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Zacharia B, Alex J, Rajmohan A. Klippel-Trénaunay Syndrome and Developmental Coxa Vara in the Same Limb: A Case Report with a Review of the Literature. Int J Angiol 2023; 32:292-295. [PMID: 37927826 PMCID: PMC10624519 DOI: 10.1055/s-0041-1729921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
We present a case of a 14-year-old girl who was first treated when she was 4 years old. She had progressive limping of the left lower limb from the age of 3 years. She was diagnosed to have developmental coxa vara of the left hip and treated by a subtrochanteric valgus osteotomy of the left femur. Later, she developed hypertrophy of the left upper and lower limbs. There were port-wine stains over the left lower limbs with multiple superficial varicosities. Her diagnosis was Klippel-Trénaunay syndrome (KTS). She is asymptomatic at the final follow-up. Both developmental coxa vara and KTS are rare conditions. We present this case to demonstrate the rarest combination of two rare conditions occurring in the same limb.
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Affiliation(s)
- Balaji Zacharia
- Department Of Orthopedics, Government Medical College, Kozhikode, Kerala, India
| | - Jittu Alex
- Department Of Orthopedics, Government Medical College, Kozhikode, Kerala, India
| | - Ashwin Rajmohan
- Department Of Orthopedics, Government Medical College, Kozhikode, Kerala, India
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Moy N, Flynn D, Henriquez J, Connelly LB, Vale L, Paolucci F. Interventions for improving clinical outcomes and health-related quality-of-life for people living with skeletal dysplasias: an evidence gap map. Qual Life Res 2023; 32:2751-2762. [PMID: 37294397 PMCID: PMC10474209 DOI: 10.1007/s11136-023-03431-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Skeletal dysplasias are rare genetic disorders that are characterized by abnormal development of bone and cartilage. There are multiple medical and non-medical treatments for specific symptoms of skeletal dysplasias e.g. pain, as well as corrective surgical procedures to improve physical functioning. The aim of this paper was to develop an evidence-gap map of treatment options for skeletal dysplasias, and their impact on patient outcomes. METHODS We conducted an evidence-gap map to identify the available evidence on the impact of treatment options on people with skeletal dysplasias on clinical outcomes (such as increase in height), and dimensions of health-related quality of life. A structured search strategy was applied to five databases. Two reviewers independently assessed articles for inclusion in two stages: titles and abstracts (stage 1), and full text of studies retained at stage 2. RESULTS 58 studies fulfilled our inclusion criteria. The included studies covered 12 types of skeletal dysplasia that are non-lethal with severe limb deformities that could result in significant pain and numerous orthopaedic interventions. Most studies reported on the effect of surgical interventions (n = 40, 69%), followed by the effect of treatments on dimensions of health quality-of-life (n = 4, 6.8%) and psychosocial functioning (n = 8, 13.8%). CONCLUSION Most studies reported on clinical outcomes from surgery for people living with Achondroplasia. Consequently, there are gaps in the literature on the full range of treatment options (including no active treatment), outcomes and the lived experience of people living with other skeletal dysplasias. More research is warranted to examine the impact of treatments on health-related quality-of-life of people living with skeletal dysplasias, including their relatives to enable them to make preference- and valued based decisions about treatment.
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Affiliation(s)
- Naomi Moy
- Department of Sociology and Business Law, University of Bologna, Bologna, Italy
| | - Darren Flynn
- Department of Midwifery, Nursing and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Josefa Henriquez
- Department of Sociology and Business Law, University of Bologna, Bologna, Italy
| | - Luke B Connelly
- Department of Sociology and Business Law, University of Bologna, Bologna, Italy
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Australia
| | - Luke Vale
- Health Economics Group, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Francesco Paolucci
- Department of Sociology and Business Law, University of Bologna, Bologna, Italy.
- Newcastle Business School, Faculty of Business and Law, University of Newcastle, Callaghan, Australia.
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Varda J, Valčić V, Blagojević V. Morphometric parameters of the proximal femoral epiphysis and their effect on the hip joint. MEDICINSKI PODMLADAK 2022. [DOI: 10.5937/mp73-33453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction: The femur is a long bone (ossa longa) that forms the hip and knee joints, supporting the weight of almost the entire body. This study is based on analyzing certain angles on the proximal femur that represent anthropometrically and surgically significant parameters, with clinical significance in diseases such as metabolic and degenerative bone disorders, arthritis, various hip trauma and disease. Aim: Determining the significance of certain morphometric parameters of the proximal femur and exploration of their impact on the hip joint. Material and methods: This cross-sectional study encompasses measuring four parameters: shaft length, the collodiaphyseal angle (CDA), the medial proximal femoral angle (MPFA) and the lateral proximal femoral angle (LPFA), on adult femora belonging to the archive of the Institute of anatomy "Niko Miljanić" of the Univerisity of Belgrade, Faculty of Medicine. A digital goniometer precise to two decimal places was used for all measurements. Results: Forty-seven femora were examined, 25 of which were left and 22 right femora of unknown gender and age, since none of the examined parameters could be used in procuring such information. The average femoral shaft length was 39.9 ± 2.7 cm, the shortest 34.8 cm and the longest 45.7 cm. The Collodiaphyseal angle (CDA) was 127.64 ± 4.25° on average, with the minimum being 119.1° and the maximum 137.7°. Average LPFA was 87.21 ± 3.07°, the lowest 81.6 and the highest 93.0°. Finally, MPFA was 86.9 ± 3.73° on average, with the smallest being 78.7° and the largest 94.5°. The Medial proximal femoral angle of right femora was significantly lower than the MPFA of left femora (p = 0,016). Conclusion: Eleven samples had a CDA below normal (< 124°), with three being defined as coxa vara (CDA < 120°). One had a CDA above normal (> 135°), being defined as coxa valga. Outside of reference values, LPFA was determined on 11 samples, being below normal (<85°) in all of them, whilst MPFA had 13 with only one of them being below normal (< 80°).
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Leunig M, Fickert S, Ganz R. Findings and Management of the Rare Caput Flexum Deformity of the Hip: A Case Report. JBJS Case Connect 2019; 9:e0321. [PMID: 31441832 DOI: 10.2106/jbjs.cc.18.00321] [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 A 10-year-old girl presented after possible occult hip trauma, with shortening of the leg being the initial clinical symptom, followed by motion-dependent pain. She had limited external rotation in extension with anterior apprehension. Radiographically, the deformity was an anterior tilt of the epiphysis with coxa vara. Surgery included surgical dislocation using a retinacular flap for the anterior open wedge femoral neck osteotomy for extension and posterior translation, with an excellent 4.5-year clinical outcome. CONCLUSIONS Caput flexum is a rare deformity with localized premature closure of the anterior growth plate of the hip. To avoid secondary impingement, an osteotomy was successfully placed close to the deformity.
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Affiliation(s)
- M Leunig
- Department of Orthopedics, Schulthess Clinic, Zurich, Switzerland
| | - S Fickert
- Hüftchirurgie, Sportorthopaedicum Straubing, Straubing, Germany.,Department of Orthopedics, University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
| | - R Ganz
- Faculty of Medicine, University of Bern, Bern, Switzerland
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The Treatment of Cleidocranial Dysostosis (Scheuthauer-Marie-Sainton Syndrome), a Rare Form of Skeletal Dysplasia, Accompanied by Spinal Deformities: A Review of the Literature and Two Case Reports. Case Rep Orthop 2018; 2018:4635761. [PMID: 30123598 PMCID: PMC6079611 DOI: 10.1155/2018/4635761] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/18/2018] [Accepted: 05/29/2018] [Indexed: 11/23/2022] Open
Abstract
Cleidocranial dysostosis is a skeletal dysplasia inherited in an autosomal dominant manner and may lead to complications such as scoliosis and kyphosis, concurrent with various orthopedic involvements. Since concurrent spinal deformities are of progressive nature, surgical treatment may be necessary. In addition to other orthopedic problems, possible accompanying complications such as atlanto-axial subluxation, myelopathy, syringomyelia, congenital spine deformities, spondylosis, and spondylolisthesis should be kept in mind while planning for the treatment of scoliosis and kyphosis. Lengthening the use of growth-friendly systems (growing rod) in patients, like ours, with an early onset of symptoms, and performing posterior instrumentation and fusion once the spinal growth is complete will yield successful results with no complications in the middle and the long term. Further multicenter studies with more comprehensive assessments are required to find solutions to spinal problems related to this rare skeletal dysplasia.
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Kenis V, Grill F, Al Kaissi A. Axial correction of the lower limb deformities in a girl with anauxetic dysplasia. Musculoskelet Surg 2014; 98:71-75. [PMID: 22528854 DOI: 10.1007/s12306-012-0200-9] [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] [Received: 09/27/2011] [Accepted: 04/04/2012] [Indexed: 05/31/2023]
Abstract
Valgus subtrochanteric osteotomies and hemiepiphyseodesis around the knees have been performed to correct severe coxa vara and genua valga in a girl patient who manifested extreme dwarfism associated with spondylometaepiphyseal dysplasia consistent with anauxetic dysplasia. To the best of our knowledge, this is the first description of the combined orthopaedic intervention in a girl with anauxetic dysplasia.
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Affiliation(s)
- Vladimir Kenis
- Department of Foot and Ankle Surgery, Neuroorthopaedics and Systemic Disorders, Pediatric Orthopedic Institute n.a. H. Turner, Parkovaya str., 64-68, Pushkin, Saint Petersburg, Russia
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Al Kaissi A, Ben Chehida F, Kenis V, Ganger R, Radler C, Hofstaetter JG, Klaushofer K, Grill F. Broad spectrum of skeletal malformation complex in patients with cleidocranial dysplasia syndrome: radiographic and tomographic study. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2013; 6:45-55. [PMID: 24023524 PMCID: PMC3762605 DOI: 10.4137/cmamd.s11933] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
PURPOSE Cleidocranial dysplasia is an autosomal dominant disorder characterized by defective ossification of the intramembraneous ossification (primarily the clavicles, cranium, and pelvis), and it is caused by mutations in the RUNX2 gene that is responsible for osteoblast differentiation. Spine deformities were of progressive nature and considered to be the major orthopedic abnormalities encountered in our practice in patients with cleidocranial dysplasia. We aimed to further delineate the underlying spine pathology and its etiological understanding. Extraspinal deformities were dealt with respectively. MATERIAL AND METHODS In this paper, we describe 7 patients who were consistent with the phenotypic and the genotypic characterization of cleidocranial dysplasia. Reformatted computed tomography (CT) scans have been applied in several instances to further understand the underlying pathology of progressive spine tilting. Radiographs were sufficient to illustrate other skeletal malformations. RESULTS Anatomical survey demonstrates that a broad spectrum of frequently unrecognized orthopedic aberrations were encountered. We believe that torticollis has evolved in connection with the persistence of synchondrosis of the skull base and the upper cervical spine and these are strongly correlated to the well-known pathology of posterior occipital synchondrosis. Similarly, scoliosis and kyphoscoliosis resulted from the pathologic aberration of the cartilaginous stage of disrupted embryological development. All our results are discussed for the first time. Coxa vara, patellar dysplasia, and genu valgum were observed as extraspinal deformities. CONCLUSION This paper includes for the first time the anatomical analysis of the malformation complex of the craniocervical and the entire spine in patients with cleidocranial dysplasia. Reformatted CT scan was the modality of choice. We were able to illustrate that the persistence of skull base and the cervical spine synchondrosis were correlated with the pathological mechanism of the posterior occipital synchondrosis. Therefore, injuries to the craniocervical region in these patients might lead to a wide range of dreadful complications, ranging from complete atlanto-occipital or atlanto-axial dislocation to nondisplaced occipital condyle avulsion fractures with the possibility of morbid and or mortal outcome. On the other hand, the persistence of a cartilaginous spine was the reason behind the progressive spine tilting. This pathological form can be considered as a notoriously unpredictable malformation complex. The value of presenting these patients is to demonsterate that the genotype is not a precise index to assess the severity and the natural history of the phenotype.
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Affiliation(s)
- Ali Al Kaissi
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK and AUVA Trauma Center Meidling, First Medical Department, Hanusch Hospital, Vienna, Austria. ; Orthopedic Hospital of Speising, Pediatric Department, Vienna, Austria
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Abstract
BACKGROUND Young children with chondrodysplasia may develop multilevel varus deformities that compromise comfort and gait. The classic treatment of performing corrective, staged osteotomies, at each level of deformity, is a daunting prospect that is fraught with potential complications. To avoid this scenario, we have adopted single-event, multilevel surgery, using guided growth to simultaneously address bilateral varus deformities of the knee and hip, with good results. METHODS Three cousins with Schmid-type metaphyseal dysplasia, presented for treatment of progressive varus deformities. In lieu of osteotomies, we used simultaneous guided growth of the proximal and distal lateral femora and proximal lateral tibiae, while ignoring the distal tibial deformity. The pan-genu 8-plates served to neutralize the mechanical axis while preserving a horizontal knee. The rationale for applying the trochanteric 8-plate was to stabilize the proximal femoral chondroepiphysis, hoping to postpone or avert intertrochanteric osteotomy. The average age at surgery was 28 months, with a range of 19 to 33 months, and follow-up has ranged from 28 to 59 months (average 48 mo). The pan-genu 8-plates were removed after an average of 12 months, leaving the trochanteric implants in situ, pending further growth. RESULTS Neutralization of the mechanical axis resolved lateral knee thrust and intoeing. As the femur is effectively adducted by knee realignment, the greater trochanteric impingement on the ilium is alleviated. Lateral tethering of the trochanteric apophysis served to increase the femoral neck-shaft angle, improving the abductor lever arm. Each patient experienced complete resolution of the fatigue hip pain and Trendelenburg gait. As knee alignment was restored, the ankle varus resolved spontaneously, requiring no direct treatment. The clinical improvement was reflected in trending of the radiographic angles and axes toward normal. CONCLUSIONS These children have benefited from outpatient guided growth, rather than the anticipated osteotomies, to correct multilevel varus deformities. Our goal is to exclusively use guided growth, repeatedly as needed, to avoid osteotomies altogether. Annual follow-up until skeletal maturity is planned. LEVEL OF EVIDENCE Level IV-retrospective case series.
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Trigui M, Ayadi K, Elhassan MO, Zribi M, Chabchoub I, Keskes H. [Cleidocranial dysplasia: report of 2 cases and literature review]. Arch Pediatr 2011; 18:672-7. [PMID: 21530191 DOI: 10.1016/j.arcped.2011.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Accepted: 03/22/2011] [Indexed: 11/25/2022]
Abstract
Cleidocranial dysplasia or dysostosis involves dental anomalies, bone abnormalities with membranous ossification (clavicles, cranium, face, pelvis), rarely of the spine and the remainder of the skeleton. We report 2 new cases and describe the different clinical aspects of this disorder and the orthopedic problems that it can pose. The clinical demonstrations of this disease are highly variable and inconsistent, which explains the diversity of circumstances of discovery. Abnormalities of the face and clavicles, as well as of pelvic ossification are most frequent and can be regarded as major signs. These clinical demonstrations do not require treatment in the majority of the cases. Dental anomalies, coxa vara and scoliosis require regular monitoring and treatment in the event of progressive aggravation. The incomplete penetrance of this autosomal dominant disease and its good tolerance explain the frequency of undiagnosed forms, whose clinical expression is discrete.
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Affiliation(s)
- M Trigui
- Service de chirurgie orthopédique et traumatologique, CHU Habib Bourguiba, faculté de médecine, 3029 Sfax, Tunisie.
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Schmid-type metaphyseal chondrodysplasia as the result of a collagen type X defect due to a novel COL10A1 nonsense mutation: A case report of a novel COL10A1 mutation. J Orthop Sci 2011; 16:245-9. [PMID: 21360259 DOI: 10.1007/s00776-011-0021-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 04/26/2010] [Indexed: 01/11/2023]
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Isik D, Guner S, Avcu S, Goktas U, Atik B. A case report of a patient with cleft palate carrying the risk of tetraplegia. Cleft Palate Craniofac J 2010; 48:773-5. [PMID: 20828273 DOI: 10.1597/09-239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Spondyloepiphyseal dysplasia congenita (SEDC) is an inherited disorder of bone growth that results in short-trunk dwarfism, skeletal abnormalities, disorders in vision and hearing, atlanto-axial instability, and cleft palate. This important anomaly of the cervical vertebrae carries the risk of tetraplegia during cleft palate operations. In this case report, we discuss a case of spondyloepiphyseal dysplasia congenita, the perioperative and postoperative measures, and the risk of tetraplegia.
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