Chest deformities: etiology and types
The fundamental cause of chest wall deformities is dyschondrogenesis, a disruption in the normal organization of cartilage tissue. Notably, no specific morphological changes are detected in the costal cartilages themselves. The pathology progresses unevenly and is directly linked to growth spurts in children, which typically occur at ages 5–6, 8–10, and 13–15 years.
The following types of defects are distinguished in clinical practice:
- Pectus excavatum deformity (occurs most frequently).
- Pectus carinatum deformity (also extremely common).
- Combined forms.
- Congenital sternal cleft.
- Costomuscular wall defects.
- Secondary deformities associated with spinal anomalies (in scoliosis, costovertebral dysplasia).
Surgical intervention is required in approximately 10% of patients with these defects.
Indications for surgical treatment ofчаст the chest wall
Conservative therapy for such conditions is completely ineffective; altering the configuration of the chest cage is impossible without surgery. Surgical treatment (primarily thoracoplasty with radical cartilage resection) is traumatic due to manipulations on the pleura and sternum, but it is the only viable option.
Indications for intervention are divided into three categories:
- Cosmetic. Based solely on the patient's desire to eliminate the visual defect.
- Functional. Occur due to compression of the cardiorespiratory system. A decrease in thoracic cavity volume leads to incomplete lung expansion and chronic hypoxia. The body compensates for this with a triad of signs: increased pulmonary blood flow (right heart overload on ECG), increased oxygen capacity (polycythemia), and weight loss. Surgery is indicated if at least two of these three signs are present.
- Orthopedic. Chest defects are often accompanied by scoliosis or kyphosis. Thoracoplasty is performed so that orthopedists can subsequently provide full treatment for spinal pathologies.
Acquired lower limb length discrepancy
Limb shortening constitutes a major sector of orthopedic pathology. Acquired forms develop after birth due to trauma, poliomyelitis, osteomyelitis, or neurological disorders. The main factor behind shortening is always damage to the bone growth plates.
The most frequent cause is pathological hip dislocation. It develops secondary to purulent processes (umbilical sepsis, hematogenous osteomyelitis). Clinical presentation:
- Pronounced limp and pelvic tilt.
- Relative leg shortening reaches 6–8 cm.
- Greater trochanter is displaced above Nélaton's line.
- Positive Trendelenburg sign.
- Adduction-flexion contracture.
Radiography reveals joint destruction: absence of the femoral head and neck, flattening of the acetabulum. The pathology is frequently combined with involvement of the contralateral humerus.
Congenital limb length discrepancy and general principles of treatment
Congenital shortenings, especially developmental anomalies of the hip, represent the most challenging group. The incidence of hip pathology is 1 case per 50,000 newborns. Such children exhibit coxa vara and dislocations. As the child grows, the leg length discrepancy increases rapidly and can reach 15–23 cm, while functional shortening is aggravated by the development of contractures. The femur frequently acquires a cone-like shape.
Principles of surgical correction:
- Main method: compression-distraction osteosynthesis according to G.A. Ilizarov.
- Goal: achieving good function, not just anatomical length alignment.
- Staged approach in children: first, the correct axis is restored and the joint is reconstructed. Due to the risk of recurrences during growth, the affected growth plate is completely resected, followed by staged lengthening.
- In cases of paresis: lengthening performed without considering muscle status can lead to loss of function. Electromyography (EMG) is mandatory, and adjacent joints are rigidly locked with an external fixation device during lengthening to prevent contractures.
Briefly: answers to topical questions
What are the clinical forms of congenital syndactyly of the hand?
Congenital syndactyly (syndactilia) is a developmental anomaly characterized by fusion between the fingers. Normally, finger separation occurs after the second month of intrauterine life, but when embryogenesis is disrupted, webs persist. Based on the type of fusion, the following clinical forms of the pathology are distinguished:
- Cutaneous syndactyly — characterized by soft-tissue fusion.
- Osseous syndactyly — accompanied by fusion of the bone structures of the fingers.
What is ectrodactyly of the hand?
Ectrodactyly (ectrodactilia) is a congenital birth defect characterized by a reduced number of digits. This pathology involves the absence of one or more fingers on the hand or foot. The primary goal of treatment is to restore hand function and eliminate the associated cosmetic defect. To achieve this, microsurgical toe-to-hand transfer is used.
Which anatomical structures are affected in Madelung's deformity?
Radiologically, Madelung's deformity reveals a decrease in the angle between the distal metaphyses of the radius and ulna. Impaired longitudinal growth of the radius can clinically manifest as Madelung's deformity.
At what age is surgical treatment indicated for simple complete syndactyly?
Surgical treatment of syndactyly, which consists of surgical separation of the fingers, is performed at the age of 2–3 years. Syndactyly occurs as a result of disrupted embryogenesis, wherein webs persist between the fingers.
What is macrodactyly of the hand and with which syndromes is it associated?
Macrodactyly (macrodactilia) is a developmental defect characterized by enlargement of individual digits. The provided materials do not specify which exact genetic syndromes are associated with this anomaly. The etiology of macrodactyly is often linked to circulatory disturbances, specifically the presence of arteriovenous fistulas. When hand or foot function is impaired, surgical treatment—amputation of the affected digit—is indicated.
Class and exam questions
At what age do chest wall deformities progress most rapidly?
Progression correlates with physiological growth spurts in children: at ages 5–6, 8–10, and 13–15 years.
Are conservative methods effective for pectus excavatum?
No, conservative methods do not change the configuration of the chest cage; the primary method is surgical.
What is included in the compensation triad for chronic hypoxia in chest wall deformities?
The triad includes: increased pulmonary blood flow, increased blood oxygen capacity (polycythemia), and weight loss.
What is the main cause of bone shortening in acquired pathologies?
Damage to the bone growth plates (resulting from trauma or infections) plays a leading role in acquired limb shortening.
What else to study on this topic
- Thoracoplasty technique: resection of costal cartilages and postoperative complications
- Trendelenburg sign and hip joint biomechanics
- Ilizarov compression-distraction apparatus: physics and biology of lengthening
- Radiological diagnostics of destructive hip dislocation
- Myoplastic surgeries in lower paresis and poliomyelitis sequelae
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