• Skip to main content
  • Skip to primary sidebar
  • Skip to footer
  • General Ortho
  • Procedures
  • Spine
  • Upper Limb
  • Lower Limb
  • Pain
  • Trauma
  • Tumors
  • Newsletter/Updates
  • About Us
  • Contact Us

Bone and Spine

Orthopedic health, conditions and treatment

Dysplasia Epiphysealis Hemimelica or Trevor Disease

By Dr Arun Pal Singh

In this article
    • Classification
      • Classic Form
      • Localized Form
      • Generalized form
    • Causes of Dysplasia Epiphysealis Hemimelica
    • Presentation of Dysplasia Epiphysealis Hemimelica
    • Differential Diagnoses
    • Imaging
      • Xrays
      • CT
      • MRI
    • Treatment of Dysplasia Epiphysealis Hemimelica
    • Complications
    • Outcome and Prognosis

Dysplasia epiphysealis hemimelica or Trevor disease rare, a non-hereditary disease characterized by osteochondromas arising from the epiphyses.

The incidence is about 1 in 1 million. Males are three times more commonly affected than females.

The condition was first described in 1926 by Mouchet and Belot and then by Trevor in 1950. The term dysplasia epiphysealis hemimelica was coined by Fairbank in 1956.

It is thought to be a variant of osteochondroma arising from an epiphysis.

Though it is a benign disorder, in its natural history, the lesion continuously increases in size until skeletal maturity [Just like osteochondroma] leading to pain and arthrosis.

Typically, only one half of the epiphysis is involved bur involvement of the entire epiphysis is known. The medial side of the epiphysis is most commonly affected

It usually presents in young children. The lower extremity is more common than upper extremity and distal ends are more affected especially on the medial side. The distal femur and talus, navicular and first cuneiform joint are most commonly affected.

Reconstructed CT image of tibial lesion of dysplasia epiphysealis hemimelica, Image courtsey From the case Dr Preetam Gongidi/Radiopaedia
Reconstructed CT image of tibial lesion of dysplasia epiphysealis hemimelica, Image courtesy From the case Dr Preetam Gongidi/Radiopaedia [Image cropped for better appearance]

Classification

By Azouz et al

Classic Form

The distribution involves more than one bone or epiphysis within a single lower limb

Localized Form

Single bone is affected either on one side or both sides.

Generalized form

This type involves the whole of the limb from pelvis to foot

Causes of Dysplasia Epiphysealis Hemimelica

The cause is uncertain but is thought to be congenital but is not genetically transmitted.

Presentation of Dysplasia Epiphysealis Hemimelica

Hard painless swelling or a mass on one side of a joint and stiffness are common complaints.

There would be deformity and muscle wasting in the area. Limb length discrepancy could be present. Sometimes, the problem of joint locking can also be complained.

Differential Diagnoses

  • Chondroblastoma
  • Osteochondroma
  • Enchondroma

Imaging

Xrays

Radiographs show an irregular mass with focal ossification arising from one side of the affected epiphysis. Widening of the joint may be noted.

CT

CT is able to define a relation between the mass and its parent bone. It also is useful for evaluation of the articular cartilage and soft tissue.

MRI

MRI depicts the unossified cartilaginous mass and status of the articular cartilage in detail. It is able to differentiate abnormal epiphyseal growth from the main epiphysis.

Treatment of Dysplasia Epiphysealis Hemimelica

The treatment should be carried out if there is a deformity, pain, or interference with function. Excision of the mass and corrective osteotomy with preservation of joint is the usual treatment

No treatment is indicated if there is no symptom or mechanical block ..

In cases where surgery is not required ie. mild symptoms, supportive joint care, joint splintage and other measures to control symptom are taken.

Complications

Recurrence, degenerative osteoarthritis, fixed deformity, leg-length discrepancy, and loose bodies following fragmentation.

Outcome and Prognosis

Untreated dysplasia epiphysealis hemimelica involves joint and can cause considerable disability if not treated.

Recurrence is known.

Spread the Knowledge
  • 8
    Shares
  •  
    8
    Shares
  • 1
  • 7
  •  
  •  
  •  

Filed Under: Pediatric

About Dr Arun Pal Singh

Arun Pal Singh is an orthopedic and trauma surgeon, founder and chief editor of this website. He works in Kanwar Bone and Spine Clinic, Dasuya, Hoshiarpur, Punjab.

This website is an effort to educate and support people and medical personnel on orthopedic issues and musculoskeletal health.

You can follow him on Facebook, Linkedin and Twitter

Reader Interactions

Comments

  1. daniel mwamuti says

    October 24, 2020 at 6:30 pm

    hello am daniel from Kenya ,a student taking orthopedic and trauma med at Kenya medical training college ,have always enjoyed your updates on the course ,I may wish to work together with you in future coz you are really helpful

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Primary Sidebar

chemonucleolysis

Chemonucleolysis – Indications, Procedure and Outcome

Chemonucleolysis is the term used to denote chemical destruction of nucleus pulposus [Cehmo+nucleo+lysis]. This involves the intradiscal injection of chymopapain which causes hydrolysis of the cementing protein of the nucleus pulposus. This causes a decrease in water binding capacity leading to a reduction in size and drying the disc. Chemonucleolysis is one of the methods […]

myasthenia gravis

Myasthenia Gravis Causes, Symptoms and Treatment

The term myasthenia gravis has a Latin and Greek origin. ItĀ  literally means “grave muscle weakness.” Myasthenia Gravis is a chronic autoimmune neuromuscular disease that results in by varying degrees of weakness of the skeletalĀ  muscles of the body. This weakness increases during periods of activity and improves after periods of rest. Certain muscles such […]

Causes of shoulder impingement syndrome

Shoulder Impingement Syndrome

Shoulder impingement syndrome is said to occur when there is impingement of tendons of the rotator cuff and/or bursa in the shoulder in subacromial space [ from bones of the shoulder. Repeated impingement leads to irritation and inflammation of the structures irritated and inflamed as they pass through the subacromial space, the passage beneath the […]

Classification of Scapular Fractures

Scapula Fracture- Types, Presentationa and Treatment

Scapula fracture is an uncommon injury. The scapula is a bone that sits congruently against the ribs and stabilizes the upper extremity against the thorax. It links the upper extremity to the axial skeleton through the glenoid, the acromioclavicular joint, clavicle, and the sternoclavicular joint. The low incidence of scapula fracture has been attributed to […]

ASIA score chart

ASIA Score and Spinal Injury Classification

ASIA score is the score developed by the American Spinal Injury Association for essential minimal elements of neurologic assessment for all patients with a spinal injury. This is based on scores as assessed by the examiner and is popularly called ASIA score. These minimal elements are strength assessment of ten muscles on each side of […]

drug resistant tuberculosis

Drug Resistant Tuberculosis – Types and Treatment

A person is said to have drug-resistant tuberculosis if the tuberculous bacteria that the person is infected with, will not respond to, and are resistant to, at least one of the main antitubercular drugs. Drug-resistant tuberculosis occurs when bacteria become resistant to the drugs used to treat TB. This means that the drug can no […]

Sinding Larsen Johansson disease

Sinding Larsen Johansson Disease

Sinding Larsen Johansson disease [ also known as Sinding-Larsen disease or Larsen-Johannson syndrome] is a type of osteochondrosis that affects the proximal end of the patellar tendon as it inserts into the inferior pole of the patella, and represents a chronic traction injury or overuse injury of the immature osteotendinous junction. It is a closely […]

Browse Articles

Footer

Pages

  • About
    • Policies
    • Contact Us

Featured Article

Osteomyelitis Presentation and Treatment

Osteomyelitis literally means inflammation of bone and its marrow regardless of whether it is due to pyogenic organisms, tuberculosis, syphilis, a … [Read More...] about Osteomyelitis Presentation and Treatment

Search Articles

© Copyright: BoneAndSpine.com