1
|
Jeandel C, Aldugman T, Delfour C, Cottalorda J, Louahem D, Delpont M, Prodhomme O. Dysplasia Epiphysealis Hemimelica Presenting as Multiple Loose Bodies: A Case Report. JBJS Case Connect 2021; 11:01709767-202112000-00012. [PMID: 34648471 DOI: 10.2106/jbjs.cc.21.00023] [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 11-year-old boy with no medical history presented with a protective limp and worsening mechanical pain in his left knee. No recent traumatic or infectious history was reported. Radiographs and ultrasonography showed multiple intra-articular loose bodies with osteocartilaginous signal. Dysplasia epiphysealis hemimelica (DEH) was confirmed by magnetic resonance imaging (MRI) and computed tomography (CT) scan. This is the first report that describes the presence of loose bodies in a knee without previous surgery as a possible case of DEH. CONCLUSION We emphasize the use of CT scan and MRI before any surgical procedure when intra-articular loose bodies are unexpectedly discovered.
Collapse
Affiliation(s)
- Clément Jeandel
- Pediatric Orthopaedic Surgery Department, Centre Hospitalier Universitaire Lapeyronie, Montpellier, France.,University of Montpellier, Faculty of Medicine, Montpellier, France
| | - Tariq Aldugman
- Pediatric Orthopaedic Surgery Department, Centre Hospitalier Universitaire Lapeyronie, Montpellier, France
| | | | - Jérôme Cottalorda
- Pediatric Orthopaedic Surgery Department, Centre Hospitalier Universitaire Lapeyronie, Montpellier, France.,University of Montpellier, Faculty of Medicine, Montpellier, France
| | - Djamel Louahem
- Pediatric Orthopaedic Surgery Department, Centre Hospitalier Universitaire Lapeyronie, Montpellier, France
| | - Marion Delpont
- Pediatric Orthopaedic Surgery Department, Centre Hospitalier Universitaire Lapeyronie, Montpellier, France.,University of Montpellier, Faculty of Medicine, Montpellier, France
| | - Olivier Prodhomme
- Pediatric Orthopaedic Surgery Department, Centre Hospitalier Universitaire Lapeyronie, Montpellier, France
| |
Collapse
|
2
|
Ionescu A, Popescu B, Neagu O, Carp M, Tevanov I, Balanescu L, Balanescu RN. Dysplasia Epiphysealis Hemimelica (Trevor's Disease) in Children, Two New Cases: Diagnosis, Treatment, and Literature Review. CHILDREN-BASEL 2021; 8:children8100907. [PMID: 34682172 PMCID: PMC8600412 DOI: 10.3390/children8100907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/02/2021] [Accepted: 10/06/2021] [Indexed: 11/16/2022]
Abstract
Dysplasia epiphysealis hemimelica (DEH), also known as Trevor’s disease, is a rare nonhereditary skeletal disorder affecting one side of the epiphyses or the epiphyses-equivalents. It is often misdiagnosed for traumatic injuries, infections, or other tumors because of the nonspecific clinical features. The diagnosis is mostly based on radiographic involvement of one half of the epiphysis displaying an overgrowth; it is hard to distinguish between DEH and osteochondroma on the gross hystopathological exam. There are few immunohistochemical markers, as well as genetic tests, for EXT1 and EXT2 gene expression that can reveal a more accurate diagnosis. No evidence of malignant changes has been reported and no hereditary transmission or environmental factor has been incriminated as an etiological factor. The natural history of the disease is continuous growth of the lesions until skeletal maturity. Without treatment, the joint might suffer degenerative modification, and the patient can develop early onset osteoarthritis. In the present paper, we report two new cases of DEH of the ankle. The aim of this paper is to consider Trevor’s disease when encountering tumoral masses in the epiphyses of pediatric patients and to present our treatment approach and results.
Collapse
Affiliation(s)
- Adelina Ionescu
- Department of Pediatric Orthopedic Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania; (A.I.); (B.P.); (I.T.)
| | - Bogdan Popescu
- Department of Pediatric Orthopedic Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania; (A.I.); (B.P.); (I.T.)
| | - Oana Neagu
- Department of Pathology, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania;
| | - Madalina Carp
- Department of Pediatric Orthopedic Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania; (A.I.); (B.P.); (I.T.)
- Correspondence: or ; Tel.: +40-21-316-93-72
| | - Iulia Tevanov
- Department of Pediatric Orthopedic Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania; (A.I.); (B.P.); (I.T.)
| | - Laura Balanescu
- Department of Pediatric Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania; (L.B.); (R.N.B.)
- Department of Pediatric Surgery and Orthopedics, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| | - Radu Ninel Balanescu
- Department of Pediatric Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania; (L.B.); (R.N.B.)
- Department of Pediatric Surgery and Orthopedics, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| |
Collapse
|
3
|
Mohamadian H, Bahardoust M, Sanandaji BM, Saberi S. Dysplasia epiphysealis hemimelica of the radial head: a rare case report. BMC Musculoskelet Disord 2021; 22:151. [PMID: 33546632 PMCID: PMC7866645 DOI: 10.1186/s12891-021-04004-2] [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: 05/02/2020] [Accepted: 01/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background Dysplasia epiphysealis hemimelica (DEH) is a rare benign overgrowth generally affecting the epiphyses and short bones of the lower limbs. DEH in the elbow joint is extremely rare, and to date, only three cases of DEH have been reported in the radial head. Case presentation In this study, we report a case of DEH located in the radial head of the right elbow of a 10-year-old boy, which was presented with elbow pain and limited range of motion. In clinical examination, an asymmetrical enlargement was observed over the elbow. The lesion was resected surgically, and the patient’s symptoms resolved afterward. The histologic analysis of the lesion confirmed the diagnosis of DEH. Conclusion This report highlights the role of DEH in the differential diagnosis of elbow pathologies, particularly its differentiation from osteochondroma.
Collapse
Affiliation(s)
- Hiva Mohamadian
- Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Mansour Bahardoust
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Saba Saberi
- Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
4
|
Knee orthopedic problems in newborns and infancy: a review. Curr Opin Pediatr 2020; 32:113-119. [PMID: 31789974 DOI: 10.1097/mop.0000000000000859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW We present the reader with insight on the most common disorders of the knee in newborns and infants. Knee issues in this population may confuse the first contact physicians due to certain peculiarities of the immature immune system, small size and underdevelopment of joint anatomy. Data presented here are recent and significant, and something to bear in mind when caring for children of this age. RECENT FINDINGS With the advent of new diagnostic methods, a shift in the causative agent of pediatric knee infections has been noted. Minimally invasive methods such as arthrocentesis and arthroscopy are successfully employed in treatment of knee problems in newborns and infants. A trial of conservative therapy in congenital patellar instability can give good results, and obviate the need for surgery in some cases. Various syndromes that affect the knee have specific characteristics that need to be recognized early to avoid problems in the future. SUMMARY Although rare, knee problems in infants can and do occur. Their cause varies significantly and good outcomes require a multidisciplinary approach. Early diagnosis, referral and initiation of treatment protocols can significantly influence the fate of the joint and with it the patients' functional status for life.
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Li B, Wen J, Liu H, Xiao S, Li X, Fang K, Zeng M, Tang Z, Cao S, Lee B, Li F. Dysplasia epiphysealis hemimelica combined with contralateral accessory scaphoid bone: A case report and literature review. Medicine (Baltimore) 2019; 98:e17887. [PMID: 31702664 PMCID: PMC6855582 DOI: 10.1097/md.0000000000017887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Dysplasia epiphysealis hemimelica (DEH), also known as Trevor disease, is a rare, developmental bone disorder of childhood. PATIENT CONCERNS A 9-year-old girl was admitted due to pain in front of the medial malleolus of her right foot after a long walk or distance movement, in which the pain could be relieved after rest, while it was repeated and lasted for several months. DIAGNOSIS Dysplasia epiphysealis hemimelica INTERVENTIONS:: The patient underwent an open resection surgery. After operation, the pain was totally relieved. Postoperative pathological diagnosis showed DEH. OUTCOMES At the 6-month follow-up, pain and claudication symptoms fully disappeared, and range of motion of the right foot returned to normal level. CONCLUSIONS Dysplasia epiphysealis hemimelica is an uncommon disease which can cause pain of foot in children. LESSONS When the pediatric orthopedic surgeon treated the children suffered with foot pain should be aware of this rare disease, especially accessory scaphoid bone was found in another foot.
Collapse
|
7
|
Ali MI, Padhye KP, Flood M, Schollenberg E, Logan KJ. Dysplasia Epiphysealis Hemimelica/Trevor Disease: Report of a Lesion Solely Involving the Lunate Bone: A Case Report. JBJS Case Connect 2019; 9:e0511. [PMID: 31651441 DOI: 10.2106/jbjs.cc.18.00511] [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 describe the case of a dysplasia epiphysealis hemimelica (DEH) lesion affecting uniquely the lunate bone in a 16-year-old boy causing pain, stiffness, and decreased range of motion. Surgical excision was performed, leading to resolution of primary symptoms with residual limitations in terminal wrist extension. CONCLUSIONS From our review of the literature, we believe this case to be the first report of a DEH lesion affecting solely the lunate bone. Although conservative and surgical management have both been described with DEH cases, we report a positive outcome following the excision of a symptomatic lesion.
Collapse
Affiliation(s)
- Malik I Ali
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kedar P Padhye
- Division of Orthopaedic Surgery, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Meghan Flood
- Division of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Erica Schollenberg
- Department of Pathology and Laboratory Medicine, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Karl J Logan
- Division of Orthopaedic Surgery, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
8
|
Asymptomatic Dysplasia Epiphysealis Hemimelica of the Shoulder in a Skeletally Mature Patient with Normal Function. Case Rep Radiol 2019; 2019:5356246. [PMID: 31032136 PMCID: PMC6457295 DOI: 10.1155/2019/5356246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 03/18/2019] [Indexed: 11/23/2022] Open
Abstract
Dysplasia epiphysealis hemimelica is a rare osteocartilaginous overgrowth syndrome of bone epiphysis, mostly encountered in the lower limbs of immature skeleton patients. We report a case of proximal humerus presentation in an adult male, with neither articular involvement nor clinical dysfunction. This case highlights the importance of stratification into intra- and extra-articular lesions, as this distinction ultimately influences both symptoms and treatment outcome. In addition, the case highlights the importance of specific imaging modalities, such as CT and MR images, which provide excellent anatomic location of the lesion, adequate extension of cartilaginous components, exact status of articular cartilage, and accurate assessment of neighboring structures, such as vessels, nerves, ligaments, tendons, and muscles. The imaging features are described, the relevant literature is reviewed, and salient features are discussed.
Collapse
|
9
|
Jang E, Danford NC, Levin AS, Tyler WK. Intra-Articular Tumors: Diagnosis and Management of the Most Common Neoplasms Involving Synovial Joints. JBJS Rev 2018; 6:e8. [PMID: 30589749 DOI: 10.2106/jbjs.rvw.17.00210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Eugene Jang
- Department of Orthopaedic Surgery, Columbia University Medical Center/NY-Presbyterian Hospital, New York, NY
| | - Nicholas C Danford
- Department of Orthopaedic Surgery, Columbia University Medical Center/NY-Presbyterian Hospital, New York, NY
| | - Adam S Levin
- Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Wakenda K Tyler
- Department of Orthopaedic Surgery, Columbia University Medical Center/NY-Presbyterian Hospital, New York, NY
| |
Collapse
|
10
|
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]
|