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Guided Growth in Leg Length Discrepancy in Beckwith-Wiedemann Syndrome: A Consecutive Case Series. CHILDREN 2021; 8:children8121152. [PMID: 34943348 PMCID: PMC8700625 DOI: 10.3390/children8121152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 11/17/2022]
Abstract
Beckwith-Wiedemann Syndrome (BWS) is a rare genetic disorder characterized by overgrowth, macroglossia, abdominal wall defects, neonatal hypoglycemia, predisposition to embryonal tumor, lateralized overgrowth, and leg length discrepancy (LLD), which can affect normal posture and gait. Aim of this study was to evaluate the effects of guided growth (temporary epiphysiodesis technique) as LLD management in BWS patients. Between 2007 and 2021, 22 BWS patients (15 F, 7 M) with a mean age of 7.9 years (2.9–14.4) and a mean LLD at first surgery of 3.65 cm (2–10), underwent temporary proximal tibial (PTE) and distal femur epiphysiodesis (DFE). In 18 patients the first surgical procedure was PTE, in one, DFE, and in 3 cases, PTE and DFE at the same time, respectively. Eleven patients reached equality of leg length after a mean follow-up of 7.7 years (3.7–13.0) and mean age of 13.3 years (12.7–27.5); 10 patients underwent 3 surgical procedures, one 7 procedures. Fifteen patients had no complications. No severe complications, infection, articular stiffness, or neuro-vascular lesions occurred in remaining patients; complications included secondary varus or valgus axial deviation in a total of 6 patients, and two screw breakages in two patients. Guided growth as a minimally invasive procedure seems efficient for LLD treatment with low complication rate in BWS patients.
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Carli D, De Pellegrin M, Franceschi L, Zinali F, Paonessa M, Spolaore S, Cardaropoli S, Cravino M, Marcucci L, Andreacchio A, Resta N, Ferrero GB, Mussa A. Evolution over Time of Leg Length Discrepancy in Patients with Syndromic and Isolated Lateralized Overgrowth. J Pediatr 2021; 234:123-127. [PMID: 33465347 DOI: 10.1016/j.jpeds.2021.01.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To provide information on evolution over time of leg length discrepancy in patients with syndromic and isolated lateralized overgrowth. STUDY DESIGN This retrospective study investigates leg length discrepancy longitudinally in 105 patients with lateralized overgrowth either isolated (n = 37) or associated with Beckwith-Wiedemann spectrum (n = 56) or PIK3CA-related overgrowth spectrum (n = 12). Discrepancy was measured by standard methods and categorized as minor, mild, severe, and critical, based on the thresholds of 1, 2 and 5, respectively. RESULTS The period of observation from diagnosis was 1.7 ± 2.6 to 9.0 ± 6.0 years. Leg length discrepancy was 11.0 ± 7.2 mm at diagnosis and 17.1 ± 14.4 mm at last visit. Both final leg length discrepancy and change over time were correlated with discrepancy at diagnosis (r2 = 0.45, P < .001 and r2 = 0.05, P = .019, respectively). Among minor leg length discrepancy at diagnosis, 47.5% remained minor, 40.0% become mild, and 12.5% severe. Among patients with discrepancy classified as severe at diagnosis, 84.6% remained severe and 15.4% evolved to critical. The isolated lateralized overgrowth group showed a milder evolution over time compared with Beckwith-Wiedemann spectrum and PIK3CA-related overgrowth spectrum groups. Among patients with Beckwith-Wiedemann, those with paternal chromosome 11 uniparental disomy had more severe leg length discrepancy at diagnosis and evolution over time. CONCLUSIONS Leg length discrepancy associated with isolated or syndromic lateralized overgrowth tends to worsen with growth and correlates with discrepancy at first observation. Among the genotypic groups, isolated lateralized overgrowth tends to have a milder evolution, whereas Beckwith-Wiedemann spectrum predisposes to a more severe outcome, especially if associated with paternal chromosome 11 uniparental disomy genotype.
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Affiliation(s)
- Diana Carli
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | | | - Luisa Franceschi
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | - Federica Zinali
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | - Matteo Paonessa
- Pediatric Orthopedic and Traumatology Unit, Department of Children Health and Cure, Regina Margherita Children Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Simone Spolaore
- Pediatric Orthopedic and Traumatology Unit, Department of Children Health and Cure, Regina Margherita Children Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Simona Cardaropoli
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | - Mattia Cravino
- Pediatric Orthopedic and Traumatology Unit, Department of Children Health and Cure, Regina Margherita Children Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Lorenzo Marcucci
- Pediatric Orthopedic and Traumatology Unit, San Raffaele Hospital, Milan, Italy
| | | | - Nicoletta Resta
- Medical Genetics, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari Aldo Moro, Bari, Italy
| | - Giovanni Battista Ferrero
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy; Pediatric Clinical Genetics Unit, Department of Children Health and Cure, Regina Margherita Children Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alessandro Mussa
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy; Pediatric Clinical Genetics Unit, Department of Children Health and Cure, Regina Margherita Children Hospital, Città della Salute e della Scienza di Torino, Torino, Italy.
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