Module 4, Pediatric Orthopaedist Level

A four year old girl presented for evaluation of short stature. She was healthy, the product of a normal pregnancy and delivery. Her height was 80 cm, below the third percentile for her age. Her lower extremities were having mild joint pain and stiffness. She had short stubby hands and feet along with a waddling gait. Limb epiphyses show delayed appearing centers of ossification, often demonstrating a fragmented appearance. Joint involvement is symmetric. Diagnosis is Multiple Epiphyseal Dysplasia (MED).

Question 4A

The more severely involved the hands are, the more severe will be the hip and knee deformities.

Question 4B

Pseudoachondroplastic dysplasia and Perthes disease are in the differential diagnosis list of most of these patients.

Question 4C

AVN may develop in the femoral head in children with MED.

Question 4D

The main difference between Perthes disease of the hips and MED of the hips is that the MED are symmetrically affected.

Question 4E

The defect for MED has been located as a chromosomal defect.

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