluation revealed a fatty filum terminale and low-lying conus medullaris. CONCLUSION Gollop-Wolfgang complex is a skeletal dysplasia usually associated with several extra skeletal anomalies. Our report describes the first case of a fatty filum terminale and low-lying conus medullaris in this complex, as well as provides an overview of the documented anomalies seen in this disorder. A multidisciplinary approach is recommended when treating these infants in order to ensure that occult manifestations of the complex are not missed.
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Affiliation(s)
- Cyril S Tankam
- Department of Neurosurgery, Penn State Children's Hospital, 30 Hope Drive, Suite 1200, Building B, Hershey, PA, 1733, USA.
| | - Mallory R Peterson
- Department of Neurosurgery, Penn State Children's Hospital, 30 Hope Drive, Suite 1200, Building B, Hershey, PA, 1733, USA
| | - Yaw Tachie-Baffour
- Department of Neurosurgery, Penn State Children's Hospital, 30 Hope Drive, Suite 1200, Building B, Hershey, PA, 1733, USA
| | - Samer Zammar
- Department of Neurosurgery, Penn State Children's Hospital, 30 Hope Drive, Suite 1200, Building B, Hershey, PA, 1733, USA
| | - Elias B Rizk
- Department of Neurosurgery, Penn State Children's Hospital, 30 Hope Drive, Suite 1200, Building B, Hershey, PA, 1733, USA
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Albright P, Veenstra J, Habeck J, Bovid K. Lower Extremity Surgical Treatment to Improve Function in a Patient with Gollop-Wolfgang Complex: A Case Report. JBJS Case Connect 2020; 9:e0254. [PMID: 31211748 DOI: 10.2106/jbjs.cc.18.00254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Gollop-Wolfgang Complex (GWC) includes congenital absence of the tibia with ipsilateral distal femur bifurcation associated with hand/foot ectrodactyly. A 20-month-old male presented with GWC, including left bifid distal femur with ipsilateral tibial hemimelia and absent extensor mechanism, hypoplastic bilateral thumbs, and right foot tarsal-type preaxial polydactyly. Left through-knee amputation preserving growth and contralateral polydactyly reconstruction were performed. Complications of wound infection and dehiscence were successfully treated. Patient is 44 months old and ambulating with left knee disarticulation prosthesis and right supramalleolar orthosis. CONCLUSIONS Through-knee amputation and prosthetic fitting provides limb function for GWC patients with tibial hemimelia lacking an extensor mechanism.
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Affiliation(s)
- Patrick Albright
- Department of Orthopaedic Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan
| | - Joshua Veenstra
- Department of Orthopaedic Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan
| | - Jason Habeck
- Watertown Regional Medical Center, Watertown, Wisconsin
| | - Karen Bovid
- Department of Orthopaedic Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan
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Ondari J, Kinyanjui J, Miano P, Sang E, Oburu E, Maru M. Femoral bifurcation and bilateral tibial hemimelia: case report. Pan Afr Med J 2018; 30:99. [PMID: 30344883 PMCID: PMC6191263 DOI: 10.11604/pamj.2018.30.99.11969] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 09/25/2017] [Indexed: 11/25/2022] Open
Abstract
Femoral bifurcation and tibial hemimelia are rare anomalies described as a variant of Gollop-Wolfgang complex. This article presents a case of Gollop-Wolfgang complex without hand ectrodactyly. A 5-year old patient presented with bilateral tibial hemimelia and left femoral bifurcation. The patient's left limb lacked knee extensor mechanism, disarticulation was done. The right leg which had Jones type 2 tibia hemimelia was treated with tibiofibular synostosis. Currently patient is ambulant with prosthesis on the left limb and ankle foot orthosis on the right. In the absence of proximal tibial anlage, especially in patients with femoral bifurcation, the knee should be disarticulated. Tibiofibular synostosis is a good choice in the presence of a proximal tibial anlage with good quadriceps function.
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Affiliation(s)
- Joshua Ondari
- Orthopaedic Surgeon, Nakuru County Hospital, Nakuru, Kenya
| | | | - Paul Miano
- Orthopaedic Surgeon, PCEA Kikuyu Rehabilitation and Orthopaedic Hospital, Kikuyu, Kenya
| | - Edward Sang
- Orthopaedic Surgeon, PCEA Kikuyu Rehabilitation and Orthopaedic Hospital, Kikuyu, Kenya
| | - Ezekiel Oburu
- Orthopaedic Surgeon and Lecturer, University of Nairobi, Nairobi, Kenya
| | - Michael Maru
- Orthopedic Surgeon and Clinical Services Manager, PCEA Kikuyu Rehabilitation and Orthopaedic Hospital, Kikuyu, Kenya
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Limb salvage treatment for Gollop-Wolfgang complex (femoral bifurcation, complete tibial hemimelia, and hand ectrodactyly). J Pediatr Orthop B 2013; 22:457-63. [PMID: 23660549 DOI: 10.1097/bpb.0b013e3283620640] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
We reported the findings from three patients with Gollop-Wolfgang complex and demonstrated the results of five limb salvage treatments for this condition. All three femoral bifurcations were accompanied by ipsilateral complete tibial hemimelia. Two patients showed contralateral complete or partial tibial hemimelia, and one patient had hand ectrodactyly. The five limb salvage treatments included resection of the anteromedial bifurcated femur in three limbs, foot centralization in five limbs, tibiofibular fusion in one limb with partial tibial hemimelia, fibular transfer (Brown's procedure) in three limbs with complete tibial hemimelia, and callus distraction lengthening in one limb. The duration from the first operation to the final follow-up ranged from 3.5 to 5.4 years. None of the three knees treated by fibular transfer achieved a successful functional result, but all of the knees were ultimately able to withstand weight bearing. Early knee disarticulation and resection of the protruded bifurcated femur, followed by fitting of a modern prosthesis is likely to be the best treatment for patients with Gollop-Wolfgang syndrome. We note that limb salvage treatment is an alternative in patients who opt to retain their feet and refuse amputation.
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Abstract
Infantile hypertrophic pyloric stenosis (IHPS) is a common condition in neonates that is characterized by an acquired narrowing of the pylorus. The aetiology of isolated IHPS is still largely unknown. Classic genetic studies have demonstrated an increased risk in families of affected infants. Several genetic studies in groups of individuals with isolated IHPS have identified chromosomal regions linked to the condition; however, these associations could usually not be confirmed in subsequent cohorts, suggesting considerable genetic heterogeneity. IHPS is associated with many clinical syndromes that have known causative mutations. Patients with syndromes associated with IHPS can be considered as having an extreme phenotype of IHPS and studying these patients will be instrumental in finding causes of isolated IHPS. Possible pathways in syndromic IHPS include: (neuro)muscular disorders; connective tissue disorders; metabolic disorders; intracellular signalling pathway disturbances; intercellular communication disturbances; ciliopathies; DNA-repair disturbances; transcription regulation disorders; MAPK-pathway disturbances; lymphatic abnormalities; and environmental factors. Future research should focus on linkage analysis and next-generation molecular techniques in well-defined families with multiple affected members. Studies will have an increased chance of success if detailed phenotyping is applied and if knowledge about the various possible causative pathways is used in evaluating results.
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Alessandri J, Isidor B, David A, Martin-Coignard D, Ghazouani J, Ramful D, Laville J, Le Caignec C. Tibial developmental field defect in valproic acid embryopathy: Report on three cases. Am J Med Genet A 2010; 152A:2805-9. [DOI: 10.1002/ajmg.a.33633] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mercadal Orfila G, Blasco Mascaró I. [Gollop-Wolfgang Complex in a baby born to an epileptic mother treated with valproic acid during pregnancy]. FARMACIA HOSPITALARIA 2010; 34:149-51. [PMID: 20471572 DOI: 10.1016/j.farma.2009.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 10/19/2009] [Accepted: 10/22/2009] [Indexed: 10/19/2022] Open
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Abstract
Femoral bifurcation and tibial agenesis are rare anomalies and have been described in both the Gollop-Wolfgang complex and tibial agenesis-ectrodactyly syndrome. This article presents a case of Gollop-Wolfgang complex without hand ectrodactyly. Tibial agenesis-ectrodactyly syndrome and Gollop-Wolfgang complex are variants of tibial field defect, which includes distal femoral duplication, tibial aplasia, oligo-ectrodactylous toe defects, and preaxial polydactyly, occasionally associated with hand ectrodactyly.This article describes the case of a patient with bilateral tibial hemimelia and left femoral bifurcation. The proximal tibial anlage had not been identified in the patient's left leg. After failed fibular transfer procedure, the knee was disarticulated. The other leg was treated with tibiofibular synostosis and centralization of fibula to os calcis. At 7-year follow-up, the patient ambulates with an above-knee prosthesis and uses an orthopedic boot for ankle stability.In patients with a congenital absence of the tibia, accurate diagnosis is of the utmost importance in planning future treatment. In the absence of proximal tibial anlage, especially in patients with femoral bifurcation, the knee should be disarticulated. Tibiofibular synostosis is a good choice in the presence of a proximal tibial anlage and good quadriceps function.
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Affiliation(s)
- Ali Akin Ugras
- Department of Orthopedics, Haseki Training and Research Hospital, Istanbul, Turkey.
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Forzano F, Viassolo V, Castagnetta M, Cavani S, Battistuzzi L, Garbati E, Emiliozzi MC, Cecchi A, Faravelli F, Lituania M. Prenatal diagnosis of Gollop-Wolfgang Complex. Prenat Diagn 2009; 29:724-6. [PMID: 19353531 DOI: 10.1002/pd.2269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mendilcioglu I, Mihci E, Pestereli E, Simsek M. Prenatal diagnosis of Gollop-Wolfgang complex (tibial agenesis and femoral bifurcation). Prenat Diagn 2009; 29:182-6. [PMID: 19180625 DOI: 10.1002/pd.2204] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Inanc Mendilcioglu
- Department of Obstetrics and Gynecology, School of Medicine, Akdeniz University, Antalya, Turkey.
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Van de Laar I, Dooijes D, Hoefsloot L, Simon M, Hoogeboom J, Devriendt K. Limb anomalies in patients with CHARGE syndrome: an expansion of the phenotype. Am J Med Genet A 2008; 143A:2712-5. [PMID: 17937444 DOI: 10.1002/ajmg.a.32008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
CHARGE syndrome is characterized by a wide clinical variability. During the past years the phenotypic spectrum was markedly expanded. Limb anomalies were initially not recognized as part of the phenotype but more recently mild limb anomalies were described in approximately 30% of the patients. We report on three patients with several major features of CHARGE syndrome who, in addition, presented severe limb anomalies including monodactyly, tibia aplasia, and bifid femora. Three different heterozygous truncating mutations in the CHD7 gene were detected. It has been hypothesized before that the CHARGE syndrome is caused by a disruption of mesenchymal-epithelial interaction. Given the expression of the CHD7 gene in the developing limb bud, it was anticipated that limb defects would belong to the spectrum of manifestations of CHARGE syndrome. The present observations provide further support to this hypothesis.
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Affiliation(s)
- Ingrid Van de Laar
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands.
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Lee ML, Chen M. Tibial agenesis-ectrodactyly syndrome associated with novel cardiovascular and bronchopulmonary malformations. Clin Dysmorphol 2007; 16:47-49. [PMID: 17159515 DOI: 10.1097/mcd.0b013e328010d03b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a 9-month-old female infant presenting, on the 15th day of life, left tibial agenesis with ectrodactyly, right talipes equinovarus, syndactyly of the second and the third toes of the right foot, an incomplete split right foot, left fibular hypoplasia, bronchial stenosis/hypoplasia, and coarctation of the aortic arch. To the best of our knowledge, coarctation of the aortic arch and bronchial stenosis/hypoplasia have never been reported in the tibial agenesis-ectrodactyly syndrome.
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Affiliation(s)
- Meng-Luen Lee
- Division of Pediatric Cardiology, Department of Pediatrics Center for Medical Genetics and Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua Departments of Medical Genetics Obstetrics and Gynecology, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
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