Chronic Dislocation of Radiocarpal Joint in two patients with Down Syndrome

Chronic Dislocation of Radiocarpal Joint in two patients with Down Syndrome Authors: Jacob Robinson, OMS-II UNTHSC-TCOM; Tyler Roberts, PGY III JPS Orthopedic Resident; Pamela J Sherman, MD Cook Children’s Medical Center Background: Down syndrome (Trisomy 21) is regarded as the most common human genetic disorder with a prevalence of about 1 in 660 live births. With the main effect being mental retardation, there are several orthopedic concerns that have raised awareness with this population. While subluxation at the atlantoaxial and hip joints have been more common orthopedic issues in patients with Down syndrome, chronic subluxation or dislocations at the wrist are not so frequently reported. Cases: We present two cases of non-traumatic volar mid-carpal dislocations occurring in two separate patients with Down syndrome. The 12-year-old female patient presented with unilateral left sided pain and bilateral dislocations, while the 13-year-old male presented with unilateral pain and dislocation on the left. Of note, several commonalities aside from an extra chromosome exist between the patients. They were of similar age, showed arthritic changes on x-ray, and were previously diagnosed with hypothyroidism. One orthopedic condition of particular interest that could be related to the cases is arthropathy of down syndrome . A study investigating this condition reported a prevalence up to 6 times greater than that of juvenile idiopathic arthritis in the general population. Conclusion: It’s likely that many cases similar to those presented are more common that currently recognized or reported. With participation of Down syndrome patients worldwide in Special Olympic Sports and other activities, this raises the question is additional screening necessary for the safety of these individuals. Sponsor: Cook Children’s/UNTHSC Pediatric Research Program