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Posterior acetabular wall deficiency in Down syndrome.
Shane K Woolf1, Richard H Gross
1Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, USA.
Journal of Pediatric Orthopedics
|October 29, 2003
Summary
Down syndrome (Trisomy 21) patients often have hip instability. A novel surgical technique addressing posterior acetabular wall deficiency provides long-term hip stability in these individuals.
Area of Science:
- Orthopedic Surgery
- Genetics
- Pediatric Orthopedics
Background:
- Down syndrome (Trisomy 21) is a common chromosomal anomaly characterized by generalized ligamentous laxity.
- Hip instability affects 1-7% of Down syndrome patients, often requiring surgical intervention.
- Previous treatments for hip instability in Down syndrome include Salter innominate osteotomy and proximal femoral osteotomy.
Observation:
- A previously unreported bilateral finding of posterior acetabular wall deficiency was observed in two patients with Down syndrome.
- Three-dimensional reconstruction computed tomography (3D CT) was utilized for diagnosis.
- The deficiency impacted the posterior coverage of the femoral head.
Findings:
- A modified Pemberton osteotomy was performed, incorporating an iliac crest bone graft.
- The graft was placed posteriorly to reconstruct and improve coverage of the posterior acetabular wall.
- Both patients achieved stable hips with excellent posterior coverage >10 years postoperatively.
Implications:
- This surgical modification offers a potential solution for hip instability in Down syndrome patients with posterior acetabular deficiency.
- Long-term follow-up demonstrates durable stability and good remodeling of the osteotomy sites.
- This technique may improve outcomes for a specific subset of hip instability in Down syndrome.