PMC4476261_01
Case 2, Initial skeletal survey at 9 days of life (A) [10/09/08] demonstrates lack of visualization of the distal femoral and proximal tibial ossification centers, (B) relatively short long bones of the left upper extremity and (C) feet with metaphyseal cupping and irregular ossification of the talus and calcaneus. The degree of platyspondyly (D) is less than that of her sibling on lateral spine radiographs.
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F4
Radiographically, no secondary ossification centers were identified, specifically to include the proximal tibial and distal femoral epiphyses, which should be present at this age. (Figure 4) The metacarpals and phalanges of her hands and feet were shortened with metaphyseal cupping.
Standing frontal projection of bilateral lower extremities (A) at age 3 years and 2 months (12/05/11) demonstrates bilateral genu varum, which was treated with bilateral lateral hemiepiphysiodesis plate and screws (B) of the proximal tibia, as shown on the right in.
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F5
She developed a mild bilateral genu varum deformity by age three and still had lack of ossification of the proximal femoral. (Figure 5) Cervical spine films show odontoid hypoplasia, with no evidence of atlantoaxial or occipitocervical instability.