Presentation
Full-color medical illustrations present key anatomic details in a clear manner. Thousands of digital-quality images depict the complete range of normal and abnormal imaging presentations. [books.google.com]
History 5 year old boy struck by car presenting with leg pain and knee abrasions. [mirc.luriechildrens.org]
Introduction A form of dwarfism characterized by irregular, delayed ossification at multiple epiphyses spectrum of disorders with a spectrum of phenotypes Epidemiology prevalence approximately 1:10000 presents between age 5-14 years of age location caused [orthobullets.com]
Attending, Pediatric Orthopaedic Surgery August 17, 1995 CLINICAL CASE PRESENTATION ORTHOPAEDIC DEPARTMENT THE ALFRED I. [gait.aidi.udel.edu]
Entire Body System
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Swelling
A rheumatoid disorder was suspected in one case because of the combination of joint pain and fusiform finger swelling (fig 1C). [jmg.bmj.com]
[…] multiple epiphyseal dysplasia are born with at least one abnormal feature, including an inward- and upward-turning foot ( clubfoot ), an opening in the roof of the mouth ( cleft palate ), an unusual curving of the fingers or toes ( clinodactyly ), or ear swelling [ghr.nlm.nih.gov]
[…] real incidence Usually evident early in childhood Clinical Features Great variation in distribution and extent of condition LLD a common feature Genu valgum may also be present Hands involved may grotesque swelling of digits Bowing of long bones also [flinders.edu.au]
The child (most often a boy) presents with a bony swelling on one side of the joint; several sites may be affected – all on the same side in the same limb, but rarely in the upper limb. 35. X-rays show an asymmetrical enlargement of the bony epiphysis [slideshare.net]
Clinical features of autosomal recessive MED associated with DTDST mutations include scoliosis and abnormal findings such as clubfoot, cleft palate, cystic ear swelling, and clinodactyly are present at birth in approximately 50% of individuals [ 16 ]. [bmcmusculoskeletdisord.biomedcentral.com]
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Fatigue
Early childhood can include waddling gait, fatigue with long walks, difficulty climbing stairs or running. Stature may be normal or short. In older children and adolescence there is an increased incidence of slipped femoral capital epiphysis. [mirc.luriechildrens.org]
Musculoskeletal
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Coxa Vara
The coxa vara deformity was corrected satisfactorily, and the femoral head was covered completely by the acetabulum. [healio.com]
The proximal femur shows features of congenital coxa vara i.e., a Fairbank's triangle which is not seen in rickets. [orthopaedicsone.com]
vara may occur; - knees: - genu valgum is common (consider early osteotomy); - abnormal normal ossification (tibial "slant sign") - flattened femoral condyles - ankles: References Early diagnosis of Multiple Epiphyseal Dysplasia. [wheelessonline.com]
Deformities such as coxa vara and genu vara/valgum can be seen. Radiographic presentation: Bilateral and symmetrical delay of long bone epiphyseal growth centers, most severe in lower extremities. [mirc.luriechildrens.org]
Irregular epiphyseal and physeal growth, skeletal deformities (coxa vara, genu valgum or varum), short limb dwarfism and short stubby hands and feet. Can present similar to bilateral Perthes' disease. [gait.aidi.udel.edu]
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Joint Deformity
Joint pain, joint deformity, waddling gait, and short stature are the main clinical signs and symptoms. [malacards.org]
The spectrum of hip joint deformity ranged from mild to severe. [healio.com]
deformities from joint incongruity hips are most common joint involved valgus knee deformity common early OA joint contractures short, stubby fingers and toes normal neurologic exam normal intelligence spine is normal normal facies Imaging Radiographs [orthobullets.com]
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Normal Stature
However, some patients in the normal- stature group showed involvement of distal radial epiphyses, and some patients in the short- stature group did not have stubby fingers. [journals.lww.com]
Recessively inherited multiple epiphyseal dysplasia with normal stature, club foot, and double layered patella caused by a DTDST mutation. J Med Genet 1999 ; 36 : 621 –4. [jmg.bmj.com]
stature, with normal neck development and absence of hearing loss and hepatomegaly. [patient.info]
Recessively inherited multiple epiphyseal dysplasia with normal stature, club foot, and double layered patella caused by a DTDST mutation. J Med Genet. 1999 Aug;36(8):621-4. Unger S, Hecht JT. [ghr.nlm.nih.gov]
View Article PubMed Google Scholar Superti-Furga LN A, Riebel T, Eich G, Steinmann B, Spranger J, Kunze J: Recessively inherited multiple epiphyseal dysplasia with normal stature, club foot, and double layered patella caused by a DTDST mutation. [bmcmusculoskeletdisord.biomedcentral.com]
Urogenital
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Pelvic Pain
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Workup
Probably needs a metabolic workup to r/o rickets. Also get x rays of the remaining joints of upper extremity. Regards, Sanjeev Sabharwal Pediatric Orthopedics E-mail: [email protected] FROM: K I. [orthopaedicsone.com]
Ultrasound
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Ovarian Mass
Features new practice guidelines for obstetric evaluation (including first trimester assessment) and gynecologic management (including evaluation of the endometrium and of ovarian masses). [books.google.com]
Treatment
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As for grade III hips, no satisfactory outcomes of surgical treatment have been reported. [healio.com]
Treatment & Complications Rx:-supportive treatment for pain and hydration Splintage of affected part Antibiotic therapy Surgical drainage. [slideshare.net]
Multiple Epiphyseal Dysplasia Treatment Sadly, there is no permanent cure for MED as such. [cyclicx.com]
Prognosis
Gloomy prognosis [ Back to the Top ] Metaphyseal Dysplasias (hyperdysplasias) 1. [flinders.edu.au]
[…] polydactyly with skeletal dysplasia usually indicates short rib polydactyly syndrome, chondrodysplasia punctata, or asphyxiating thoracic dysplasia Treatment and prognosis The prognosis is widely variable, ranging from being lethal to very mild cosmetic [radiopaedia.org]
Molecular analysis is likely to expand the clinical spectrum of MED and may also provide data relevant to prognosis and future therapeutic intervention. The overall incidence of MED is estimated to be 1 in 10,000 births. [eurofinsclinicalgenetics.co.in]
Coxa vara in chondrodysplasia: prognosis study of 35 hips in 19 children. [lpamrs.memberclicks.net]
Etiology
The exact etiology of MED remains unclear. [emedicine.medscape.com]
Pseudoachondroplasia and multiple epiphyseal dysplasia: New etiologic developments. Source/Author: Unger S, Hecht JT. Am J Med Genet. 2001 Winter;106(4):244-50. Abstract Discussion of the genetic etiology of MED and pseudoachondroplasia. [lpamrs.memberclicks.net]
DUPONT INSTITUTE WILMINGTON, DELAWARE Etiology/History: .First described by Fairbanks in 1937 One of the osteochondrodysplasias. Inherited disorder, that is predominantly autosomal dominant. [gait.aidi.udel.edu]
雑誌 Pediatr Pathol Mol Med 22:53-75 (2003) 文献 PMID: 11891674 著者 Unger S, Hecht JT タイトル Pseudoachondroplasia and multiple epiphyseal dysplasia: New etiologic developments. [genome.jp]
Etiology: The genetic basis for this disorder is now reasonably well understood. MED is a heterogeneous disorder. [posna.org]
Epidemiology
Relevant External Links for MATN3 Genetic Association Database (GAD) MATN3 Human Genome Epidemiology (HuGE) Navigator MATN3 Atlas of Genetics and Cytogenetics in Oncology and Haematology: MATN3 No data available for Genatlas for MATN3 Gene Mutations in [genecards.org]
Introduction A form of dwarfism characterized by irregular, delayed ossification at multiple epiphyses spectrum of disorders with a spectrum of phenotypes Epidemiology prevalence approximately 1:10000 presents between age 5-14 years of age location caused [orthobullets.com]
Congenital generalised bone dysplasias: a clinical, radiological, and epidemiological survey. J Med Genet. 1989; 26(1):37-44. Wynne-Davies R, Gormley J. The prevalence of skeletal dysplasias. [healio.com]
Epidemiology: Clinical Findings: Patients typically present later in childhood with joint pain in the lower extremities, decreased range of motion, gait disturbance, or angular deformities of the knees, such as genu varum or valgum. [posna.org]
Epidemiology The incidence is unknown but estimates have ranged from 1 case per 75,000 people in Northern Ireland to 1 case per 200,000 people in British Columbia. [ 2 ] Inheritance is as autosomal recessive trait. [patient.info]
Pathophysiology
Pathophysiology delay of epiphyseal endochondral ossification lack of osseous support yields secondary articular cartilage deformity most commonly affects proximal femur and proximal humerus Genetics autosomal dominant is most common mutation in COMP [orthobullets.com]
The exact pathophysiological mechanism is unclear; however it is most probably associated with the expression of type II and IX collagen in the inner ear 2, 4. [centogene.com]
Pathophysiology Cartilage oligomeric matrix protein (COMP) and matrilin-3 (MATN3) are thought to bridge extracellular matrix proteins. Collagen IX is important for the adhesive properties of cartilage. [emedicine.medscape.com]
Cartilage: Volume 2: Pathophysiology. 2017 Journal Articles Refereed Best practices in peri-operative management of patients with skeletal dysplasias. American Journal of Medical Genetics. [findanexpert.unimelb.edu.au]
Prevention
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Mutations in the COMP or MATN3 gene prevent the release of the proteins produced from these genes into the spaces between the chondrocytes. [ghr.nlm.nih.gov]
Sulforaphane in Broccoli is powerful anti-cancer agent Vitamin deficiencies will lead to depression and mood swings Healing menopause symptoms naturally Tips for disease prevention in kids Common allergens to look out for [cyclicx.com]
(PMID: 15523498) Jakkula E … Ala-Kokko L (European journal of human genetics : EJHG 2005) 3 22 45 60 Multiple epiphyseal dysplasia mutations in MATN3 cause misfolding of the A-domain and prevent secretion of mutant matrilin-3. [genecards.org]
Intraoperatively, excision of the greater trochanter growth plate is necessary, which can prevent the overgrowth of the greater trochanter postoperatively. [healio.com]