Module 58, General Orthopaedist Level

1, 2, 3

An 11 year old white male presented with a diagnosis of Multiple Epiphyseal Dysplasia (MED). Initially he presented with x-rays revealing mild genu valgum (image1) which progressed (image2) such that he required surgery. He had a supracondylar osteotomy which was performed in 1993 for genu valgum(image3). Two years later he was last seen for low back pain.

Question 58A

Increased lordosis often occurs resulting in severe back pain. An MRI is indicated for a full work up to rule out nerve root compression.

Question 58B

A repeat knee osteotomy is likely required.

Question 58C

His hips are usually very sore and stiff in the morning. He should be worked up for possible rheumatoid arthritis.

Question 58D

The knee deformity in individuals with MED is usually very nearly symmetrical.

Question 58E

The basic defect is a disturbance in the development of the epiphyseal ossification centers.

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