• 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

Methylene blue injection in elbow

Intrarticular Methylene Blue Injection Procedure

Methylene blue injection is an easy and safe way to rule out or confirm breakage of the joint capsule when there is an injury near or around the joint,  thus establishing or ruling out the presence of open joint injury. Open joint injuries consist of are skin and soft-tissue injuries which communicate with the joint. It […]

Pellegrini Stieda Syndrome Lesion

Pellegrini Stieda Syndrome

Pellegrini Stieda syndrome is the presence of pain and limitations of movement of the knee in the patient with a previous injury to the medial collateral ligament of knee, due to ossification of the femoral attachment. The calcified lesion is known as Pellegrini Stieda lesion or sign. Most of the cases of Pellegrini Stieda lesions […]

Inlet outlet views of pelvic fractures

Pelvic Fractures- Presentation and Treatment

Pelvic fractures and soft tissue injuries break the continuity of pelvic ring. Most pelvic fractures are stable and occur with a low-energy mechanism of injury. However pelvic fractures can be unstable. These unstable fractures are usually a result of high energy trauma and are associated with injuries to surrounding viscera, vessels and nerves and are […]

odontoid fractures Classification

Dens or Odontoid Fractures

Odontoid fractures are fractures of dens or odontoid process of axis vertebra or C2. Dens is a strong, tooth-like process projecting upwards from the body of the axis. Fractures of the axis make up 27% of all cervical spine injuries. Fractures of the odontoid process are the most common subtype of axis fractures (41%). Odontoid […]

wound-dressings

Wound Dressings and Coverings

Wound care dressings and procedures aim at rapid covering healing of skin defects are for better wound healing. The best method for healing a wound is to close the defect by surgical means as quickly after the injury as possible. However, this may not always be possible. Where primary closure is not possible [ large […]

nail anatomy

Nail Anatomy and Funtions

The nail is an integral component of the digital tip. It is a unique hardened structure formed by keratinized squamous cells. Nail functions to protect the fingertip and provides a counterforce to tactile sensation and for aiding in the grip formed by fingertips [ as in pinching]. It is also involved in temperature control [thermoregulationion] which […]

anterior cruciate ligament injury

Anterior Cruciate Ligament Injury or ACL Injury

Anterior cruciate ligament injury is a very common injury of the knee. It may occur in isolation or along with other soft tissue or bony injury of the knee. Anterior cruciate ligament injury or ACL injury most commonly results from a low velocity, noncontact deceleration injuries or pivoting injuries and contact injuries with a rotational […]

Browse Articles

Footer

Pages

  • About
    • Policies
    • Contact Us

Featured Article

Erb’s Palsy Causes, Presentation and Treatment

Erb’s Palsy is also called brachial palsy or Erb Duchenne palsy and it occurs due to injury to the upper group of the arm's main nerves, specifically … [Read More...] about Erb’s Palsy Causes, Presentation and Treatment

Search Articles

© Copyright: BoneAndSpine.com