ORTHOPEDIC MANIFESTATIONS OF CONGENITAL VASCULAR MALFORMATIONS OF THE LOWER EXTREMITIES

Abstract

The spectrum of orthopedic manifestations of congenital vascular malformations of lower limbs remains insufficiently studied. Objective. To analyze the results of examination of patients with orthopedic manifestations of congenital vascular malformations. Methods. 24 patients with various forms of congenital vascular malformations of the lower extremities were examined. Distribution of patients according to the Hamburg classification of vascular malformations: arteriovenous type — 14 patients; venous — 6; capillary — 2; capillaryvenous — 1; lymphatic — 1 patient. The diagnosis of orthopedicpathology was performed on the basis of clinical examination, X-ray, ultrasound, X-ray densitometry. Results. All patients with congenital  vascular malformations were diagnosed with orthopedic pathology: leg length discrepancy (75 %), secondary scoliotic deformity (16 %), knee flexion contracture 40° (8 %), flatfoot (12 %), equinus deformity of the foot (8 %), osteoporosis of the affected limb (16 %), areas of pathological reconstruction of the affected bone (lytic areas) (4 %), hip osteoarthritis of the affected limb (grade 2) (4 %). Leg length discrepancy was observed due to the elongation of the affectedlimb — in 16 patients (67 %), shortening — in 2 (8 %). Leg length discrepancy was in the range of 0.5–6 cm. Elongation of the affected limb < 2 cm was noted in 5 patients (21 %), > 2 cm — in 11 patients (46 %); shortening of the affected limb < 2 cm was observed in one patient (4 %), > 2 cm — in one patient (4 %). Among the patients with  leg length discrepancy, 61 % had combinations of several orthopedic manifestations of the disease. Conclusions. Patients with congenital vascular malformations have a wide range of orthopedic pathology, among them the leading is leg length discrepancy (75 %) due to elongation(67 %) or shortening of the affected limb (8 %). Leg length discrepancy is most often observed in patients with arteriovenous type of vascular malformation (67 %), elongation of the lower limb > 2 cm (75 %) significantly predominating in this category. Among patients with a difference in the length of the lower limbs in 61 % of cases, there is a combination with other orthopedic manifestations of the disease. Systematization of orthopedic pathology and development lesions’ classification of the musculoskeletal system taking into account the forms of vascular malformation will improve the diagnosisof the disease and improve the tactics of its orthopedic treatment.