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Awowole IO, Ugowe OJ, Afeniforo BL, Ayodele SA, Abdur-rahim ZF. Proximal Focal Femoral Deficiency: Prenatal Diagnosis of a Rare Congenital Skeletal Anomaly. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793221144276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A rare case of proximal focal femoral deficiency (PFFD) is presented due to concerns for a short fetal femur. A 32-year-old patient (G3P2002) was reviewed at 37 weeks of gestation. Sonography revealed an appropriately maturing female fetus, with a left femoral diaphyseal length of 36.1 mm (<1st percentile), while the right measured 71.4 mm (35th percentile). The proximal epiphysis, head, and trochanter of the left fetal femur were absent on 3D sonography, with significant overlap of the femur on the pubic bone. At delivery, the baby weighed 3240 g, with a lower limb-length discrepancy of 56 mm. A radiograph confirmed left-sided hypoplastic proximal femur, absent femoral head, and a poorly formed acetabulum. The baby was conservatively managed, with plans for possible surgery and limb prosthesis. A high index of suspicion and capacity building to facilitate prenatal diagnosis are essential for optimal care of babies with PFFD.
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Affiliation(s)
- Ibraheem O. Awowole
- Department of Obstetrics, Gynaecology and Perinatology, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Obstetrics, Gynaecology and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Osagie Joseph Ugowe
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | | | - Zainab Foyeke Abdur-rahim
- Department of Obstetrics, Gynaecology and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
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Thomas MM, Tosson AM, Taher MB. Unilateral Isolated Proximal Femoral Focal Deficiency in an Egyptian Infant and Review of Literature. JOURNAL OF CHILD SCIENCE 2020. [DOI: 10.1055/s-0040-1716918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractProximal femoral focal deficiency (PFFD) is a rare congenital anomaly of the femur ranging from mild shortening to total agenesis. If left untreated, it could lead to impaired child growth, abnormal gait, vertebral abnormalities, cosmetic problems, and behavioral changes. We report on an Egyptian female, presenting to us at the age of 15 days with a short left lower limb. Both upper limbs and the right lower limb were normal and she was not dysmorphic. The skeletal survey showed an isolated short left femur. At the age of 11 months, clinical reexamination confirmed left femur shortening. Echocardiogram and abdominal sonography revealed no abnormality. Magnetic resonance imaging (MRI) of the pelvis and lower limbs revealed isolated left proximal femoral focal deficiency. Her developmental milestones were normal. She was referred to pediatric orthopaedics for early intervention and proper management. To our knowledge and after reviewing the literature, this patient represents the first case of unilateral isolated proximal focal femoral deficiency in Egypt. In conclusion, PFFD diagnosis needs a systemic skeletal–facial–genital phenotyping to differentiate from overlapping genetic disorders. Early diagnosis and radioimaging are highly important for proper management.
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Affiliation(s)
- Manal M. Thomas
- Human Genetics and Genome Research Division, Clinical Genetics Department, National Research Centre, Egypt
| | - Angie M.S. Tosson
- Department of Pediatrics, Faculty of Medicine, Cairo University, Egypt
| | - Mohamed B. Taher
- Human Genetics and Genome Research Division, Clinical Genetics Department, National Research Centre, Egypt
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Gupta A, Sehgal RR, Fazal TS, Jagtiani N, Saini P. Antenatal Diagnosis of Bilateral Proximal Femoral Focal Deficiency (PFFD). JOURNAL OF FETAL MEDICINE 2019. [DOI: 10.1007/s40556-019-00213-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gerscovich EO, Sekhon S, Loehfelm TW, Greenspan A. Fetal ultrasound: Early diagnosis and natural evolution of proximal femoral focal deficiency. J Ultrason 2018; 17:294-298. [PMID: 29375906 PMCID: PMC5769671 DOI: 10.15557/jou.2017.0043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/28/2017] [Accepted: 12/01/2017] [Indexed: 11/22/2022] Open
Abstract
Proximal femoral focal deficiency is an extremely rare congenital anomaly with only a few case reports in the literature. This case illustrates one diagnosed by prenatal ultrasound. The diagnosis may be isolated or associated with other abnormalities and syndromes. This report describes the early obstetrical ultrasound diagnosis, its evolution and associated findings throughout pregnancy. To the best of our knowledge, it is the first report associating this diagnosis with sickle cell trait. Another finding in our patient was a concomitant intrauterine growth restriction that we attribute to placental infarctions and a retro placental hemorrhage, also on the basis of sickle cell trait. At birth, placental weight was under the 10th percentile for gestational age. Obstetrical ultrasound in the prenatal diagnosis of proximal femoral focal deficiency is important, because early recognition of this malformation could provide useful information to parents and physicians regarding newborn management and therapeutic planning.
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Affiliation(s)
| | - Simran Sekhon
- Department of Radiology, UC Davis Health, Sacramento, California, USA
| | - Thomas W Loehfelm
- Department of Radiology, UC Davis Health, Sacramento, California, USA
| | - Adam Greenspan
- Department of Radiology, UC Davis Health, Sacramento, California, USA
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Zhang Z, Yi D, Xie R, Hamilton JL, Kang QL, Chen D. Postaxial limb hypoplasia (PALH): the classification, clinical features, and related developmental biology. Ann N Y Acad Sci 2017; 1409:67-78. [PMID: 28990185 PMCID: PMC5730483 DOI: 10.1111/nyas.13440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 06/18/2017] [Accepted: 06/28/2017] [Indexed: 12/29/2022]
Abstract
Postaxial limb hypoplasia (PALH) is a group of nonhereditary diseases with congenital lower limb deficiency affecting the fibular ray, including fibular hemimelia, proximal femoral focal deficiency, and tarsal coalition. The etiology and the developmental biology of the anomaly are still not fully understood. Here, we review the previous classification systems, present the clinical features, and discuss the developmental biology of PALH.
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Affiliation(s)
- Zeng Zhang
- Department of Orthopedic Surgery, Shanghai Jiao-Tong University Affiliated the Sixth People’s Hospital, Shanghai, China
| | - Dan Yi
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Rong Xie
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - John L. Hamilton
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Qing-Lin Kang
- Department of Orthopedic Surgery, Shanghai Jiao-Tong University Affiliated the Sixth People’s Hospital, Shanghai, China
| | - Di Chen
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
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D'Ambrosio V, Pasquali G, Squarcella A, Marcoccia E, De Filippis A, Gatto S, Camilla A, Pizzuti A, La Torre R, Giancotti A. Prenatal diagnosis of proximal focal femoral deficiency: Literature review of prenatal sonographic findings. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:252-259. [PMID: 26408260 DOI: 10.1002/jcu.22306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 08/16/2015] [Indexed: 06/05/2023]
Abstract
Proximal focal femoral deficiency (PFFD) is a rare musculoskeletal malformation that occurs in 0.11-0.2 per 10,000 live births. This congenital anomaly involves the pelvis and proximal femur with widely variable manifestations, from mild femoral shortening and hypoplasia to the absence of any functional femur and acetabular aplasia. Prenatal diagnosis of PFFD is still a challenge, but early recognition of this malformation could provide useful information to both parents and physicians concerning management and therapeutic planning. For this review, we analyzed all the cases of prenatally diagnosed PFFD that were reported in the literature from 1990 to 2014 and provide a description of the most common prenatal sonographic findings.
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Affiliation(s)
- Valentina D'Ambrosio
- Department of Experimental Medicine, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Gaia Pasquali
- Department of Obstetrics, Gynecology and Urologic Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Antonia Squarcella
- Department of Obstetrics, Gynecology and Urologic Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Eleonora Marcoccia
- Department of Obstetrics, Gynecology and Urologic Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Angela De Filippis
- Department of Obstetrics, Gynecology and Urologic Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Silvia Gatto
- Department of Obstetrics, Gynecology and Urologic Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Aliberti Camilla
- Department of Obstetrics, Gynecology and Urologic Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Antonio Pizzuti
- Department of Experimental Medicine, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Renato La Torre
- Department of Obstetrics, Gynecology and Urologic Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Antonella Giancotti
- Department of Obstetrics, Gynecology and Urologic Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
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Abstract
Abnormalities that affect the developing human limb range from subtle differences that are of no functional or cosmetic consequence, to complete absence of all limbs. Advances in non-invasive imaging have improved antenatal detection of these conditions and has broadened the options available to prospective parents. This paper considers congenital femoral deficiency and includes an overview of limb bud development and the mechanisms involved in normal growth. The use of ultrasound in antenatal screening and the clinical and radiological features in childhood will be discussed in addition to management including surgical reconstruction and prosthetic use. This should be one component of a multidisciplinary approach to provide the parents of an affected child with balanced information on functional prognosis, management choices and implications for future pregnancies.
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Unilateral isolated proximal femoral focal deficiency. Case Rep Obstet Gynecol 2013; 2013:637904. [PMID: 23984135 PMCID: PMC3745897 DOI: 10.1155/2013/637904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 07/07/2013] [Indexed: 11/17/2022] Open
Abstract
Objective. To discuss a patient with a prenatal diagnosis of unilateral isolated femoral focal deficiency. Case. Antenatal diagnosis of unilateral isolated femoral focal deficiency was made at 20 weeks of gestation. The length of left femur was shorter than the right, and fetal femur length was below the fifth percentile. Proximal femoral focal deficiency was diagnosed. After delivery, the diagnosis was confirmed with skeletal radiographs and magnetic resonance imaging. In prenatal ultrasonographic examination, the early recognition and exclusion of skeletal dysplasias is important; moreover, treatment plans should be initiated, and valuable information should be provided to the family.
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Lin TH, Chung CH, Shih JC, Lin CH, Lee CN, Su YN. Prenatal diagnosis of proximal femoral focal deficiency: A case report and literature review. Taiwan J Obstet Gynecol 2013; 52:267-9. [PMID: 23915863 DOI: 10.1016/j.tjog.2013.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2012] [Indexed: 10/26/2022] Open
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