Re: Downs syndrome patients - Tim Stecher where are you?

[Guest guest]

Matt and - two of my prized pupils. You definately have the information correct.

Besides Downs and the inflammatory spondyloarthropathies (as previously mentioned) be aware that hyper-elastic connective tissue dysplasias like Marfans and Ehlers-Danlos may have compromised transverse ligaments. Also arthropathies we tend to think are peripheral like gout have shown up at C1-2 destroying the transverse ligament. So be cautious in adjusting the upper neck when suspicious of any of these conditions.

-- D. Stecher, DC,DACBR,CCSP Beaverton, OR www.xraydoctors.com (503)380-5333

--------- Constipation in 4 year old downs syndrome child> >Date: Mon, 07 Nov 2005 09:15:16 -0800> >> >Hi,> >My niece needs to poop.>> _________________________________________________________________> Is your PC infected? Get a FREE online computer virus scan from McAfeeR> Security. http://clinic.mcafee.com/clinic/ibuy/campaign.asp?cid=3963>>>>> OregonDCs rules:> 1. Keep correspondence professional; the purpose of the listserve is to> foster communication and collegiality. No personal attacks on listserve> members will be tolerated.> 2. Always sign your e-mails with your first and last name.> 3. The listserve is not secure; your e-mail could end up anywhere. >However,> it is against the rules of the listserve to copy, print, forward, or> otherwise distribute correspondence written by another member without >his or> her consent, unless all personal identifiers have been removed.>

[Guest guest]

Tim,

Do you know of any preponderance to slipped cap fem epiphysis or other hip dysplasias in Down's syndromes males?

Freeman Re: Downs syndrome patients - Tim Stecher where are you?

Matt and - two of my prized pupils. You definately have the information correct.

Besides Downs and the inflammatory spondyloarthropathies (as previously mentioned) be aware that hyper-elastic connective tissue dysplasias like Marfans and Ehlers-Danlos may have compromised transverse ligaments. Also arthropathies we tend to think are peripheral like gout have shown up at C1-2 destroying the transverse ligament. So be cautious in adjusting the upper neck when suspicious of any of these conditions.

-- D. Stecher, DC,DACBR,CCSP Beaverton, OR www.xraydoctors.com (503)380-5333

--------- Constipation in 4 year old downs syndrome child> >Date: Mon, 07 Nov 2005 09:15:16 -0800> >> >Hi,> >My niece needs to poop.>> _________________________________________________________________> Is your PC infected? Get a FREE online computer virus scan from McAfeeR> Security. http://clinic.mcafee.com/clinic/ibuy/campaign.asp?cid=3963>>>>> OregonDCs rules:> 1. Keep correspondence professional; the purpose of the listserve is to> foster communication and collegiality. No personal attacks on listserve> members will be tolerated.> 2. Always sign your e-mails with your first and last name.> 3. The listserve is not secure; your e-mail could end up anywhere. >However,> it is against the rules of the listserve to copy, print, forward, or> otherwise distribute correspondence written by another member without >his or> her consent, unless all personal identifiers have been removed.>

[Guest guest]

,

Don't know male vs. female incidence but it is reported that there is some hip

pathology(displasia/dislocation, SCFE, AVN) associated with Down syndrome. See

below:

Clin Orthop Relat Res. 1992 May;(278):101-7.

The hip joint in Down's syndrome. A study of its structure and associated

disease.

Shaw ED, Beals RK.

Oregon Health Sciences University, Portland 97201.

Clinical and roentgenographic examination of the hip was performed in 114

patients with Down's syndrome to study range of motion, roentgenographic

anatomy, and incidence of hip pathology. The study found increased external

rotation of the hip. Roentgenographic studies demonstrate that, in comparison

with a normal acetabulum, the acetabulum of a patient with Down's syndrome is

deep, more horizontally placed, and has increased anteversion. The proximal

femur of a patient with Down's syndrome has a normal neck-shaft angle and a

moderate increase in anteversion. Of the patients, 7.9% had some hip

abnormality, including dysplasia, dislocation, avascular necrosis, or slipped

capital femoral epiphysis.

J Pediatr Orthop. 2004 Sep-Oct;24(5):508-13.

Slipped capital femoral epiphysis in down syndrome.

Dietz FR, Albanese SA, Katz DA, Dobbs MB, Salamon PB, Schoenecker PL, Sussman

MD.

University of Iowa, Iowa City, Iowa 52242, USA. frederick-dietz@...

Slipped capital femoral epiphysis (SCFE) and Down syndrome are both uncommon in

the population at large, and rarely are both conditions present in a single

individual. Institutional records were searched for both Down syndrome and SCFE.

At least 2 years of follow-up was required. Eight patients were identified. At

presentation four patients could not walk due to pain and four could walk. Six

of eight hips presented with grade III SCFE. Four hips were treated with

internal fixation in situ and four were manipulatively reduced in the operating

room at the time of fixation with percutaneous screws or pins. Three hips healed

uneventfully. Five hips developed aseptic necrosis (three partial, two whole

head). This small retrospective study suggests an extremely high rate of

complications in adolescents with Down syndrome and SCFE.

J Pediatr Orthop. 2004 May-Jun;24(3):271-7.

Slipped capital femoral epiphysis in patients with Down syndrome.

Bosch P, ston CE, Karol L.

Texas ish Rite Hospital for Children, Dallas, Texas, USA.

The authors report their experience with eight patients (11 hips) with Down

syndrome who sustained a slipped capital femoral epiphysis (SCFE). Six patients

were diagnosed with hypothyroidism. All patients were greater than the 85th

percentile for body mass index. Initial treatment was by in situ pinning in all

hips. Six of the 11 slips progressed, 2 had collapse consistent with avascular

necrosis, and 1 developed collapse secondary to joint sepsis and osteomyelitis.

Additional surgery was necessary on seven hips. Four of eight hips followed

until maturity had substantial femoral head deformity. Three of these patients

had a noticeable limp and pain. Treatment of SCFE in patients with Down syndrome

is difficult and the prognosis is guarded. These patients should be screened for

hypothyroidism.

J Bone Joint Surg Br. 2005 Apr;87(4):544-7.

Periacetabular osteotomy in patients with Down's syndrome.

Katz DA, Kim YJ, Millis MB.

Department of Orthopaedic Surgery, Children's Hospital, 300 Longwood Avenue,

Boston, MA 02115, USA. katzdortho@...

We treated eight dysplastic acetabula in six skeletally mature patients with

Down's syndrome by a modified Bernese periacetabular osteotomy. The mean age at

the time of surgery was 16.5 years (12.8 to 28.5). Mean length of follow-up was

five years (2 to 10.4).Pre-operatively the mean (Tonnis) acetabular angle was 28

degrees, the centre-edge angle was -9 degrees, and the extrusion index was 60%;

post-operatively they were 3 degrees, 37 degrees, and 17%, respectively. Two

patients with post-operative (Tonnis) acetabular angles > 10 degrees developed

subluxation post-operatively and required secondary varus derotation femoral

osteotomies. Another patient developed a late labral tear which was treated

arthroscopically. All eight hips remain clinically stable, and are either

asymptomatic or symptomatically improved.These results suggest that the modified

Bernese periacetabular osteotomy can be used successfully in the treatment of

acetabular dysplasia in patients with Down's syndrome.

J Pediatr Orthop. 2003 Nov-Dec;23(6):708-13.

Posterior acetabular wall deficiency in Down syndrome.

Woolf SK, Gross RH.

Department of Orthopaedic Surgery, Medical University of South Carolina,

ton, USA.

Trisomy 21 or Down syndrome is the most common chromosomal anomaly and is

associated with musculoskeletal abnormalities related to a generalized

ligamentous laxity. Approximately 1% to 7% of Down syndrome patients have hip

instability. Prior studies on the topic recommend Salter innominate osteotomy,

capsular plication, and a varus derotational osteotomy of the proximal femur,

which typically is in an anteverted and valgus position. The authors present a

previously unreported bilateral finding in two patients noted on

three-dimensional reconstruction computed tomography: deficiency of the

posterior acetabular wall. Each was treated using a modification of the

Pemberton osteotomy in which a wedge of iliac crest graft is placed posteriorly

to hinge the posterior wall into a position of better posterior coverage of the

femoral head. Both patients' hips have remained stable more than 10 years

postoperatively. Follow-up imaging demonstrates well-remodeled osteotomy sites

and excellent posterior coverage of the femoral heads.

-

D. Stecher, DC,DACBR,CCSP

Beaverton, OR

www.xraydoctors.com

(503)380-5333

Tim,

Do you know of any preponderance to slipped cap fem epiphysis or other hip dysplasias in Down's syndromes males?

Freeman Re: Downs syndrome patients - Tim Stecher where are you?

Matt and - two of my prized pupils. You definately have the information correct.

Besides Downs and the inflammatory spondyloarthropathies (as previously mentioned) be aware that hyper-elastic connective tissue dysplasias like Marfans and Ehlers-Danlos may have compromised transverse ligaments. Also arthropathies we tend to think are peripheral like gout have shown up at C1-2 destroying the transverse ligament. So be cautious in adjusting the upper neck when suspicious of any of these conditions.

-- D. Stecher, DC,DACBR,CCSP Beaverton, OR www.xraydoctors.com (503)380-5333

--------- Constipation in 4 year old downs syndrome child> >Date: Mon, 07 Nov 2005 09:15:16 -0800> >> >Hi,> >My niece needs to poop.>> _________________________________________________________________> Is your PC infected? Get a FREE online computer virus scan from McAfeeR> Security. http://clinic.mcafee.com/clinic/ibuy/campaign.asp?cid=3963>>>>> OregonDCs rules:> 1. Keep correspondence professional; the purpose of the listserve is to> foster communication and collegiality. No personal attacks on listserve> members will be tolerated.> 2. Always sign your e-mails with your first and last name.> 3. The listserve is not secure; your e-mail could end up anywhere. >However,> it is against the rules of the listserve to copy, print, forward, or> otherwise distribute correspondence written by another member without >his or> her consent, unless all personal identifiers have been removed.>