Congenital Dislocation of the Patella

A dislocation of the kneecap from birth is usually associated with rotatory subluxation of the tibia on the femur, with internal femoral torsion and with flexion contracture of the knee. If left untreated, arthritis of the knee will develop. The flexion contracture of the knee makes the limb appear shorter than the other side. This condition can be unilateral or bilateral. The best treatment for this condition is the superknee procedure.

Congenital Femoral Deficiency (also known as PFFD: Proximal Femoral Focal Deficiency)

Congenital Femoral Deficiency can lead to a congenitally short femur with different degrees of a lack of formation of the hip and knee joints. In the mildest cases, the hip and knee are properly formed and only the femur is short. In more severe cases, the hip is severely deformed, the knee is unstable, or has a flexion contracture and the femur is short. In the most severe cases, there is either no connection between the femoral head and the femoral shaft, or there is no hip joint at all and the knee is not only contracted, but also stiff (limited in its motion). The treatment for cases with a well-formed femur is lengthening. For the more severe deformity, the superhip and superknee procedures are used to reconstruct the hip and knee before lengthening. If there is a true pseudarthrosis (false joint), the superhip 2 procedure is used to build a femoral neck and connect the femoral shaft with the femoral head. Finally, in the most severe cases, Syme’s amputation and rotationplasty should be considered. 

Congenitial Dislocation of the Hip, (now referred to as DDH, Developmental Dislocation of the Hip)

A rue congenital dislocation of the hip refers to dislocation of the hip that occurs before birth. This is also referred to as teratologic dislocation of the hip.

Congenitial Pseudarthosis of the Tibia

Congenital pseudarthosis of the tibia is a condition in which the tibia develops a fracture that does not heal. This is probably a disease of the periosteum (the tissue covering the bone). The periosteum essentially strangles the underlying bone leading it to become thinner and also fracture.  Over half of reported cases have neurofibromatosis. The rest are idiopathic (no known cause) or related to fibrous dysplasia. We treat this with pharmacologic treatment using biphosphonates to prevent bone absorption by the osteoclast cells, as well as surgery to fix the bone with a rod and bone as well as periosteal graft and external fixator. 

Book Chapter: Congenital Pseudarthrosis of the Tibia: Combined Pharmacologic and Surgical Treatment Using Biphosphonate Intravenous Infusion and Bone Morphogenic Protein with Periosteal and Cancellous Autogenous Bone Grafting, Tibio-Fibular Cross Union, Intramedullary

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