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| Year : 2014 | Volume
: 60
| Issue : 3 | Page : 351 |
Valgus deformity caused by dysplasia epiphysealis hemimelica in the knee
AA Salunke1, GI Nambi2, J Shah3, C Dhamne4
1 Department of Orthopedic Surgery, Pramukswami Medical College, Anand, Gujrat, India; Division of Musculoskeletal Oncology, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
2 Hand and Reconstructive Microsurgery, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
3 Department of Orthopedic Oncosurgery, Aum Orthopaedic Hospital, Ahmadabad, Gujarat, India
4 Paediatric Oncology, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
| Date of Web Publication | 14-Aug-2014 |
Correspondence Address:
Dr. A A Salunke
Department of Orthopedic Surgery, Pramukswami Medical College, Anand, Gujrat, India; Division of Musculoskeletal Oncology, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0022-3859.138838
How to cite this article:
Salunke A A, Nambi G I, Shah J, Dhamne C. Valgus deformity caused by dysplasia epiphysealis hemimelica in the knee. J Postgrad Med 2014;60:351 |
Sir,
The April June 2014 issue of the journal brought to us an interesting case of valgus deformity caused by dysplasia epiphysealis hemimelica in the knee [1] and we wish to present an addendum.
Dysplasia epiphysealis hemimelica can be classified according to Auzoz et al. into three types i.e. localized or monostotic type, classical type with more than one area of involvement in a single lower limb (knee, ankle) and a generalized or severe type with involvement of entire lower limb(pelvis to foot). [2]
A bone scan is the preferred modality of investigation in these patients as compared to radiological skeletal survey for the assessment of entire skeletal system. [3] An arthrogram is useful for the assessment of articular surface and joint involvement. It evaluates the extent of cartilaginous mass and detects the epiphyseal plate involvement. [4] This test can be performed at a lower cost as compared to magnetic resonance imaging. The disadvantage of arthrogram is that it is invasive. Computerized tomography (CT) scan and an arthrogram helps for the assessment of anatomy of the epiphyses and affected joint. [5] Magnetic resonance imaging detects secondary osteoarthritic changes in the articular cartilage and soft tissue affection of surrounding ligaments, tendons and muscle. These imaging modalities assit in prognosis and an adequate surgical planning of osteotomy and soft tissue release procedures. [5]
Positron emission tomography of the patients with dysplasia epiphysealis hemimelica is useful to differentiate it from chondrosarcoma. For benign cartilage tumors, it shows a lower standardized uptake value (SUV) 0.96 (0.7 to 1.3) as compared to chondrosarcoma that has a higher standardized uptake value (SUV) 2.23 (1.3 to 3.3). [6]
Cartilaginous tumors with aggressive radiological features can be investigated with positron emission tomography as standardized uptake value is a useful parameter for tumor grading and prognosis. [6]
| :: References | |  |
| 1. | Zhu J, Cheng H, Yang C, Zhu Q. Valgus deformity caused by dysplasia epiphysealis hemimelica in the knee. J Postgrad Med 2014;60:77-80. 
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| 2. | Azouz RM, Slomic AM, Marton D, Rigault P, Finidori G. The variable manifestations of dysplasia epiphysealis hemimelica. Pediatr Radiol 1985;15:44-9.
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| 3. | Teixeira AB, Sá de Camargo Etchebehere EC, Santos AO, Lima MC, Ramos CD, Camargo EE. Scintigraphic findings of dysplasia epiphysealis hemimelica: A case report. Clin Nucl Med 2001;26:162.
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| 4. | Peduto AJ, Frawley KJ, Bellemore MC, Kuo RS, Foster SL, Onikul E. MR imaging of dysplasia epiphysealis hemimelica: Bony and soft-tissue abnormalities. AJR Am J Roentgenol 1999;172:819-23.
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| 5. | Ho AM, Blane CE, Kling TF Jr. The role of arthrography in the management of dysplasia epiphysealis hemimeliea. Skeletal Radiol 1986;15:224-7.
[PUBMED] |
| 6. | Aoki J, Watanabe H, Shinozaki T, Tokunaga M, Inoue T, Endo K. FDG-PET in differential diagnosis and grading of chondrosarcomas. J Comput Assist Tomogr 1999;23:603-8.
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