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Vashisht S, Aggarwal P, Bhagat R, Garg A, Gupta PN, Garg SK. Dysplasia Epiphysealis Hemimelica (Trevor Disease) of the Patella: A Case Report. JBJS Case Connect 2021; 10:e2000003. [PMID: 32865949 DOI: 10.2106/jbjs.cc.20.00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report a rare case of dysplasia epiphysealis hemimelica in an 11-year-old male child involving the patella. The patient noticed swelling in the right knee 6 months before presentation. On evaluation, there was a mass lesion originating from superior pole of the patella extending into the suprapatellar pouch. On opening the knee joint, it was found to be mainly cartilaginous in nature. Surgical excision of the mass was carried out. CONCLUSION Trevor disease should be considered in the differential diagnosis of a mass originating from the patella in children. The recommended treatment is complete excision of the mass.
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Affiliation(s)
- Saurabh Vashisht
- 1Department of Orthopaedics, Government Medical College & Hospital, Chandigarh, India 2Department of Radiodiagnosis & Imaging, Government Medical College & Hospital, Chandigarh, India 3Department of Pathology, Government Medical College & Hospital, Chandigarh, India
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Shahcheraghi GH, Javid M. Dysplasia Epiphysealis Hemimelica Can Be Controlled by Growth Modulation: A Case Report. JBJS Case Connect 2020; 10:e0353. [PMID: 32224672 DOI: 10.2106/jbjs.cc.19.00353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CASE Dysplasia epiphysealis hemimelica (DEH), or Trevor disease, is an abnormal nonmalignant overgrowth of the epiphysis on one side of the body, often confined to one half of a joint of a limb. There is no known etiology or treatment for it. We are reporting the case of a 4.5-year-old boy with osteochondral-like growths on one side of the knee and ankle that could not be controlled by repeated excision. He underwent epiphyseal stapling at the knee and ankle. The regrowth was halted in both locations and has lasted for over 8 years. CONCLUSION Modulation of physeal growth by stapling can halt the uncontrollable overgrowth of lesions in DEH.
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Affiliation(s)
- Gholam Hossain Shahcheraghi
- Department of Orthopaedic Surgery, Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahzad Javid
- Department of Orthopaedic Surgery, Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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More Than Epiphyseal Osteochondromas: Updated Understanding of Imaging Findings in Dysplasia Epiphysealis Hemimelica (Trevor Disease). AJR Am J Roentgenol 2018; 211:910-919. [DOI: 10.2214/ajr.18.19712] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Abstract
Trevor's disease, also known as dysplasia epiphysealis hemimelica, is a rare nonhereditary skeletal development disorder that affects epiphyses. This type of dysplastic lesion was first reported by Mouchet and Berlot in 1926 under the name 'tarsomegaly'. The main aim of this study is to raise awareness of Trevor's disease among orthopedic surgeons and underline some important aspects of treatment by a detailed presentation of four different possible manifestations of the disease. Four different treatment methods were used on four different patients (three localized in hindfoot ankle region and one classic Trevor's disease case). Treatment methods, localization of the sides involved, different characteristics of entire lower extremity, asymetry, distal femoral lateral epiphysis involvement, and hip involvement were analyzed thoroughly and the results were compared with those found in the most recent literature. Of our four patients, three were localized (hind foot ankle) cases and one was a classic dysplasia epiphysealis hemimelica with hemimelic distribution of the entire lower extremity. We used arthroscopic resection, observation, excision, and temporary hemiepiphysiodesis treatment methods in each of our cases. Clinical follow-up results were reported to be between good and excellent. In sum, our opinion is that the treatment for this condition should be customized according to lesion localization and lesion size. Majority of cases with ankle involvement show good prognosis following excision. Observation is also an alternative in patients who refuse surgery. If an intra-articular lesion is present, the surgeon should perform an arthroscopy for assessment of lesion surface. If the lesion is adapted to the joint curvature, it should be left alone and hemiepiphysiodesis should be considered for correction. The most risky involvements that are related to deformities and limb-length discrepancies are the hip and the knee. This is usually the result of corrective osteotomy targeted at the supracondylar femoral area in immature skeletons. Hemiepiphysiodesis might be a more feasible option in those cases as it provides the surgeon with the choice to remove the staples when necessary.
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Abstract
Masses in the pediatric foot are relatively uncommon and can present a diagnostic challenge. The literature lacks a comprehensive overview of these types of lesions. Most are benign soft-tissue lesions that can be diagnosed on the basis of history and physical examination. However, some rare malignant neoplasms can mimic benign masses. It is imperative to recognize these lesions because the consequences of a delayed or missed diagnosis can be substantial. A thorough history and physical examination of all pediatric patients with foot lesions are crucial to ensure that any lesion not readily identified as benign is appropriately managed.
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Clarke DO. Trevor's Disease: Management Difficulties and Proposed Classification. Orthopedics 2016; 39:e967-9. [PMID: 27248334 DOI: 10.3928/01477447-20160526-03] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 11/18/2015] [Indexed: 02/03/2023]
Abstract
Dysplasia epiphysealis hemimelica, also known as Trevor's disease, is a rare developmental disorder with osteocartilagenous overgrowth of the epiphysis or epiphyseal equivalent. The condition bears similarities to osteochondroma in terms of its radiographic appearance, but differs in its pathobiology and geographic occurrence. Unlike the metaphyseal occurrence of osteochondromata, it arises from the epiphysis. The clinical presentation is wide and varied, but mechanical symptoms and deformities predominate. Early reports of the condition suggested involvement of the lower limbs only. However, since then, numerous reports have indicated a more generalized distribution. Difficulties in management and recurrence rates seem to hinge on whether its origin is intra-articular or extra-articular. A new classification system to include these parameters is discussed. [Orthopedics.2016; 39(5):e967-e969.].
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Dysplasia epiphysealis hemimelica of the knee: an unusual presentation with intra-articular loose bodies and literature review. J Pediatr Orthop B 2015; 24:326-9. [PMID: 25647567 DOI: 10.1097/bpb.0000000000000150] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Dysplasia epiphysealis hemimelica (DEH) is a rare disease characterized by the formation of osteochondromas asymmetrically at the epiphysis of extremities, typically involving the ankle and the knee. It progresses during childhood and presents with limited range of motion, swelling, and angular deformities. A 9-year-old boy with a 7-year history of DEH and previous removal of ankle osteochondromas presented with acute knee pain, swelling, and limited range of motion. A clinical, radiographic, and literature review of this case was conducted to better describe this occurrence. On the basis of clinical and radiographic analyses, loose bodies were found to be originating from intra-articular osteochondromas. Because of the patient's symptoms, an exploratory arthroscopy was performed to further assess the formations, and the loose bodies were removed. After the procedure, the patient's function and symptoms improved. To the best of our knowledge, this is the first report of a case that identifies a complication of DEH to be loose bodies with a clear etiology and acute progression of symptoms. The possibility of loose bodies should be considered when examining a patient diagnosed with DEH with acute progression of symptoms. Level of evidence level IV, case report.
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Comment on the article 'Dysplasia epiphysealis hemimelica of the knee: an unusual presentation with intra-articular loose bodies and literature review' by Wheeldon and Altiok. J Pediatr Orthop B 2015; 24:377-8. [PMID: 26035353 DOI: 10.1097/bpb.0000000000000187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Bosch C, Assi C, Louahem D, Alkar F, Mazeau P, Delfour C, Canavese F, Prodhomme O, Cottalorda J. Diagnosis and surgical treatment of dysplasia epiphysealis hemimelica. A report of nine cases. Orthop Traumatol Surg Res 2014; 100:941-6. [PMID: 25453924 DOI: 10.1016/j.otsr.2014.07.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 07/04/2014] [Accepted: 07/12/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Dysplasia epiphysealis hemimelica (DEH) is a rare developmental bone disorder with hemimelic involvement of one or more epiphysis. We report on nine new cases and discuss the clinical manifestations, the value of MRI, and the results of complete and early surgical resection of these lesions. MATERIALS AND METHODS In this retrospective study, nine patients with a diagnosis of DEH were evaluated. Age at presentation ranged from 1 year to 12 years. The main complaint at diagnosis was a swelling bony mass. Angular deformities were recorded in two patients. All patients were surgically treated and followed up clinically and by imaging. Eight patients underwent excision only. RESULTS The average follow-up was 5.6 years (range, 2-10.5 years). All patients had a good outcome without related symptoms. No epiphysiodesis, angular deformity or recurrence was observed. One patient with femoral lesion involving the distal medial part of the epiphysis developed, four months after surgical excision, a calcification outside the area of total excision. This calcification did not increase in size at two years follow-up. Another patient with lateral involvement of the proximal tibial epiphysis presented a postoperative nervous complication. Spontaneous nervous recovery occurred three months after surgery. DISCUSSION MRI was useful to find a potential plane of cleavage between the epiphysis and the pathological tissue. We recommend early removing ossifications when a cleavage plane is identified. Waiting a possible complication or increasing of size does not seem logical. Of course, the treatment will be not the same if no cleavage plane is found on MRI. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- C Bosch
- Department of Pediatric Orthopaedics Surgery, University hospital of Montpellier, 34295 Montpellier, France
| | - C Assi
- Department of Pediatric Orthopedics Surgery, University hospital of Beirut, Beirut, Lebanon
| | - D Louahem
- Department of Pediatric Orthopaedics Surgery, University hospital of Montpellier, 34295 Montpellier, France
| | - F Alkar
- Department of Pediatric Orthopaedics Surgery, University hospital of Montpellier, 34295 Montpellier, France
| | - P Mazeau
- Department of Pediatric Orthopaedics Surgery, University hospital of Montpellier, 34295 Montpellier, France
| | - C Delfour
- Department of Histopathology, University hospital of Montpellier, 34295 Montpellier, France
| | - F Canavese
- Department of Pediatric Surgery, University hospital of Clermont-Ferrand, 69003 Clermont-Ferrand, France
| | - O Prodhomme
- Department of Pediatric Radiology, University hospital of Montpellier, 34295 Montpellier, France
| | - J Cottalorda
- Department of Pediatric Orthopaedics Surgery, University hospital of Montpellier, 34295 Montpellier, France.
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van der Reijden JJ, Vergroesen DA, van den Bekerom MPJ. Letter to the editor. J Foot Ankle Surg 2013; 52:558-9. [PMID: 23663878 DOI: 10.1053/j.jfas.2013.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Indexed: 02/03/2023]
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Kircher J, Westhoff B, Bittersohl B, Ziskoven C, Krauspe R. A rare case of Trevor's disease (dysplasia epiphysealis hemimelica) in the elbow. J Shoulder Elbow Surg 2013. [PMID: 23206405 DOI: 10.1016/j.jse.2012.10.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jörn Kircher
- Department of Orthopedics, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
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Luevitoonvechkij S, Khunsree S, Sirirungruangsarn Y, Settakorn J. Dysplasia epiphysealis hemimelica: a huge articular mass with unpredictable surgical results. BMJ Case Rep 2012; 2012:bcr-2012-007259. [PMID: 23175015 DOI: 10.1136/bcr-2012-007259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Dysplasia epiphysealis hemimelica or Trevor's disease is a rare disorder of localised osteochondral overgrowth affecting the epiphysis of extremities. This paper reports a 12-year-old boy presenting with a large bony mass at the left ankle diagnosed as dysplasia epiphysealis hemimelica. The articular surface of the ankle joint of the patient was evaluated with preoperative and postoperative MRIs. The 2-year postoperative MRI showed early osteoarthritis of the ankle, therefore demonstrating the importance of early excision avoiding more complex resections of intra-articular lesions.
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Tyler PA, Rajeswaran G, Saifuddin A. Imaging of dysplasia epiphysealis hemimelica (Trevor's disease). Clin Radiol 2012; 68:415-21. [PMID: 23040212 DOI: 10.1016/j.crad.2012.08.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 07/28/2012] [Accepted: 08/03/2012] [Indexed: 10/27/2022]
Abstract
Dysplasia epiphysealis hemimelica (DEH; synonyms; Trevor's or Trevor Fairbank disease) is a rare developmental disorder of the skeleton characterized by asymmetric osteochondral overgrowth of the cartilage of a medial or lateral epiphysis or epiphyseal equivalent. Imaging plays an important role in the diagnosis and management of DEH and in assessing the need for biopsy to differentiate it from more sinister diseases. There is no recent comprehensive review of the imaging of DEH and the purpose of this article is to describe the modern radiological manifestations of DEH.
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Affiliation(s)
- P A Tyler
- Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, UK.
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Struijs PAA, Kerkhoffs GMMJ, Besselaar PP. Treatment of dysplasia epiphysealis hemimelica: a systematic review of published reports and a report of seven patients. J Foot Ankle Surg 2012; 51:620-6. [PMID: 22819617 DOI: 10.1053/j.jfas.2012.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Indexed: 02/03/2023]
Abstract
Dysplasia epiphysealis hemimelica is a rare entity. It is characterized by cartilage overgrowth in the epiphyses and is considered to be an epiphyseal osteochondroma. It usually presents during childhood and can cause pain and functional limitations. The aim of the present study was to describe the entity through our cases and published data and to present the results of our suggested treatment. A systematic search was performed to retrieve and describe all studies on dysplasia epiphysealis hemimelica. Studies were included if sufficient information on the patient characteristics, lesion location, treatment, and outcomes were described. In addition, we report on 7 of our patients. In our review, 48 studies were found, of which 42 could be included. Owing to the large heterogeneity in the studies, no pooling of data was performed. The studies included 138 patients with 255 lesions. Approximately 27% were female patients. The age at presentation ranged from 3 months to 66 years; however, in most, the entity was discovered before 8 years of age. No apparent guidelines were presented concerning the treatment strategy; however, most investigators performed resection because of pain or limitations in the range of motion. Most lesions were located in the ankle or foot (139 of 255). In our own cases, 5 of 7 patients experienced pain, limited range of motion, or activity restriction. The mean follow-up period was 4 years. Dysplasia epiphysealis hemimelica is a rare entity, occurring predominantly in the lower extremity of in young male patients. Its aggressive growth warrants aggressive treatment in the case of pain or functional or range of motion limitations.
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Affiliation(s)
- P A A Struijs
- Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
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Hatta T, Sugita T, Aizawa T, Ohnuma M, Takahashi A, Itoi E. Bony island within the articular cartilage of the knee in a child: a rare condition for early osteoarthritis. Orthop Rev (Pavia) 2011; 3:e5. [PMID: 21808717 PMCID: PMC3143997 DOI: 10.4081/or.2011.e5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 03/21/2011] [Accepted: 03/21/2011] [Indexed: 11/24/2022] Open
Abstract
Articular cartilage is a specific type of connective tissue composed of hydrated proteoglycans within a matrix of collagen fibrils. In the elderly population, it shows degenerative changes that may results in osteoarthritis. The more severe form of osteoarthritis occasionally demonstrates bone formation within the cartilage, which is designated as a bony protuberance, however, such lesions are rare in children. This report presents the case of a 10-year-old boy with a bony protuberance within the articular cartilage of the knee. The patient initially complained of knee pain and he subsequently developed flexion contracture. Radiological and arthroscopic examinations revealed a bony protuberance in the articular cartilage and degenerative changes of the cartilage above it. He was successfully treated by the removal of the bony protuberance and osteochondral grafting. The bony protuberance may have caused cartilage degradation since the thickness of the cartilage above it was thinner than that around the lesion. The bony protuberance within the articular cartilage formed in the younger population may be a possible cause of osteoarthritis. This case is a noteworthy with regard to the pathogenesis of osteoarthritis.
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Affiliation(s)
- Taku Hatta
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai
| | | | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai
| | - Masahiro Ohnuma
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai
| | - Atsushi Takahashi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai
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Hatta T, Sugita T, Aizawa T, Ohnuma M, Takahashi A, Itoi E. Bony island within the articular cartilage of the knee in a child: a rare condition for early osteoarthritis. Orthop Rev (Pavia) 2011; 3:e7. [PMID: 21808719 PMCID: PMC3144001 DOI: 10.4081/or.2011.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 03/21/2011] [Accepted: 03/21/2011] [Indexed: 11/23/2022] Open
Abstract
Articular cartilage is a specific type of connective tissue composed of hydrated proteoglycans within a matrix of collagen fibrils. In the elderly population, it shows degenerative changes that may results in osteoarthritis. The more severe form of osteoarthritis occasionally demonstrates bone formation within the cartilage, which is designated as a bony protuberance, however, such lesions are rare in children. This report presents the case of a 10-year-old boy with a bony protuberance within the articular cartilage of the knee. The patient initially complained of knee pain and he subsequently developed flexion contracture. Radiological and arthroscopic examinations revealed a bony protuberance in the articular cartilage and degenerative changes of the cartilage above it. He was successfully treated by the removal of the bony protuberance and osteochondral grafting. The bony protuberance may have caused cartilage degradation since the thickness of the cartilage above it was thinner than that around the lesion. The bony protuberance within the articular cartilage formed in the younger population may be a possible cause of osteoarthritis. This case is a noteworthy with regard to the pathogenesis of osteoarthritis.
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Affiliation(s)
- Taku Hatta
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai
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Gölles A, Stolz P, Freyschmidt J, Schmitt R. Trevor's disease (dysplasia epiphysealis hemimelica) located at the hand: case report and review of the literature. Eur J Radiol 2011; 77:245-8. [PMID: 21236611 DOI: 10.1016/j.ejrad.2010.11.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Trevor's disease, also known as dysplasia epiphysealis hemimelica (DEH), is a rare developmental bone dysplasia, characterized by benign osteocartilaginous overgrowth. The lesion arises from an epiphysis. Its localization may be different, and it mostly occurs unilateral. In this report, we present a 40 years old woman suffering from Trevor's disease with unusual localization at the hand. Because of significant symptoms surgical excision was chosen.
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Affiliation(s)
- A Gölles
- Department of Radiology, Cardiovascular Center Bad Neustadt, Germany.
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Abstract
BACKGROUND Multiple hereditary exostoses, also termed as multiple osteochondromas, is a heritable disorder of connective tissue with primarily orthopaedic clinical manifestations. Understanding of its biological underpinnings has been advanced on a variety of fronts in recent years. METHODS The multifaceted literature regarding osteochondromagenesis and the major clinical challenges in patients with multiple osteochondromas were reviewed. RESULTS Consideration of recent advances in molecular biology, biochemistry, and animal modeling of osteochondroma pathogenesis yields a unified model. CONCLUSIONS Mechanistic details and therapeutic targets have yet to be elucidated, but the general biology of osteochondroma formation is increasingly clear, as well as its implications in the orthopaedic clinical setting.
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Baek GH, Rhee SH, Chung MS, Lee YH, Gong HS, Kang ES, Kim JK. Solitary intra-articular osteochondroma of the finger. J Bone Joint Surg Am 2010; 92:1137-43. [PMID: 20439659 DOI: 10.2106/jbjs.i.00876] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A solitary osteochondroma of the finger occasionally occurs intra-articularly and may cause clinical symptoms, including limited motion and deformity. The present report describes the clinical features and the results of operative treatment for a series of patients who had a solitary intra-articular osteochondroma of the finger. METHODS Ten patients with a solitary intra-articular osteochondroma of a phalanx of a finger were managed surgically. Eight patients were male, and two were female. The average age at the time of surgery was fourteen years. Treatment consisted of mass excision for three patients and mass excision with corrective osteotomy for six. One additional patient had a boutonniere deformity and underwent extensor tendon reconstruction combined with mass excision. The average duration of follow-up was forty-four months. RESULTS The proximal phalanx was affected in six patients, and the middle phalanx was affected in four. All tumors involved the distal epiphysis. All patients had postoperative improvement in terms of deformity and/or limitation of motion. Six patients had a preoperative mean coronal plane deformity of 29 degrees, which improved to 4 degrees after surgery. The preoperative mean arc of flexion-extension improved from 54 degrees to 78 degrees in four patients who had a motion deficit at the proximal interphalangeal joint and from 60 degrees to 80 degrees in one patient who had a motion deficit at the distal interphalangeal joint. Two patients had a residual flexion contracture, one with preexisting osteoarthritis and one with a longstanding progressive boutonniere deformity. There were no other complications or recurrences. CONCLUSIONS Isolated intra-articular osteochondroma of the finger can cause deformity and/or motion limitation. Early mass excision and corrective osteotomy when indicated are recommended to restore full range of motion and to prevent osteoarthritis and secondary deformity.
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Affiliation(s)
- Goo Hyun Baek
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
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Perl M, Brenner RE, Lippacher S, Nelitz M. Dysplasia epiphysealis hemimelica: a case report with novel pathophysiologic aspects. Clin Orthop Relat Res 2009; 467:2472-8. [PMID: 19526273 PMCID: PMC2866937 DOI: 10.1007/s11999-009-0925-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Accepted: 05/28/2009] [Indexed: 01/31/2023]
Abstract
Dysplasia epiphysealis hemimelica (DEH) is a rare developmental disorder. The underlying pathophysiology is largely unclear. Its diagnosis is based on clinical findings and may be difficult due to its low incidence and close relationship to other disorders such as osteochondroma. We describe a 13-year-old boy who presented with a unilateral lesion of the left medial femoral condyle and left ankle. In addition to standard diagnostic tools such as radiographs and MRI, arthroscopy-guided biopsy was performed; histologic/immunohistochemical findings from cartilage-bone specimens confirmed the diagnosis and provided novel information toward a disease mechanism. The cellular phenotype of clustered chondrocytes exhibited characteristics of chondroprogenitor cells and terminally differentiated cells, suggesting dysregulation of resident progenitor cells. No other surgery was performed and during a 2 year period, we observed spontaneous ossification of the lesion associated with decreased joint impairment. Immunohistochemical analysis of the lesion provided a more accurate diagnosis and may contribute to unraveling potential novel mechanisms involved in its pathogenesis.
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Affiliation(s)
- Mario Perl
- Department of Orthopaedics, University of Ulm Medical School, Ulm, Germany ,Department of Traumatology, Hand- and Reconstructive Surgery, University of Ulm Medical School, Ulm, Germany
| | - Rolf E. Brenner
- Division for Biochemistry of Joint and Connective Tissue Diseases, Department of Orthopaedics, University of Ulm Medical School, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Sabine Lippacher
- Department of Orthopaedics, University of Ulm Medical School, Ulm, Germany
| | - Manfred Nelitz
- Department of Orthopaedics, University of Ulm Medical School, Ulm, Germany
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Karam AR, Birjawi GA, Saghieh S, Tawil A, Khoury NJ. Generalized dysplasia epiphysealis hemimelica with contralateral sacro-iliac joint involvement. Skeletal Radiol 2008; 37:1147-52. [PMID: 18810433 DOI: 10.1007/s00256-008-0591-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 08/25/2008] [Indexed: 02/02/2023]
Abstract
Dysplasia epiphysealis hemimelica (or Trevor's disease) is a rare developmental bone dysplasia characterized by benign osteocartilaginous overgrowth involving one or multiple epiphyses, usually of a single lower extremity. It is classified as localized form, classical form (most common), and generalized form. In this report we describe a case of generalized form of dysplasia epiphysealis hemimelica with involvement of the contralateral sacroiliac joint, which is an extremely rare presentation.
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Affiliation(s)
- Adib R Karam
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Bliss Street, P.O. Box 11-0236, Beirut, Lebanon
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