FROM
AN
ATLAS
OF
GENERAL
11.
AFFECTIONS
Achondroplasia
ossification
head and,
and
most
ancient
he was
(1878)
chondrodystrophia
condition
“
of the
hands.
is clear
“
from
suggested
by
Kaufmann
(1948)
City forty-three
in the same
achondroplasiacs
period
there
were
dwarfs,
ten
Achondroplasia
cases
of gargoylism
undoubtedly
occurs
reported
which
were
fifteen
for the
that
cases
at the
explanation
of the
Hereditary
disease
has been reported
in rabbits
and
familial
influences-These
stunting
of limb-growth
Even
thousand
belong
been
years
from rickets,
The
term
in recent
really
Babies’
years
to the
published
Hospital
many
chondrowhich
at
in New
York
in the course
of fifteen
years;
imperfecta,
fourteen
ateleiotic
of multiple
animals,
but
satisfactory
several
have
identified
radiologically
cases
of osteogenesis
and
nine
in certain
enchondral
with a large
of dwarfism
affection
was distinct
title,
achondroplasia.
in 1892.
‘ ‘
with
type,
associated
commonest
type
of its existence
‘ ‘
to classify.
Caffey
interference
short
limb
It is the
evidence
as examples
of achondroplasia
while
numerous
atypical
it is impossible
As to its frequency,
form
ENGLAND
resulting
dwarfism
trident
: there
was
reported
group,
SKELETON
Micromelia
LONDON,
not the first to recognise
that this
who
suggested
the
descriptive
foetalis
cases have been
osteo-dystrophy
foetalis,
FAIRBANK,
is a congenital
the
ago.
Although
it was
Parrot
present
THOMAS
and is characterised
by
in many
cases,
so-called
perhaps
THE
ACHONDROPLASIA
Synonyms-Chondrodystrophia
H. A.
OF
exostoses
it is no
(diaphysial
aclasis).
longer
regarded
as a
in all short-limbed
species.
(Brown
and
Pearce
1945).
are apparent
only in a minority
A lethal
of cases
but
;
achondroplasia
has been traced
through
as many
as six generations
in the male line (Phemister
1924).
Most cases-nearly
90 per cent. of the series
studied
by M#{246}rch(1941)-are
sporadic.
Nevertheless
there
is a 50 per cent. chance
that a child,
one of whose
parents
is an achondroplastic
dwarf,
will also be affected.
Difficulties
in labour
in the female
achondroplasiac
interfere
with inheritance.
It has been met with in twins,
one or both being
Sex-Females
are rather
more
frequently
affected
than
males.
Rischbieth
(1912) found
seventy
females
and fifty-six
males
in the series they investigated.
Age-The
characteristics
are present
at birth, whereas
in cretinism
and
dystrophy
said
the
that
eighth
cent.
most
special
die
month.
of affected
features,
before,
at
of foetal
in the
life.
eliminates
suggested
a small
four
600
most
limbs.
feet
and
the
soon
after
dwarfism,
birth,
,
possibility
When
may
which
is
hospital
during
the
records
examined
first year of life.
survive
so singularly
are
towards
the
and
occurrence
the
end
of an endocrine
in prehistoric
of the
after
often
error
times.
are obvious
feature,
adult
be as little
the
life
at birth,
reduction
is reached
as two
feet
in
and
or
and
child
due
ceases
the
The
THE
mid-point
JOURNAL
and,
which
they
live
(1912)
hydramnios
or
true to type?
to
height
or dead.
is usually
shortness
of stature
HONE
as already
Jansen
is alive
chiefly
OF
80 per
it is
third
month,
of a pair of twins,
all races
conditions
the
being
that
the
in the
one
pressure
caused
either
by
most
cases are so singularly
growth
is usually
about
in the ovum,
the
have
been suggested
of the long bones
early
It affects
of the
whether
height
six inches.
at
robust,
in only
cause.
is one
It
premature
and
month,
condition
as the
This
chondro-osteo-
birth.
by M#{246}rchshowed
that
In view of these
statements
sturdy
second
of the
the result
of excessive
intra-uterine
; but if this is true,
how is it that
striking
develop
results
from
a developmental
fault
inherent
unknown.
Of the various
explanations
that
acceptance.
The failure
of normal
ossification
features-These
is the
lower
fact
it occurred
were
amnion
Clinical
that
foetus
This
the
mentioned,
or
The
maternity
children
died
curious
that the patients
to an advanced
age.
Etiology-Achondroplasia
cause
of which
is entirely
none
has received
general
is apparent
including
affected.
and Barrington
Dwarfism
of the
is always
AND
JOINT
less
than
above
SURGERY
601
ACHONDROPLA5IA
the
umbilicus
affected
fingers
in
may
some
the
humeri
and
head is large
degree,
excessive
laid
Dentition
lordosis
curvature
on its
in the
joints
and
The
than
The
the
trident
are
cases
with
hand.
The
and
by osteotomy
not
large
perform
quite
skin
is thick
and
they
which
are
being
knees,
in
that
and
the
soft
folds
and
furrows
Intelligence
by their
of a more
examination
reveals
is normal
from
distribution
may
are
and
thick,
: thus
diverge,
is formed
The
from
is always
the
the
deformity
Correction
head
rolls
; but
the
other
children
floor
; exceptionally
with
body
long
in one
for the
of fat.
subjects
is normal,
is affected,
of
of the
fibula
movement
pelvis
and
though
it
present.
to be too
between
The
limbs
abdomen
of achondroplasia
or by the
curiosity
so that,
is rather
may
they
VOL.
31
In
B,
NO.
the
some
of
long
be less than
exaggerated.
4,
NOVEMBER
major
1949
be
invoke
if
or it may be somewhat
excessive.
the impairment
of growth
the
dwarfism
both
humeri
dwarfed
were all of normal
size.
is even
to
is
confined
a marked
to
degree
bones
two-thirds
The shafts
are
short,
strong
of the normal
may be thickened
and
rather
length.
The
but usually
The
dense.
curves
and
the increase
in diameter
is more apparent
than real and is due to the reduction
in length.
The medullary
canal
is reduced
in size and may be obliterated
by cancellous
bone.
Splaying
of the ends
the shafts
is more
abrupt
and obvious
than
in normal
bones
and the terminal
surface
irregular.
en
in whom
in some
is one of sturdiness
with some
is often
above
the average
: these
rise
seem
space
main
“
children
associated
tibiae,
a
length
the
the
bones.
necessary.
limbs
to
of the
of these
display
abnormal.
appearances-The
and humeri
impressions
short
nearly
of
degrees.
of equal
of the
musculature
Sexual
development
the whole
skeleton
nothing
120
they
is seldom
formed
The author
has seen a woman
forearms,
lower limbs,
head and
Radiographic
at
invariably,
part
deformity
difference
limited
checked
more
but
generally
are
Fixed
Extension
are
to curvature
able
1948).
reported.
not
upper
be
perhaps
but
wide
is
curve
with
(Caffey
been
child
cartilages
are
of the shoulder
because
of the backward
tilt of the
; it is certainly
not due to coxa vara,
this
tissues
short
: the costal
Movements
limited
all rather
mainly
as the
a kyphotic
fingers
the
and
out
be
bowed,
except
in younger
valgoid.
The bowing,
is due
of strength
the
may
limbs
surprisingly
flat,
buttocks
than
to
abnormally
was
is
The
are often thick
and
may be somewhat
flatten
may
has
spine
(rhizomehic
micromelia).
which
may be present
frontal
region
is rather
not
being
particularly
is rolling-probably
of the hip joints
prominent.
occasionally
femora
muscular
and
be justifiable,
join a performing
troupe.
Although
in most
cases
Blood
frequently,
trunk.
the
is often
of the
There
somewhat
and
incorrectly,
psychologically
one limb.
while the
be
is short
invariably,
feats
stated,
children,
affected
ribs
broad,
fingers
may
(Parsons
1 936).
The gait
the posterior
displacement
in younger
may
high.
The general
appearance
of the ends of the bones.
The
may
the
finger
of the
deformity
The
flat,
The legs are often
and only
occasionally
but
usually,
is often
and
the
with
The lips
mandible
does
flexed.
limitation
of adduction,
case examined,
extension
digits,
third
hyperextension
occurring
patients
deformity
fully
Although
of the lower
limbs
segments
of the
may be lordotic
but
unusual
prominence
are
forearms
short
and
The middle
second
lies abnormally
enlargement
The shortness
The proximal
and flattened.
protrude.
The
This
hips
is small
the
of Marie
(1900).
usually
straight
“
they
the
chest
of
are
in a normal
between
sternum.
in comparison
trochanters.
when standing.
spine.
when
of the upper
limbs,
with
may he limited
: in one
hands
deformity.
of the
short
at their
anterior
extremities
(Parsons
1936)
breadth
of the shoulders
is up to the average.
supination
abduction
the elbows
typical
“
lumbar
even
region.
beading
unaffected.
The
end
is normal.
The spine
being
due more
to the
not
“
lower
strikingly
of the nose is depressed
of life the tongue
may
of the
back,
dorsal
some
are
femora-are
more affected
than the distal
segments
and brachycephahic,
and suggestive
of hydrocephalus
though
it is not progressive
(Dandy
1921).
The
prominent
and the bridge
during
the early
months
prognathous.
the apparent
as the
limbs
below
the greater
his toes with ease
a
mild
be as high
extent,
may not reach
child to kiss
enable
-the
The
and
to
long
hones,
notably
in the
region
of the
knee
joint,
the
of
is
end
602
of the
large
while
shaft
is notched
but as a rule
fusion
with
normal
time.
the shaft,
present.
that
centrally
they
the
is
A striking
confirmed
form
occasionally
histological
diaphyses
The
broad
pubic
arch
of the
than
the
is unusually
protruding
common,
The
position
of the
examination.
diaphysis
(Fairbank
that
is broader
than
back than usual,
promontory
The
epiphysial
of the V-shaped
notch
may appear
to embrace
more
radius,
In
results
1934).
than
half
and
of the
fibulae
fibula
as it may
head.
The pelvis
is reduced
and the crest
is thickened.
acetabulum,
lies farther
surface.
epiphyses
even
skull
centre
young
children
in considerable
In a stillborn
the
length
are
may
close
the
be
and the bone
the acetabulum
wide.
invariably
is large : the
The
than
sacrum
usual
present,
sella may
‘ ‘
pre-sphenoid,
curve
in
the
of the
several
in
into
is narrow
the
but this
be small.
‘ ‘
post-sphenoid
is long
two
cartilage
and
types
limb
other
absent
overlaps
of
the
of the
be such
is formed
general
by
affections
and
The ilium,
especially
part
of the ilium,
and
pelvic
is not
The
tilted
cavity.
the
of the
basi-occipital,
to
in adults,
above
the
shape.
The hip joint
notch.
Sometimes
to an abnormal
Coxa
supported
characteristic
gradual.
Nevertheless
vara
degree,
is often
stated
its
to be
by examination
of radiographs.
feature
is premature
fusion
form
angular
of chondro-osteo-dystrophy,
of
the
of the cartilage
and
unusually
arrangement
growth.
position
an
os tri-basilare
which
is
of the base of the
may
be reduced
to
may be somewhat
total reduction
in length
of the spine is much
less marked
than that
in size of the ossific
centres
for the vertebral
bodies
was regarded
Parrot
(1878) ; but the bodies
are never
noticeably
shallow
and the
is relative
cells
degeneration
vacuolated
irregular
is
kyphosis,
was
suggestive
in
seen
only
two
two
adults
of that
undoubted
‘ears
are
old
the
deformity
far
below
always
met
cases
of
the
in height.
Pathology-There
all
of
affected
than
other
long
as a persistence
of the
as a whole is of a curious
abuts on the sacro-sciatic
achondroplasia
examined
by the author
: in one patient
almost
disappeared
on standing.
Progress-Even
when
fusion
of the epiphyses
is delayed,
normal
end
when
this
impression
increase
in depth
infant
there
may
much
less
be regarded
in size in all diameters.
In children
the lower
normal
so that
more
reduced
in depth
but the
of the limbs.
Reduction
as a constant
feature
by
with
to be
early;
at the
to the
of the metaphysis
the epiphysis-an
abnormally
short.
As a result
there
is considerable
diminution
in length
skull.
The foramen
magnum
is small
and funnel-shaped
; its diameter
half the normal.
The facial
bones
are unaffected.
The vertebral
bodies
kyphotic
appear
ribs are short-sometimes
even less than half the normal
length.
The sternum
and thick,
and the sternal
angle
is increased.
The scapula
is deformed,
its
that the inferior
angle has been cut off ; and the glenoid
is too small for the
suggesting
humeral
is small
a V-shaped
to be present
normally
at the eighth
month
of foetal
life.
The fibular
usual : occasionally
it may
even
participate
in the formation
of the
the shaft
of the fibula
is bowed.
The ulna,
on the other
hand,
is
shorter
skeleton.
is short,
FAIRI3ANK
THOMAS
is the
apex
notch
(Khoo
1945).
The clavicles
The relative
excess
in length
condition
that
is said
head
lies higher
than
knee
joint.
Sometimes
the
feature
by
of the
shape
to
centre
so close to the
as seen in radiographs
shortness
epiphyses
bones.
A.
are not abnormal
in size.
They may begin to ossify somewhat
shafts
shows
great
variation,
occurring
either
early,
late or
and tucked
into the
The two limbs
of the
epiphysial
joint space
H.
and
at the
tends
cartilage-formed
in which
it was noted
part of the epiphysis.
of cartilage
is
is
the
vascular.
at
regards
the
is normal
“
ends
(Keith
shafts
long
to
It may be
the normal
of
bones.
Harris
as the
serial
The
This
explains
that
the cortex
of the metaphvsis
An important
feature,
often hut not
TIlE
the
‘ ‘
radiographic
appears
to embrace
invariably
present,
JOURNAL
OF
fibrillar,
palisade
spongiosa
is
or entirely
of lines
ferrule
BONE
AND
of
mucoid
degenerate,
columnar
summation
periosteal
Growth
(1933),
calcification
is erratic.
The
cores
diminished
in calibre
or excessive.
1919).
of the
According
underlying
feature.”
There
is absence
“
bone
the
disorderly.
epiphysial
line, and provisional
to be dense,
with
the cartilage
(Caffey
1 948) . Harris
Periosteal
ossification
the
aplasia
epiphyses
of arrested
outstrips
and
appearances
the
is the
adjacent
ingrowth
JOINT
SURGERY
1)R(
.(‘llON
from
the
periosteuin
between
and
the
the
of the
fibrous
layer
extends
further
growth
Knaggs
the
constant
shaft
this
The
at
inadequate
the
or
size
of
may
diameter
be
or
line
this
of the
cease.
formed
bone,
According
by
metaplasia
pituitary
and
layer
epiphysial
happens,
necessarily
after
of
the
oedema
to
four
the
of
shouv
max’
the
and
no
heavy
facies,
enlargement
features
The
only
that
condition
is osteogenesis
this
condition,
may
display
with
the
any
doubts
seen
in
to the
rare
not
likely
their
in
these
is the
rule.
ph\’
is
deficiency,
corneal
spleen.
at
simulate
the
pre-natal
or (lead
limbs
Short
limbs
compared
settles
may
but
this
radiographic
achondroinfant.
is due
Note
chiefly
limbs
to shortness
of tile lower
---not
the
trunk.
The
mid-point
of stature
is at the
lower
end
of
time sternum.
Tile
fingers
reach
only to tile greater
trochanters.
lime soft
tissues
of the
limbs
are
birth,
once
at birth
punctata,
unique
Case
17. Typical
piasia
ill a female
that
the (Iwarfism
case
t
as
at
52
FIG.
birth.
achondroplasia
alive
of
(lis-
In cretinism
examination
with
dwarfism
recognisable
whether
epiphvsialis
first
gargovlism
: in a severe
diagnosis.
condition
am!
to
radiographic
dysplasia
exceedingly
liver
shortening
but
as
mental
are
subject,
marked
trunk;
wilile
iniperfecta
the
owe
of
the
chondro-osteo-dvstr
of the
is
for
lordosis,
of
normal
features
; moreover
apparent
are
characteristic
and
that
types
two
normal
limbs
type
t\’pical
the
of
as
to the
reduction
been
said
at birth.
their
life,
the
than
the
at birth
pass
to
rather
In the Morquio-Brailsford
the
head
afl(l
face
opacities,
usually
than
kyphosis,
by
display
either
post-natal
of
It has
(lifhcultV
cause
with
either
excessive
to
magnum.
ascites
rather
is attril)uted
or
thorax
infants
years
tinguished
birth
the
foramen
and
spine
dwarfs
be
whole
thyroid
chondro-osteo-dvstrophv
of
the
band
shortly
Diagnosis-Achondroplasiacs
at birth,
uvhereas
to
as occasionally
thvmus,
capacity
general
one
the
; if,
must
hand
at
changes.
Death
in
across
(1927)
fibrous
cartilage
epiphysis
of the
cartilage.
vascular
ossifying
of
rest
to
a
of
zone
603
)PL.SI.
also
too
there
is an
long
for
are
creases
features.
tile
bones
so that
many
cutaneous
and
rolls
of fat.
RE FERENCES
BROWN,
\V.
CAFFEY,
J.
(1948)
DANDY,
W.
F:.
H.
ELLIS,
H.,
W.
edition,
p.
I.OIldOn
A.
1\l.
foetalis).
F.
H.
KNAGGS,
MORcH,
L.
E.
III.
PARROT,
J.
(Publishers),
I).
University
B.
B,
No.
1.ondon
..
an(i
: Uutterworth
E.,
: \\‘.
& Co.
F.
Battell,
i)isease.
: 13aillire,
(lie
E.,
Oxford:
Timmdall
&
an(l
F.
PriorCo.,
Inc.
(Publishers),
Ltd.
‘I’hursfieki,
I.’Iliversity
H.
Third
Press.
London:
(ox.
F0(’tal(’
SOgeIlaIlIlt(’.
8,
ii,
cx
Racilitis
(Chondrod’strophia
\lission
(alladiall
15,
Press.
10.
17.
Biologiae
1)01110
Munksgaar(I.
British
:
of SiIrger’,
(Ic la Socitt
:
:
(1924)
and
(Extract
Hereditariac
in
(le
of
Hulilanac
British
(l.nthropologie,
Encyclopaedia
.BT,
I.
4,
N0\’EMRER
.\.,
e(litor
A.
I3ARRINGn)N,
1, 47 1.
I ‘ress,
31
241.
\Iarvlan(I
?dedical
\lc(iiCal
Pans,
3S.1,
Practice.
Uimmversitatis
Journal,
1949.
Flafnicnsis.
1, 402.)
296.
l.olidOIl
:
&
l3utterworth
1, 135.
H.,
RISCHBIETH,
Hagerstown,
5.
259.
Health
54, 101.
Chengtu
Journal
: Ejnar
(1936)
I..t(i.,
PHEMISTER,
32,
Garrod,
iil)er
: Opera
: Bulletin
G.
2,
IV.
& Company.
in
1.ondomm
Idicalc,
(1941)
(1878)
L.
Arnold
Growth
of Anatomy,
I)vstrophies.
: British
Copenhagen
PARSONS,
Practice,
Children.
of
‘Lntersucllullgell
: Presse
TRIER
Bulletin,
82,
‘slcdicine,
Vol.
Reinier.
(1927)
(1900)
P.
MARIE,
:
(1919)
: Journal
Y. (1945)
: Bone
A.
KEITH,
: (.
Experimental
154.
(1892)
Berlin
Surgical
: Achondroplasia.
E.
of
Hospital
I)iseases
: Edward
p.
(1912)
KAUFMANN,
:
: Bone
(1933)
Journal
Pediatrics.
Hopkins
: British
(1934)
Milford,
JANSEN,
KHoo,
T.
:
(1945)
Practiceof
: Johns
(1948)
A.
865.
Humphrey
VOL.
(1921)
13.
H.
HARRIS,
L.
PEARCE,
: Brennemann’s
H.
FAIRBANK,
Vol.
and
1949
lk’(liatrics,
(1912):
Treasury
5,
80.
of
Phila(ie11)llia
Human
: Vt’. B.
Inheritance.
Saunders
London:
& Co.
Cambridge
Co.
604
CASE
(Figs.
H.
THOMAS
..
FAIRBANK
18-ACHONDROPLASIA
53-57.)
Male,
aged
seven
years.
Extension
of the elbow
joints
the left elbow : the subluxation
normal
position
on extension.
Typical
limited.
case.
Some
Subluxation
OCCU5
on
Outer
ends
flexion,
Case
I 8.
Tpical
(Fig.
53)
with
forehead,
small
abdomen,
kyphosis
flat
the
53
head
bent
of
of the
extension
resuming
down.
of the
radius,
hips.
particularly
an
(Under
in
approximately
Dr
R.
S. Frew.)
54
alld
sllort-linlhed
large
head
radial
of clavicles
lIGS.
linuitation
of the
head,
dwarf
pronlillent
depressed
bridge
of nose,
chest
and
pronlillellt
long
dorsi
- lumbar
with
minimal
true
lordosis
hut
with
prominent
relati’e
shortness
ParticularlY
the
of
buttocks,
all four
proximal
and
limbs,
segments
micromelia)
.
Figure
54
the
unusual
shape
of the
ilia,
and
tile absence
of coxa
vara
though
tile
femoral
necks
are
prolonged
inwards
at the
epipimysial
lines.
Note
tile
silOrt
femoral
shafts,
splayed
at
the
extremities,
particularly
the
(rllizomeiic
shows
lower
IlOtclleS
FIG.
which
show
Vllicll
into
the typical
central
tile e)ipliyses
fit.
53
18.
Case
Hallds
showing
typical
trident
deformity
and
timick
FIG.
Case
(Fig.
18.
56),
Note’ time marked
the
celltral
notches
tileepiphyses
The
upper
shape
of
to
limb
tll(’
their
(Fig.
respective
57)
extreniltles
nornlai
i)ositioIl,
digits.
FIG.
splaying
of time metaphvses
particuiari’
in tile
femora,
shafts,
of time femora
time close
joint
space
57
and
tibiae
proximity
in both
of
and
the
\Vi(Ie
knees.
shows
time stout
shaft
of time imlllllerus
vitlm an unusual
of tile
bone.
lime
ra(llal
imea(l
is iim amm approximately
time
(‘11)0w
i)(.’illg
(‘xtc1m(lc(1
to time’ iilliit.
THE
JOURNAL
OF
BONE
AND
JOINT
SURGERY
ACHONDROPLASIA
CASE
19-.ACIIONDROPLASIA
( Fig.
all
58.)
the
features
asymmetry
were
than
with
of
upper
limbs,
: both
the
the
lower
right.
pointed
(Under
The
head
fingers.
Dr
R.
itg(’(l
5t’V(’II
cartilaginous
III
Ill
a(’liondroplasia.
limbs
I)ut
the
was
left
large.
There
relatively
upper
There
was
a
low
(lisj)lay(’(l
\\1I()
115,
‘l’here
were
some
uvas
short,
limb
as
was
were
also
shorter
trident
(lorsal
hands
kyphosis.
S. Freuv.)
58
FIG.
Case
19.
epiphysial
the
en(ls
1
I
child,
l’I1iLlt
Radiograpim
of time leg simows
time Position
of time
centres
in time region
of time knee
joint,
close
to
of time slmafts
and
not
in
the
nlid(Ile
of
time
epiphvses.
Note
time apparellt
wi(iening
of
joint
spaces.
FIG.
CASE
20-ACHONDROPLASIA
(Figs.
59
and
60.)
Female,
Case
20.
spiaying
metaphyses,
time length
at
VOL.
31
B,
NO.
4,
the
NOVEMBER
age(l
Lower
at
ankle
five
limbs
the
an(i
of the
‘ears.
slmowing
extremities,
cimaracteristic
Typical
the
case.
typical
irregularity
position
simort
of
of
time
tibula
: the head
is abnormally
joint
time fibula
reaches
rather
1949
stout
time
ossific
high
lower
l)ones
witim
ends
of
the
centres.
Note
in both
than
legs:
usual.
5i
H.
Case
2(1.
in Figure
Time fenu
CASE
21-ACHONDROPLASIA
(Figs.
61
and
)rai
62.)
radiographicallv,
clu
lk’lvis
54.
and
imlps
the
Note
slmov
imecks
Female,
except
)ndro-osteo-dvstr(
that
mphies.
A.
liioM.\S
showing
time
flat
Imorizontal
sonic
sanme
roof
upping
aged
five
the
spine
(l...Tiuler
FA1RitANK
the
on
and
a
curlous
shape
of
of time acetahululll
t lii’ in mr
sI(i(’ hut
half
(hisj)laVs
late
Sir
\‘ears.
art’
in
t varoid.
Typical
deformity
Henry
ilia as sceim
otm hoth
sides
time
case,
that
is
clinically
suggestive
and
of
the
Gauvain.)
‘-1
FIG.
Case
view
of
21.
of tile
an
angular
seen
Pimotograpim
spine
in
61
simows
FIG.
time
silows
tile
twelftil
kvpllosis.
Note
tlmat
time Morquio-Hraiisford
typical
features
of
aclmoimdroplasia
(lorsal
body,
slightly
wedge-shaped,
the
shape
of tile
vertebral
bodies
svimdrorne
and
fronm
timat
typical
TIlE
JOURNAL
(Fig.
62
61).
Time
forming
differs
botim
of gargovlisrn.
OF
BONE
ANI)
lateral
time
from
JOINT
apex
that
SURGERY
607
ACi1()Nl)1)PL.SIA
CASE
22-ACHONDROpLASIA
( Figs.
63-65.)
l’Inale,
aged
of the
limbs,
especially
the
normal.
Hands
of the
spine
trident.
with
Radiographic
ends
at
of
22.
femora
kyphosis
VOL.
31
B,
NO.
22.
of
bones
siloulders
square
“
64
extelision
and
of
witim
angles
for
large
: facies
the
standing
had
been
1949
age.
not
elbow
Relative
typical.
Angular
joints.
kvphosis
almost
achondroplasia.
of
cut off.
elevated
to
show
time
curious
of time scapulae.
-
Pelvis
and
lower
limbs
silowing
time
typical
and
tibiae
(Fig.
64).
Lateral
view
of
the
at
tile
first-second
lumbar
level
but
witilout
either
type
of chondro-osteo-dvstrophy.
4, NOVEMBER
her
the
ilia is typical
arms
“
height
of
on
as if the angles
ammd
FIG.
Head
junction:
long
Tilorax
Case
limitation
are square,
normal
segnients.
dorsi-lumbar
appearance
Case
I kiow
years.
Slight
apex
of the scapulae
t\v()
proximal
FIG.
65
simape
spine
shows
features
of
the
ilia,
angular
typical
of
shortness
Intelligence
kyphosis
disappears.
The
lower