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J Am Acad Orthop Surg, Vol 14, No 11, October 2006, 610-619.
© 2006 the American Academy of Orthopaedic Surgeons
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Down Syndrome in Children: The Role of the Orthopaedic Surgeon

Michelle S. Caird, MD, Brian P.D. Wills, MD and John P. Dormans, MD

Dr. Caird is Lecturer, Department of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI. Dr. Wills is Orthopaedic Surgery Resident, Department of Orthopaedic Surgery, University of Wisconsin School of Medicine, Madison, WI. Dr. Dormans is Chief of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, and Professor of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Caird, Dr. Wills, and Dr. Dormans.

Reprint requests: Dr. Dormans, Division of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, 2nd Floor Wood Building, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399.

Down syndrome, the result of trisomy of chromosome 21, is one of the most common chromosomal abnormalities. Patients have a characteristic facial appearance, variable levels of intelligence and self-care skills, and a variety of associated medical conditions. Orthopaedic manifestations occur frequently; most are related to hypotonia, joint hypermobility, and ligamentous laxity. Atlanto-occipital and atlantoaxial hypermobility, as well as bony anomalies of the cervical spine, can produce atlanto-occipital and cervical instability. Methods of screening for this instability, particularly with regard to participation in sports, are a subject of controversy. Scoliosis, hip instability, slipped capital femoral epiphysis, patellar instability, and foot deformities are other musculoskeletal conditions found in patients with Down syndrome that can be challenging for the orthopaedic surgeon to treat.






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