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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Down's Syndrome: Orthopaedic Considerations



- Associated Conditions:
    - ligament laxity
    - hypotonia
    - mental impairment
    - heart disease (50%)
    - endocrine disorders (hypothyroidism and diabetes)
    - premature aging
    - spinal abnormalities:
           - atlantoaxial rotatory subluxation in Down's syndrome
                 - evaluated with flexion and extension views of spine;
                 - C1/C2 fusion has a high complication rate in these patients and is usually reserved for patients w/ neurological comprimise (often w/ > 7 mm
                         of instability demonstrated on flexion/extension views);
           - scoliosis: may develop in upto 50% of patients;
           - spondylolithesis
           - references:
                 - Complications of posterior arthrodesis of the cervical spine in patients who have Down syndrome.
                 - Atlantoaxial dislocation in Down's syndrome: Report of 2 cases requiring surgical correction
                 - Chronic atlanto-axial instability in Down syndrome. 
                 - Atlantoaxial instability in individuals with Down's syndrome: A fresh look at the evidence.  
                 - Surgical treatment of symptomatic atlantoaxial subluxation in Down's syndrome.
    - hip joint:
           - SCFE
           - hip dysplasia:
                  - references:
                         - Hip disease in adults with Down syndrome.  
                         - The hip joint in Down's syndrome. A study of its structure and associated disease.
                         - Management of dislocation of the hip in Down Syndrome.  
                         - Dislocation of the hip in trisomy 21.  
                         - Total hip replacement in Down's Syndrome.  
                         - The hip joint in Down's syndrome. A study of its structure and associated disease.
                         - Total hip arthroplasty in patients with Down's syndrome.  

    - knee:
           - patella dislocation
                  - reference: Treatment of patellofemoral instability in Down's syndrome.
    - feet:
           - planovalgus feet;
           - severe planovalgus deformities may lead to midfoot breakdown during childhood, which may at first glance seem to resemble the hindfoot
                  valgus deformities often seen in cerebral palsy;
                  - unlike CP, there is probably few indications for surgical reconstruction



Orthopedic disorders in patients with Down's syndrome.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, May 30, 2012 3:54 pm