case_images: PMC11788561_01
case_images: Clinical and radiographic presentation of skeletal abnormalities. (A) Photograph showing valgus deformity in childhood. (B) Photograph of the legs after orthopedic correction of the valgus deformities. (C) Whole-body X-ray demonstrating straight leg axes following tibial osteotomies and scoliosis. (D) X-ray of the thoracic and LS, with anterior-posterior (left) and lateral (right) views showing scoliosis with opaque endplates but no platyspondyly. Metaphyseal widening (yellow arrow) is evident in X-rays of (E) the left lower arm postfracture, (F) the right proximal humerus, and (G) the proximal femora and pelvis, where screw osteosynthesis was applied after a pelvic ring fracture. (H) Magnified view of the left femur from panel (C) showing diaphyseal sclerosis due to thick cortical bone (white arrow), along with thinning and widening of the metaphyses, resulting in an Erlenmeyer shape. (I) Magnified view of the left distal femur from (H) displaying diffuse sclerosing trabecular patterns (green arrow). X-rays of the left tibia, with anterior-posterior (left) and lateral (right) views (J) show the previous plate osteosynthesis and (K) recent osteosynthesis after a peri-implant fracture. The fracture was not yet healed by the time of examination, with a visible gap (red arrow). Structural alterations such as diaphyseal cortical thickening, metaphyseal widening with thin cortices, and diffuse medullary sclerosis (green arrows) are also observed in the tibiae (J, K).
case_images: ziae179f1.jpg
case_images: PMC11788561_01_ziae179f1.jpg
case_images: f1
case_images: In childhood, she developed bilateral valgus deformities (Figure 1A), which were corrected through multiple osteotomies and epiphysiodesis, resulting in straight leg axes (Figure 1B and C). She exhibited scoliosis (Figure 1C and D), with several deformed thoracic and lumbar vertebrae, though without classic platyspondyly. Radiographs showed increased radiodensity in the vertebral endplates without the typical sandwich conformation (Figure 1D). Persistent metaphyseal widening with thin cortices was observed at the distal radius (Figure 1E), proximal humerus (Figure 1F), and proximal femora (Figure 1G). Additionally, the femora exhibited diaphyseal cortical thickening and sclerosis, with an Erlenmeyer shape (Figure 1H). There was also metaphyseal widening with thin cortices and diffuse sclerotic zones in the trabecular compartment (Figure 1I). The tibiae also showed diaphyseal sclerosis with metaphyseal widening and thin cortices (Figure 1J). Recently, she underwent plate osteosynthesis for a peri-implant fracture of the left tibia, which had not fully healed by her presentation (Figure 1K).