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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.