2. Skeletal dysplasias are a heterogeneous group of more than 200
disorders characterized by abnormalities of cartilage and bone
growth, resulting in abnormal shape and size of the skeleton
and disproportion of the long bones, spine, and head.
patients with disproportionately short stature have skeletal
dysplasia (osteochondrodysplasia).
Short stature is defined as height that is 3 or more standard
deviations below the mean height for age. If short stature is
proportional, the condition may be due to endocrine or
metabolic disorders or chromosomal or nonskeletal dysplasia
genetic defects.
3. During the 1950s and 1970s, many new bone dysplasias were
identified based on clinical manifestations, radiographic
findings, inheritance patterns, and morphology of the growth
plate.
In the 1980s, research focused on defining the natural history
and variability of the disorders.
In the 1990s, the focus shifted toward mutations and the
pathogenetic mechanisms
In 1997, the International Working Group on Bone Dysplasias
proposed a newly revised "International Nomenclature and
Classification of the Osteochondrodysplasias
4. Families of disorders -based on recent etiopathogenetic information concerning
the gene and/or protein defect involved
Component disorders result from mutations of the identical gene
Based on molecular genetic cause, the dysplasias grouped by the function of the
protein product of the causative gene
Many of the genes mutated in skeletal dysplasias encode proteins that play
critical roles in the growth plate.
An understanding of the role in growth plate function gives important clues into
the molecular pathology of the skeletal dysplasia
Mutations in type II collagen cause a large number of disorders classified as
spondyloepiphyseal dysplasia
Mutations in type IX collagen and cartilage oligomeric protein, cause multiple
epiphyseal dysplasia
5.
6. Epiphysial Dysplasia
A) Epiphysial Hypoplasia
1. Failure of cartilage – SED congenita & tarda
2. Failure of ossification – MED congenita & tarda
B) Epiphysial hyperplasia
1. Dysplasia epiphysialis hemimelica
Physial Dysplasias
A) Cartilage hypoplasia
1. Failure of proliferation – Achondroplasia cong. & tarda
2. Failure of hypertrophic – Metaphysial dysostosis
B) Cartilage hyperplasias
1. Excess proliferation – Hyperchondroplasia
2. Excess hypertrophy - Enchondromatosis
7. Metaphyseal Dysplasias
A) Metaphysial hypoplasias
1. Failure of primary spongiosa – Hypophosphatasia
2. Failure to absorb primary Spongiosa - Osteopetrosis
3. Failure to absorb sec. spongiosa – Craneo met.dysplas
B) Metaphysial hyperplasia
1. Excessive spongiosa – Multiple exostosis
Diaphyseal Dysplasias
A) Diaphyseal hypoplasia
1. Failure of perio. Bone formation – Osteogen. Imperfecta
2, Failure of endo. Bone formation- Idio.osteoporosis
B) Diaphyseal hyperplasia
1. Exc. Perio.bone – progressive diaphyseal dysplasia
2. Exc. Endo. Bone - Hyperphosphatasemia
8. The overall incidence -1 case per 4000-5000 births.
The true incidence may be twice as high.
Lethal skeletal dysplasias - 0.95 per 10,000 deliveries.
4 most common skeletal dysplasias are thanatophoric dysplasia, achondroplasia,
osteogenesis imperfecta, and achondrogenesis
Thanatophoric dysplasia and achondrogenesis account for 62% of all lethal
skeletal dysplasias.
Achondroplasia is the most common nonlethal skeletal dysplasia.
infants with skeletal dysplasias detected at birth, approximately 13% are stillborn,
and 44% die during the perinatal period.
The overall frequency of skeletal dysplasias in infants who die perinatally is 9.1
per 1000
9. Males are primarily affected in X-linked recessive disorders.
X-linked dominant disorders may be lethal in males.
Skeletal dysplasias are usually detected in the newborn period or
during infancy.
Some disorders may not manifest until later in childhood
10. Family History
Spontaneous abortions / still births
Parents , siblings & other relatives
Multiple affected siblings – normal parents – Auto.Rece
Affected parent – Autosomal dominant pattern
Abortion/still birth male / female = X linked
Affected male & maternal uncle = X recessive nature
Pregnancy & Birth history
Maternal hydramnios
Fetal hydrops
Reduced Fetal activity - lethal types of skeletal dysplasia
warfarin or phenytoin - stippling of the epiphyses
Still births - lethal chondrodysplasias
11. Anthropometric parameters ~ gestational age / chronologic age
short-limb skeletal dysplasia
Rhizomelic shortening - short proximal segment (achondroplasia,
hypochondroplasia, chondrodysplasia punctata, congenital short femur.
spondyloepiphyseal dysplasia, Jansen type of metaphyseal dysplasia
Mesomelic shortening - short middle segments (Langer and Nievergelt types of
mesomelic dysplasias, Robinow syndrome, and Reinhardt syndrome
Acromelic shortening – short distal segments (acrodysostosis and peripheral
dysostosis )
Acromesomelic shortening (acromesomelic dysplasia )
Micromelia – Entire short limb (achondrogenesis, fibrochondrogenesis, Kniest
dysplasia, dys-segmental dysplasia, and Roberts syndrome.)
Short trunk (Morquio syndrome, Kniest syndrome, Dyggve-Melchior-Clausen
disease, metatrophic dysplasia, SED, and spondyloepimetaphyseal dysplasia
(SEMD).
18. Conventional radiography – Most useful diagnostic tool
The skeletal survey - skull (anteroposterior [AP], lateral, and Towne
views), chest (AP), spine (AP and lateral), pelvis (AP), tubular bones
(AP), and/or hands and feet (AP)
Oval translucent area in proximal femora and humeri - Achondroplasia
Bowing of limbs (camptomelia) : Camptomelic dysplasia, osteogenesis imperfecta syndromes,
and thanatophoric dysplasia
Spikes at lateral femoral metaphyses : Thanatophoric dysplasia and achondrogenesis type I & II
Cupping of the ends of the rib and long bones and metaphyseal flaring : Achondroplasia,
metaphyseal dysplasias, asphyxiating thoracic dysplasia, and
chondroectodermal dysplasia
Long bone fractures : Osteogenesis imperfecta syndromes, hypophosphatasia, osteopetrosis, and
achondrogenesis type I (Parenti-Fraccaro syndrome)
Absence of epiphyseal ossification centers : SED congenita, multiple epiphyseal dysplasia, and
other SED
Cone-shaped epiphyses : cleidocranial dysplasia
Abnormal pelvic configuration : Achondroplasia, Ellis-van Creveld syndrome
Severe hypoplasia of the scapula: Camptomelic dysplasia and Antley-Bixler syndrome
19. CT scan and MRI of the skull and brain
Reveal concurrent brain anomalies
3D images - craniofacial anomalies
MRI of the spine
assess atlantoaxial instability , Spinal canal stenosis,
Narrowing of Foramen magnum, Cord oedema, Gliosis
Compressive Myelopathies, progressive spinal
deformities and scoliosis
CT 3D reconstruction : surgical planning for osteotomies for
complex pelvic and hip dysplasias
Other Tests :
Sleep studies, Molecular analyses, Cytogenetic study
20. Useful in cases with positive history of Dysplasia
2D ultrasonography : 60 % Reliability
3D ultrasonography – better tool with more accuracy specially in
facial dysmorphism and anomalies involving the hands and feet
Appropriate time : 30 weeks’ gestation
Possible Evaluation : Short limb Dysplasia
thoracic dimensions
fetal ribs
fetal spine
hands and feet
fetal craniofacial structures
fetal movement
maternal hydramnios, fetal hydrops, increased
nuchal translucency thickness, and other fetal anomalies, such as congenital
heart defects and cystic renal malformation .
21.
22.
23.
24.
25. Close monitoring during antenatal period
Prenatal detection - influence the obstetric and perinatal treatment
Treatment is supportive
Medical care : to prevent neurologic & orthopedic complications
Neonatal resuscitation and ventilatory support
Obstructive sleep apnea – Treated by adenotonsillectomy, weight
reduction, continuous airway pressure by a nasal mask, and
tracheostomy in extreme cases
Monitoring height, weight, and head circumference
Recombinant human growth hormone treatment
26. Thoracolumbar kyphosis – Prevented by brace & casts
Progressive kyphosis – Managed by anterior & posterior fusion
Canal decompression – To reduce oedema and cord compression
Correction of scoliosis with newer techniques & fusion
Ilizarov procedure – To lengthen short bones, correct angular
deformity
Bone marrow transplantation - congenital immune deficiencies,
mucopolysaccharidosis, lipidosis, osteopetrosis, and Gaucher
disease
Cesarean delivery - In mothers with skeletal dysplasia
Plastic reconstructive procedures for cranio facial naso cranial &
complex head & neck deformities.
27. Intrauterine complications:
Polyhydramnios and fetal hydrops IUGR , Int.Uterine death
Respiratory complications:
Respiratory distress, upper airway obstruction, hypoxic
episodes
CNS complications: Hydrocephalus , Foramen Magnum stenosis
Skeletal complications: C1-C2 InstabilityVertebral abnormalities,
hip dysplasia, tight and loose joints, bowed legs
Muscular complications: Truncal hypotonia leading to
kyphoscoliosis – Achondroplasia, MPS
Ophthalmologic complications : Myopia with MED –Stickler’s Syn
Kniest dysplasia and SED congenita
Dental complications - with many types of chondrodystrophy
28. Nutritional complications – Obesity, Failure to thrive &
severe malnutrition in oro-pharyngeal-palateal anomalies
Anesthesia – in some form of chondrodysplasias
Malignant hyperthermia – in osteogenesis imperfecta
Numerous obstetric and gynecologic problems
29. Certain skeletal dysplasia – lethal
Non lethal dysplasia – normal or near normal life
prognosis depends on the degree of skeletal abnormalities
and concomitant anomalies.
Socio-economic and marital concerns
Psychiatric issues and stigma – less in males Vs Females
Relevance of the disability label