1
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Anderson JA, Laucis N, Symanski J, Blankenbaker D. Imaging of Disease and Normal Variant Patterns in Pediatric Hips. Semin Musculoskelet Radiol 2024; 28:447-461. [PMID: 39074727 DOI: 10.1055/s-0044-1786153] [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: 07/31/2024]
Abstract
The pediatric hip undergoes significant changes from infancy through adolescence. Proper maturation is crucial for the development of a stable and functional hip joint. Imaging interpretation of the pediatric hip requires distinguishing normal variants and maturation patterns from pathology. We review femoral ossification centers, variants, and conditions that affect the proximal femur, such as Legg-Calvé-Perthes disease; the acetabulum, such as developmental hip dysplasia; the acetabular labrum, such as femoroacetabular impingement; and synovial pathology in children through adolescence. Understanding the spectrum of hip conditions and using advanced imaging techniques are essential for the accurate diagnosis and effective management of pediatric hip disorders.
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Affiliation(s)
- Jade A Anderson
- Department of Radiology, Musculoskeletal Imaging and Intervention, UW Health: University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - Nicholas Laucis
- Department of Radiology, Musculoskeletal Imaging and Intervention, UW Health: University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - John Symanski
- Department of Radiology, Musculoskeletal Imaging and Intervention, UW Health: University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - Donna Blankenbaker
- Department of Radiology, Musculoskeletal Imaging and Intervention, UW Health: University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
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2
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Deisenhofer J, Greitemann B, Putz C, Horsch A, Wolf M, Mick P, Renkawitz T, Alimusaj M. [Possibilities of orthopedic technical care for extremity lengthening and reconstruction]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:756-766. [PMID: 37491653 DOI: 10.1007/s00132-023-04424-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Orthopedic technical care plays a crucial role in improving function and mobility for patients undergoing limb lengthening and reconstruction. The treatment strategy is based on a precise classification of the defect, taking into account factors such as joint instability, muscle pathology and limb length discrepancy. CHOICE OF AIDS The selection of orthopedic aids depends on the specific deformity, its classification and the individual needs of the patient. Through interdisciplinary decision-making and customized adaptations of prostheses and orthoses, optimal function and aesthetically pleasing outcomes can be achieved. The utilization of custom-made technical components, such as traction devices combined with elastic liners, is essential for long-term treatment success and can support surgical interventions. The treating physician's expertise is crucial in selecting the appropriate orthopedic technical device following limb lengthening and reconstruction.
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Affiliation(s)
- Julian Deisenhofer
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | | | - Cornelia Putz
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - Axel Horsch
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - Matthias Wolf
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - Paul Mick
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - Tobias Renkawitz
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - Merkur Alimusaj
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland.
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3
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Cheng K, Peng Y, Yan X, Wen X, Ding H. Feasibility of Computer-Aided Design in Limb Lengthening Surgery: Surgical Simulation and Guide Plates. Orthop Surg 2022; 14:2073-2084. [PMID: 35924698 PMCID: PMC9483076 DOI: 10.1111/os.13328] [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: 12/15/2021] [Revised: 05/02/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the feasibility and utility of computer‐aided design (CAD) in surgical treatment of leg length discrepancy (LLD) using monorail external fixators. Methods In the present case series, we retrospectively analyzed seven patients diagnosed with LLD who were surgically treated using a monorail external fixator between June 2018 and August 2020. A personalized surgical emulation of each patient was designed using CAD based on preoperative CT scans to measure limb parameters. Through reverse engineering, a surgical guide plate was then designed to assist with correcting the limb deformity. Patient general information and clinical history, leg length, mechanical lateral distal femoral angle (mLDFA), anatomical anterior distal tibial angle (aADTA), and surgical parameters were recorded during the perioperative period. Three months after external fixator removal, distraction‐consolidation time (DCT), healing index (HI), and lower extremity function score (LEFS) were calculated, and statistically analyzed by paired T‐test. Results The mean limb lengthening achieved was 6.41 ± 2.54 (range, 3.30–10.54) cm with either varus or valgus correction. The mean operative duration was 151 ± 41.87 (84–217) minutes and mean blood loss was 53.58 ± 22.51(25–87) ml. The mean distraction‐consolidation time was 3.67 ± 1.13 (range, 2.5–6.0) months and mean external fixator duration was 11 ± 2.45 (range, 8–14) months. The mean healing index (HI) was 18.11 ± 3.58 (range, 12.8–22.7) days/cm. Mean LEFS scores improved postoperatively from 32.17 ± 8.57 (range, 24–45) to 61.17 ± 6.68 (range, 50–67) with a significant difference (T = –14.26,P < 0.001). Conclusions Simultaneous length and angular correction can be achieved by incorporating CAD into the surgical treatment of patients with LLD, without compromising postoperative lower limb function. CAD demonstrates utility in the surgical treatment of LLD by improving the functionality of monorail external fixators.
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Affiliation(s)
- Kai Cheng
- School of Medicine, South China University of Technology, Guangzhou, China.,Department of Orthopedic Surgery, Guangzhou First People's Hospital, Guangzhou, China
| | - Yuanhao Peng
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Xiaonan Yan
- School of Biomedical Sciences and Engineering, South China University of Technology, Guangzhou, China
| | - Xinghua Wen
- School of Biomedical Sciences and Engineering, South China University of Technology, Guangzhou, China
| | - Huanwen Ding
- School of Medicine, South China University of Technology, Guangzhou, China.,Department of Orthopedic Surgery, Guangzhou First People's Hospital, Guangzhou, China
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4
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Gill KG. Congenital musculoskeletal anomalies - key radiographic findings. Pediatr Radiol 2022; 52:777-785. [PMID: 34731287 DOI: 10.1007/s00247-021-05200-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/23/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Abstract
Although radiographs are generally performed in the neonatal period to evaluate for causes of respiratory distress or to evaluate line placement, close attention to the osseous structures can provide important clues to an underlying diagnosis. Although segmentation anomalies can be random, they are frequently associated with more complex entities such as VACTERL association. A butterfly vertebral body can hint at a possible diagnosis of Alagille syndrome even before jaundice develops in an infant with a murmur. Close evaluation of the sacrum can identify abnormalities that point to caudal regression or Currarino triad. Other classic musculoskeletal abnormalities in the extremities are readily apparent on physical exam but require radiographic evaluation to define anatomy. Diagnoses such as congenital pseudoarthrosis of the clavicle, Apert syndrome, constriction band syndrome, and proximal focal femoral deficiency have pathognomonic imaging findings. Given that treatment for these is usually delayed until later in life, extremity imaging might not occur in the neonatal period.
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Affiliation(s)
- Kara G Gill
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Clinical Science Center, MC3252, 600 Highland Ave., Madison, WI, 53892, USA.
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5
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Chauvin NA, Khwaja A. Musculoskeletal imaging in neonates: use of ultrasound. Pediatr Radiol 2022; 52:765-776. [PMID: 34490498 DOI: 10.1007/s00247-021-05152-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/01/2021] [Accepted: 07/12/2021] [Indexed: 11/28/2022]
Abstract
High-resolution US is a practical, cost-effective modality to evaluate the musculoskeletal system in neonates. US can be performed portably in the neonatal intensive care unit so that the critically ill infant can be evaluated with minimal distress. Sonography is noninvasive and does not require sedation; typical questions that might require the use of MRI or CT in older children can be rapidly resolved with US. Dynamic imaging can be used in real time to stress joints and see how articular structures relate. Given the advantages of US within the neonatal population, it has been widely used to evaluate for neonatal fractures, congenital joint abnormalities, limb deficiencies as well as muscular and soft-tissue abnormalities.
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Affiliation(s)
- Nancy A Chauvin
- Department of Radiology, Penn State Children's Hospital, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033, USA.
| | - Asef Khwaja
- Department of Radiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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6
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Karout L, Naffaa L. Pediatric Hip Disorders: Imaging Guidelines and Recommendations. Radiol Clin North Am 2021; 60:149-163. [PMID: 34836561 DOI: 10.1016/j.rcl.2021.08.007] [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: 10/19/2022]
Abstract
Hip disorders are a wide range of conditions commonly affecting patients in the pediatric age group. Reaching an accurate diagnosis of these conditions in children may be challenging. The optimal use of image modalities in the approach of a child with possible hip pathology is essential, which allows radiologists and clinicians to narrow the differential diagnosis and reach a definitive diagnosis, which can consequently result in early and appropriate interventions leading to improved outcomes. Therefore, this article aims to provide practicing radiologists and clinicians with up-to-date and evidence-based imaging spectrum guidelines and recommendations for common pediatric hip disorders.
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Affiliation(s)
- Lina Karout
- Department of Radiology, Massachusetts General Hospital, 25 New Chardon Street, Boston, MA 02114, USA
| | - Lena Naffaa
- Radiology Department, University of Central Florida, Nemours Children's Hospital, 6535 Nemours Parkway, Orlando, FL 32827, USA.
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7
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Applebaum A, Nessim A, Cho W. Overview and Spinal Implications of Leg Length Discrepancy: Narrative Review. Clin Orthop Surg 2021; 13:127-134. [PMID: 34094002 PMCID: PMC8173231 DOI: 10.4055/cios20224] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/20/2020] [Accepted: 12/23/2020] [Indexed: 11/25/2022] Open
Abstract
Leg length discrepancy (LLD) is an underrecognized and prevalent condition among the U.S. population, with effects varying depending on the cause and size of the discrepancy. LLD occurs when the paired lower extremities are unequal in length and can be etiologically classified as functional or structural. Length differences are typically less than 10 mm and asymptomatic or easily compensated for by the patient through self-lengthening or shortening of the lower extremities. Literature review of the etiology, diagnostic modalities, clinical complications, and treatment option for patients with LLD. LLD can be assessed directly through tape measurements or indirectly through palpation of bony landmarks. Imaging modalities, specifically radiography, are more precise and help identify coexistent deformity. Once LLD has been diagnosed, evaluation for potential adverse complications is necessary. Discrepancies greater than 20 mm can alter biomechanics and loading patterns with resultant functional limitations and musculoskeletal disorders, such as functional scoliosis. Functional scoliosis is nonprogressive and involves a structurally normal spine with an apparent lateral curvature, which regresses fully or partially when the LLD is corrected. Long-standing LLD and functional scoliosis often result in permanent degenerative changes in the facet joints and intervertebral discs of the spine. Further understanding of the contribution of LLD in the development of scoliosis and degenerative spine disease will allow for more effective preventative treatment strategies and hasten return to function.
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Affiliation(s)
- Ariella Applebaum
- Department of Orthopedic Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Adam Nessim
- Department of Orthopedic Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Woojin Cho
- Department of Orthopedic Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
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8
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Hootnick DR, Levinsohn EM. Embryology of the lower limb demonstrates that congenital absent fibula is a radiologic misnomer. Anat Rec (Hoboken) 2021; 305:8-17. [PMID: 33773063 DOI: 10.1002/ar.24628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/09/2021] [Accepted: 02/26/2021] [Indexed: 11/11/2022]
Abstract
The congenitally shortened limb (CSL) with fibular deficiency or absence has historically been graded by plain radiography, while associated cartilaginous and arterial soft tissue anomalies have been comparatively neglected. Consistent pathological evidence of remnant cartilaginous bodies in place of the fibula presupposes earlier existence of a preformed cartilaginous template of the fibula. In complete fibular radiographic absences, often associated with midline metatarsal deficiencies, the two usual nutrient arteries to the fibula fail to form, as they normally would have, around the (16-18 mm stage) sixth embryonic week. The histopathology of fallow persisting fibular anlagen, in association with missing arteries and retained primitive arteries, suggests the anlage is a dystrophic, but otherwise normally prefigured, cartilaginous scaffold of the fibula. Thus, the widely employed term absent fibula, which has been grounded in plain radiography, is a misnomer. Additionally, since the metatarsals missing in congenitally shortened limb are midline, the related term, fibular hemimelia, is similarly inaccurate. A new taxonomy, based on embryological principles rather than radiographic appearance alone, will promote limb dystrophism as a more accurate term combining arrested embryonic vascular development and congenitally shortened limb of the lower extremity.
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Affiliation(s)
- David R Hootnick
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York, USA.,Department of Cellular and Developmental Biology, SUNY Upstate Medical University, Syracuse, New York, USA.,Department of Pediatrics, SUNY Upstate Medical University, Syracuse, New York, USA
| | - E Mark Levinsohn
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York, USA.,Department of Radiology, Crouse Irving Memorial Hospital, Syracuse, New York, USA
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9
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Prenatal differential diagnosis of fibular agenesis, tibial campomelia and oligosyndactyly. Clin Dysmorphol 2021; 30:147-149. [PMID: 33605603 DOI: 10.1097/mcd.0000000000000366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Al-Chalabi MMM, Wan Sulaiman WA. Usual Presentation Has Odds: Unilateral Tibial Hemimelia in One of Dizygotic Twins. Cureus 2021; 13:e12834. [PMID: 33633877 PMCID: PMC7899282 DOI: 10.7759/cureus.12834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Tibial hemimelia is a relatively rare congenital tibial longitudinal deficiency (approximately 1 per 1 million live births), unilateral or bilateral, with a relatively intact fibula. Hemimelia results from a disruption of the lower limb developmental field during embryogenesis due to slow or even abort of chondrification process, which results in leg length discrepancy. Affected leg commonly appears short and deformed with knee, ankle, and foot involvement. It may present with a variety of associated anomalies. Surgical treatment varies according to the type and degree of deformity, and reconstructive interventions are still limited. Reported cases of tibial hemimelia are very infrequent, especially tibial hemimelia in twins. Usually, the cases were in single embryo or less frequently in one of the monozygotic twins, but no reported cases regarding tibial hemimelia in one of the dizygotic twins as this article reports.
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Affiliation(s)
| | - Wan Azman Wan Sulaiman
- Plastic and Reconstructive Surgery, Universiti Sains Malaysia School of Medical Sciences, Kubang Kerian, MYS
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11
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Litrenta J, Masrouha K, Wasterlain A, Castaneda P. Ultrasound Evaluation of Pediatric Orthopaedic Patients. J Am Acad Orthop Surg 2020; 28:e696-e705. [PMID: 32769718 DOI: 10.5435/jaaos-d-17-00895] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Ultrasonography is a valuable tool that can be used in many capacities to evaluate and treat pediatric orthopaedic patient. It has the capability to depict bone, cartilaginous and soft-tissue structures, and provide dynamic information. This technique can be readily applied to a wide range of pediatric conditions, including developmental dysplasia of the hip, congenital limb deficiencies, fracture management, joint effusions, and many other musculoskeletal pathologies. There are many benefits of implementing ultrasonography as a regular tool. It is readily accessible at most centers, and information can be quickly obtained in a minimally invasive way, which limits the need for radiation exposure. Ultrasonography is a safe and reliable tool that pediatric orthopaedic surgeons can incorporate into the diagnosis and management of a broad spectrum of pathology.
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Affiliation(s)
- Jody Litrenta
- From the Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY (Dr. Litrenta, Dr. Masrouha, and Dr. Castaneda), and Middlesex Orthopedic, Middletown, CT (Dr. Wasterlain)
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12
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Schlung J, Schiffman S, Chaturvedi A. Top Ten Adult Manifestations of Childhood Hip Disorders. Radiol Clin North Am 2020; 58:529-548. [DOI: 10.1016/j.rcl.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Abstract
Midline metatarsal ray deficiencies, which occur in approximately half of congenital short limbs with fibular deficiency, provide the most distal and compelling manifestation of a fluid spectrum of human lower-extremity congenital long bone reductions; this spectrum syndromically affects the long bone triad of the proximal femur, fibula, and midline metatarsals. The bony deficiencies correspond to sites of rapid embryonic arterial transitioning. Long bones first begin to ossify because of vascular invasions of their respective mesenchymal/cartilage anlagen, proceeding in a proximal-to-distal sequence along the forming embryonic limb. A single-axis artery forms initially in the embryonic lower limb by means of vasculogenesis. Additional arteries evolve in overlapping transitional waves, in proximity to the various anlagen, during the sixth and seventh weeks after fertilization. An adult pattern of vessels presents by the eighth week. Arterial alterations, in the form of retained primitive embryonic vessels and/or reduced absent adult vessels, have been observed clinically at the aforementioned locations where skeletal reductions occur. Persistence of primitive vessels in association with the triad of long bone reductions allows a heuristic estimation of the time, place, and nature of such coupled vascular and bony dysgeneses. Arterial dysgenesis is postulated to have occurred when the developing arterial and skeletal structures were concurrently vulnerable to teratogenic insults because of embryonic arterial instability, a risk factor during arterial transition. It is herein hypothesized that flawed arterial transitions subject the prefigured long bone cartilage models of the rapidly growing limb to the risk of teratogenesis at one or more of the then most rapidly growing sites. Midline metatarsal deficiency forms the keystone of this developmental concept of an error of limb development, which occurs as a consequence of failed completion of the medial portion of the plantar arch. Therefore, the historical nomenclature of congenital long bone deficiencies will benefit from modification from a current reliance on empirical physical taxonomies to a developmental foundation.
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14
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Hootnick DR. Congenital fibular dystrophisms conform to embryonic arterial dysgenesis. Anat Rec (Hoboken) 2020; 303:2792-2800. [PMID: 31872958 DOI: 10.1002/ar.24348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/19/2019] [Accepted: 09/25/2019] [Indexed: 01/09/2023]
Abstract
The congenital short limb (CSL) with fibular deficiency has traditionally been graded by plain radiography. The most popular orthopedic classification sorts the fibular dysmorphologies into three radiographic groupings: IA (thinned), IB (proximally truncated), or II (absent). In contrast, the soft tissues have been relatively neglected. Since bone formation of the fibula progresses from the anlage, a scaffolding cartilage mold intermediate, cartilage transformation to bone is dependent upon timely embryonic arterial invasion. Absences of the requisite arteries predicate specific skeletal dysmorphologies. The usual arterial supply of the fibula is comprised primarily of the anterior tibialis artery (ATA), which uniquely supplies the proximal portion of the fibula, and also joins the peroneal artery (PA) in supplying the mid to distal fibular shaft. Combinations of the two nutrient arteries allow four potential variations of fibular vascular supply, among which the ATA and PA conjoin to supply the normal fibula and variably supply the three dysmorphic fibular models. The IA and IB deformities conform, respectively, to the absences of the PA and the ATA. Combined ATA and PA absences present in the radiographically "absent" fibula. Thus, each of the four fibular (dys)morphologies conforms to a specific embryonic pattern of arterial development. The term "dystrophism" most accurately characterizes such malformed long bones.
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Affiliation(s)
- David R Hootnick
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York.,Department of Cell and Developmental Biology, SUNY Upstate Medical University, Syracuse, New York.,Department of Pediatrics, SUNY Upstate Medical University, Syracuse, New York
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15
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Uduma FU, Dim EM, Njeze NR. Proximal femoral focal deficiency - a rare congenital entity: two case reports and a review of the literature. J Med Case Rep 2020; 14:27. [PMID: 32019581 PMCID: PMC7001305 DOI: 10.1186/s13256-020-2350-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 01/14/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Proximal femoral focal deficiency is an extremely rare congenital anomaly with an incidence of 1.1-2.0 in 100,000 live births. It is a dysplastic phenomenon with predilections for the proximal two-thirds of the femur leading to limb length discrepancies. We report two cases of proximal femoral focal deficiency, which is a rare entity. CASE PRESENTATIONS Case 1 A 4.5-month-old baby Annang tribe girl was referred in April 2019 to our Radiology Department, University of Uyo Teaching Hospital, Nigeria for lower limb radiographs. This was on account of her shortened left lower limb from birth despite uneventful antenatal history. An examination revealed bulky left thigh with abduction of her left hip joint. Radiographic evaluations showed absent left femoral capital epiphysis, with deficient proximal left femur. A diagnosis of proximal femoral focal deficiency was made. Sadly, the parents and baby failed to honor future orthopedic consultations on intimation of sequential management protocols. Case 2 A 4-month-old baby Ibibio tribe girl was similarly referred in August 2019 to the same Radiology Department for lower limb conventional radiographs due to short left lower limb that was noticed from birth. An examination showed shortened left lower limb in external rotation. Her right and left lower limbs measured 27 cm and 23 cm, respectively, with landmark taken from anterior superior iliac spine to tip of medial malleolus. A diagnosis of proximal femoral focal deficiency was made. Corroborating radiographs showed shortened and hypoplastic left femoral shaft but preserved femoral capital epiphysis. Coincidentally, the parents have not brought back their baby to our orthopedic clinic. CONCLUSIONS The discovery of two cases of proximal femoral focal deficiency, a rare entity, from referrals for conventional radiography in our Radiology Department encourages literature documentation. Such recognition will facilitate early institution of management, thus ensuring meaningful childhood growth.
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Affiliation(s)
- Felix U Uduma
- Department of Radiology, Faculty of Clinical Sciences, College of Health Sciences, University of Uyo, Uyo, Nigeria.
| | - Edwin M Dim
- Department of Trauma and Orthopaedics, Faculty of Clinical Sciences, College of Health Sciences, University of Uyo, Uyo, Nigeria
| | - Ngozi R Njeze
- Department of Radiation Medicine, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
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16
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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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17
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Silva MS, Fernandes ARC, Cardoso FN, Longo CH, Aihara AY. Radiography, CT, and MRI of Hip and Lower Limb Disorders in Children and Adolescents. Radiographics 2019; 39:779-794. [DOI: 10.1148/rg.2019180101] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mariana S. Silva
- From the Division of Musculoskeletal Radiology, Laboratório Delboni Auriemo, DASA, São Paulo, Brazil (M.S.S., F.N.C., C.H.L., A.Y.A.); and Department of Diagnostic Imaging, Federal University of São Paulo (Departamento de Diagnóstico por Imagem, Universidade Federal de São Paulo), Napoleão de Barros 800, 04024-002 São Paulo, SP, Brazil (A.R.C.F., F.N.C., A.Y.A.)
| | - Artur R. C. Fernandes
- From the Division of Musculoskeletal Radiology, Laboratório Delboni Auriemo, DASA, São Paulo, Brazil (M.S.S., F.N.C., C.H.L., A.Y.A.); and Department of Diagnostic Imaging, Federal University of São Paulo (Departamento de Diagnóstico por Imagem, Universidade Federal de São Paulo), Napoleão de Barros 800, 04024-002 São Paulo, SP, Brazil (A.R.C.F., F.N.C., A.Y.A.)
| | - Fabiano N. Cardoso
- From the Division of Musculoskeletal Radiology, Laboratório Delboni Auriemo, DASA, São Paulo, Brazil (M.S.S., F.N.C., C.H.L., A.Y.A.); and Department of Diagnostic Imaging, Federal University of São Paulo (Departamento de Diagnóstico por Imagem, Universidade Federal de São Paulo), Napoleão de Barros 800, 04024-002 São Paulo, SP, Brazil (A.R.C.F., F.N.C., A.Y.A.)
| | - Carlos H. Longo
- From the Division of Musculoskeletal Radiology, Laboratório Delboni Auriemo, DASA, São Paulo, Brazil (M.S.S., F.N.C., C.H.L., A.Y.A.); and Department of Diagnostic Imaging, Federal University of São Paulo (Departamento de Diagnóstico por Imagem, Universidade Federal de São Paulo), Napoleão de Barros 800, 04024-002 São Paulo, SP, Brazil (A.R.C.F., F.N.C., A.Y.A.)
| | - André Y. Aihara
- From the Division of Musculoskeletal Radiology, Laboratório Delboni Auriemo, DASA, São Paulo, Brazil (M.S.S., F.N.C., C.H.L., A.Y.A.); and Department of Diagnostic Imaging, Federal University of São Paulo (Departamento de Diagnóstico por Imagem, Universidade Federal de São Paulo), Napoleão de Barros 800, 04024-002 São Paulo, SP, Brazil (A.R.C.F., F.N.C., A.Y.A.)
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Hootnick DR, Vargesson N. The syndrome of proximal femur, fibula, and midline metatarsal long bone deficiencies. Birth Defects Res 2018; 110:1188-1193. [DOI: 10.1002/bdr2.1349] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/19/2018] [Accepted: 04/25/2018] [Indexed: 02/06/2023]
Affiliation(s)
- David R. Hootnick
- Department of Orthopedic Surgery; SUNY Upstate Medical University; Syracuse New York
- Department of Anatomy and Cell Biology; SUNY Upstate Medical University; Syracuse New York
- Department of Pediatrics; SUNY Upstate Medical University; Syracuse New York
| | - Neil Vargesson
- School of Medicine, Medical Sciences and Nutrition, Institute of Medical Sciences; University of Aberdeen; Foresthill, AB25-2ZD Scotland
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19
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Saghir S, Bousbaa H, Agadr A. Bilateral fibular hemimelia associated with hip dislocation and femoral head necrosis. Clin Case Rep 2018; 6:959-960. [PMID: 29744100 PMCID: PMC5930189 DOI: 10.1002/ccr3.1489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 02/16/2018] [Accepted: 02/23/2018] [Indexed: 12/02/2022] Open
Abstract
We describe a case of association of congenital bone abnormalities. It will allow clinicians to look systematically for other skeletal malformations and teach them how to evaluate these cases for the first time. This early screening will enable appropriate treatment to avoid complications and to preserve functional prognosis.
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Affiliation(s)
| | - Hicham Bousbaa
- Orthopedics Department; Military Hospital Moulay Ismail; Meknes Morocco
| | - Aomar Agadr
- Pediatric Department; Military Hospital Mohammed V; Rabat Morocco
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20
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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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21
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Kraus C, Ayyala RS, Kazam JK, Wong TT. Imaging of Juvenile Hip Conditions Predisposing to Premature Osteoarthritis: Pediatric Imaging. Radiographics 2017; 37:2204-2205. [PMID: 29131774 DOI: 10.1148/rg.2017170067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Carl Kraus
- From the Department of Diagnostic Radiology, New York Presbyterian Hospital/Columbia University Medical Center, 630 W 168th St, MC-28, New York, NY 10032
| | - Rama S Ayyala
- From the Department of Diagnostic Radiology, New York Presbyterian Hospital/Columbia University Medical Center, 630 W 168th St, MC-28, New York, NY 10032
| | - Jonathan K Kazam
- From the Department of Diagnostic Radiology, New York Presbyterian Hospital/Columbia University Medical Center, 630 W 168th St, MC-28, New York, NY 10032
| | - Tony T Wong
- From the Department of Diagnostic Radiology, New York Presbyterian Hospital/Columbia University Medical Center, 630 W 168th St, MC-28, New York, NY 10032
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22
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23
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Hootnick DR, DeSesso JM, Vargesson N. Congenital Embryonic Arterial and Skeletal Dysgeneses. Radiographics 2016; 36:1257. [DOI: 10.1148/rg.2016150243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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