Trevor, J Bone Joint Surg Br 1950 - Tarso-Epiphysial Aclasis; a Congenital Error of Epiphysial Development

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Tarso-Epiphysial Aclasis; a Congenital Error of Epiphysial Development

Trevor·J Bone Joint Surg Br·1950·134 citations·Case series

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Trevor's 1950 case series of 8 pediatric patients describes tarso-epiphysial aclasis — later called dysplasia epiphysealis hemimelica — as a congenital developmental error of the epiphysis. The paper asks: what are the clinical, radiographic, operative, and histologic features of this distinct disorder, and how should it be treated?

Key Findings

All 8 patients had unilateral lower limb involvement; both knee and ankle were affected together in 5/8 cases, always on the same hemimelic side — medial knee paired with medial ankle, lateral with lateral, never crossing
Medial epiphysial overgrowth caused valgus deformity; lateral involvement caused varus. One child under age 5 had 4.5 inches of intermalleolar separation from medial condylar overgrowth
Radiographically, changes were confined strictly to the epiphysis with a normal metaphysis, appearing as a cartilaginous mass with multiple ossification foci in only one half of the epiphysis. A key distinguishing feature from dyschondroplasia and diaphysial aclasis
Histology in 4 operated cases showed normal hyaline cartilage with areas of ossification, confirming the non-neoplastic, developmental nature of the lesion
Pain was absent in all cases; function was preserved in several patients managed non-operatively with orthotic correction alone

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Tarso-Epiphysial Aclasis; a Congenital Error of Epiphysial Development

Trevor·J Bone Joint Surg Br·1950·134 citations·Case series

|

Trevor's 1950 case series of 8 pediatric patients describes tarso-epiphysial aclasis — later called dysplasia epiphysealis hemimelica — as a congenital developmental error of the epiphysis. The paper asks: what are the clinical, radiographic, operative, and histologic features of this distinct disorder, and how should it be treated?

Key Findings

All 8 patients had unilateral lower limb involvement; both knee and ankle were affected together in 5/8 cases, always on the same hemimelic side — medial knee paired with medial ankle, lateral with lateral, never crossing
Medial epiphysial overgrowth caused valgus deformity; lateral involvement caused varus. One child under age 5 had 4.5 inches of intermalleolar separation from medial condylar overgrowth
Radiographically, changes were confined strictly to the epiphysis with a normal metaphysis, appearing as a cartilaginous mass with multiple ossification foci in only one half of the epiphysis. A key distinguishing feature from dyschondroplasia and diaphysial aclasis
Histology in 4 operated cases showed normal hyaline cartilage with areas of ossification, confirming the non-neoplastic, developmental nature of the lesion
Pain was absent in all cases; function was preserved in several patients managed non-operatively with orthotic correction alone

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