Isolated lower limb hypoplasia secondary to congenital varicella syndrome: a rare occurrence and management of its complications

Isolated lower limb hypoplasia is a rare consequence of maternal congenital varicella syndrome (CVS). The hypoplastic limb is susceptible to multiple injuries, including fractures, especially if there is associated muscle weakness and lack of sensation. We describe a unique index case of a woman aged 26 years with a background of CVS who presented with a distal femur fracture following a fall onto her insensate, hypoplastic right leg. This report highlights the complexities involved in the diagnosis and management of fractures in patients with an anaesthetic limb, and in particular describes limb amputation as a successful treatment modality for distal femur fractures.

Spinal muscular atrophy variant with congenital fractures

A single report of brothers born to first-cousin parents with a form of acute spinal muscular atrophy (SMA) and congenital fractures suggested that this combination represented a distinct form of autosomal recessive SMA. We describe a boy with hypotonia and congenital fractures whose sural nerve and muscle biopsies were consistent with a form of spinal muscular atrophy. Molecular studies identified no abnormality of the SMN(T) gene on chromosome 5. This case serves to validate the suggestion of a distinct and rare form of spinal muscular atrophy while not excluding possible X-linked inheritance.

Unusual fetal movement in congenital myotonic dystrophy

Congenital myotonic dystrophy is the most extreme and early expression of a multisystem autosomal dominant disorder. Decreased fetal and infantile movement is a defining feature. We report a case of congenital myotonic dystrophy with an unusual pattern of persistent repetitive fetal movements detected by a Doppler fetal movement detector.

Correction of deformity after femoral birth fracture. 16-year follow-up

At birth a girl sustained a displaced femoral fracture that healed with considerable shortening and angulation. The correction by growth of the deformity was followed radiographically during the entire 16-year growth period.

Perinatal fractures in arthrogryposis multiplex congenita

Thirty-six patients with arthrogryposis have been followed at The James Lawrence Kernan Hospital of Baltimore since 1951. In this group, nine patients sustained 16 perinatal fractures. Femoral shaft fractures and epiphyseal separations were found more commonly in patients with fixed knee extension or dislocated hips and were related to relative stiffness and obstructed delivery. Femoral fractures were more common than humeral or tibial fractures. Arthrogrypotic infants displaying irritability and poor feeding are suspect of skeletal trauma. Thickening of limbs or joints may be the only clinical indication of fracture of epiphyseal injury. Plain radiographs of joints were inadequate for the diagnosis of epiphyseal separation when the epiphysis was not yet ossified. Arthrography is therefore recommended as a primary diagnostic tool.

[The operative treatment of the subtrochanteric pseudarthrosis of the femur in the case of pffd (author's transl)]

The authors discuss 7 cases of congenital subtrochanteric pseudarthroses of the femur which do not fit into the traditional schemes--neither from the histologically nor from the X-ray aspects. A valgus angulation osteotomy was carried out in each case. The procedure depending on the acutness of the angle. The results are positive.