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Hip Pathology in Majewski Osteodysplastic Primordial Dwarfism Type II

Karatas, Ali F. MD; Bober, Michael B. MD, PhD; Rogers, Kenneth PhD, ATC; Duker, Angela L. MS; Ditro, Colleen P. MSN, CPNP; Mackenzie, William G. MD

Journal of Pediatric Orthopaedics: September 2014 - Volume 34 - Issue 6 - p 585–590
doi: 10.1097/BPO.0000000000000183
Hip/Femur

Introduction: Majewski osteodysplastic primordial dwarfism type II (MOPDII) is characterized by severe prenatal and postnatal growth failure with microcephaly, characteristic skeletal dysplasia, an increased risk for cerebrovascular disease, and insulin resistance. MOPDII is caused by mutations in the pericentrin (PCNT) gene and is inherited in an autosomal-recessive manner. This study aimed to determine the incidence of hip pathology in patients with molecularly confirmed MOPDII and to describe the functional outcomes of surgical treatment.

Methods: Thirty-three enrolled patients had a clinical diagnosis of MOPDII. Biallelic PCNT mutations or absent pericentrin protein was confirmed in 25 of these patients. Twelve patients (7 female) had appropriate clinical and radiographic records at this institution and were included in this study. The data collected included age at presentation, age at surgery, sex, body weight and height, weight-bearing status at diagnosis, and the clinical examination.

Results: Four patients (31%) had coxa vara: 3 unilateral and 1 bilateral. Three unilateral patients had in situ pinning at a mean age 4 years. The patient with bilateral coxa vara had valgus osteotomy at the age of 5 years. Two children had bilateral hip dysplasia and subluxation with no surgery. One patient had bilateral developmental hip dislocations. The patient was treated by open reduction-spica cast and 2 years after surgery, coxa valga was noted. Another patient was diagnosed at an age of 12 years with bilateral avascular necrosis of the hips. Four patients did not have hip pathology.

Conclusions: Hip pathology is common among children with MOPDII; coxa vara is the most frequent diagnosis. Routine clinical and radiographic hip evaluation is important. The capital femoral epiphysis appears to slip down along the shaft, giving the appearance of a proximal femoral epiphysiolysis. A hip diagnosed with slipped capital femoral epiphysis in early life may progress to severe coxa vara.

Level of Evidence: Level IV.

Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE

The Potentials Foundation and the Walking with Giants Foundation partially funded this project.

The authors declare no conflicts of interest.

Reprints: William G. Mackenzie, MD, Department of Orthopedic Surgery, Nemours/Alfred I. duPont Hospital for Children, P.O. Box 269, Wilmington, DE 19899. E-mail: wmackenz@nemours.org.

© 2014 by Lippincott Williams & Wilkins