engleski

Dysplasia epiphysealis hemimelica (Trevor's disease) in the knee joint - Arthroscopically buying time procedures in 6-year old boy

Introduction: Dysplasia epiphysealis hemimelica (DEH) also known as Trevor's disease is characterized by abnormal osteocartilaginous overgrowth in the epiphysis. Open physis patients are affected, presuming that besides early joint degeneration, axial deviations could be expected. When a knee joint is involved the usual presentation id a painless lump on a single side of the knee. Methods and Results: Here we report on a 6-year old boy presented to us with prominence on medial side of the left knee. Medical history was uninformative. Physical examination pointed to painless osseus mass tha gave appearance of slight valus knee deformity. Imaging workout confirmed the DEH on the medial condyle of the left femur. At initial surgeryloosebodies were removed arthroscopically followed by open resection of the osseocartilagineous lump. Expose cancellous bone surface at medial femoral condyle was treated with microfractures. Pronounced valgus instability was treated with plastic knee splint. Following surgery, patient was painless, and returned fully to activities of daily living with minimal sports restrictions. However, at one year of follow up, he complained on large effusion and knee locking. Second look arthroscopy showed repaired but soft cartilage at femoral medial condyle. Arthrocopic removal of big loose body and synovectomy were done. Patient is gradually returned to regular activities. Conclusions: When dealing with such complex knee disorder, onset of progression of symptoms (mass enlargement, reduction in range of motion, contracture, axial deviation, increased pain and swelling) indicates the need for surgery. Arthrocopy showed to be valuable method in treatment of DEH on the knee. The aim of this report is to increase awarness of DEH among orthopedic surgeons dealing with knee distrubances, and to underline important asspects of treatment of this rare disorder.

Trevor's disease, child ; knee ; arthrocopy

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