Module 31, General Orthopaedist Level

1,2,3,4,5

This 3 year boy presented with shortening of the right humerus. Clinical examination revealed 4 cm shortening of right arm and painless limitation of ROM of right shoulder; abduction was 150 degrees with 80 degrees at the glenohumeral joint and internal rotation was significantly limited(image 1). There was also a 1 cm shortening of the right leg and a 10 degree valgus deformity of the same knee(image 2). Radiological examination showed absence of proximal epiphysis of the right humerus(image 1)with marked deformity of the metaphyseal region. By age 11 the child had a good gait pattern however the upper extremity length discrepancy was becoming a cosmetic and functional concern. X-rays at age 11 show significant angulation developed in the humerus(image 3,4 & 5). However tibial growth was good .

Question 31A

These deformities can all be explained by a neonatal septic event.

Question 31B

Epiphysiodesis of the left humerus should be considered as part of the limb equalization procedure.

Question 31C

Correction of the angular deformity should be considered as part of the treatment.

Question 31D

One stage lengthening on the right humerus would be a reasonable consideration.

Question 31E

The best timing for surgical treatment of the humerus is to wait until the completion of the child's growth so there is no risk of further growth plate injury.