J Korean Orthop Assoc.  2014 Aug;49(4):321-325. 10.4055/jkoa.2014.49.4.321.

Eighteen Year Follow-Up Results of Accessory Lower Limb Disarticulation and Pelvic Bone Reconstruction for Monocephalus Tripus Tribrachius

• Kim TS
• Shin TY
• Kim SJ

• KMID: 2185196
• DOI: http://doi.org/10.4055/jkoa.2014.49.4.321

Abstract

Monocephalus tripus tribrachius, a type of conjoined twins with one head and three upper and lower extremities, is a rare congenital disorder. To date, no long-term follow-up results of surgical procedures for this condition have been reported in Korean literature. We experienced a case of monocephalus tripus tribrachius, which had been surgically managed with an accessory lower limb disarticulation and pelvic bone reconstruction to manage this accessory limb and accompanying comorbidities in hip joint and pelvis. Subsequently, ipsilateral Syme amputation was done for intractable deformity of foot, and later, ipsilateral femoral varus derotational osteotomy was done for inadequate coverage of femoral head observed in follow-up. We report 18-year follow-up results of the procedures with a review of literatures.

Keyword

conjoined twins; disarticulation; pelvis; reconstruction

MeSH Terms

Amputation
Comorbidity
Congenital Abnormalities
Congenital, Hereditary, and Neonatal Diseases and Abnormalities
Disarticulation*
Extremities
Follow-Up Studies*
Foot
Head
Hip Joint
Lower Extremity*
Osteotomy
Pelvic Bones*
Pelvis
Twins, Conjoined

Figure

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  Figure 1 (A) Initial plain radiograph of monocephalus tripus tribrachius. Accessory lower limb is shown on the middle portion of the pelvis and the redundant ischial bone is forming an accessory acetabular structure. (B) Schematic presentation of the initial gross appearance of the case.

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  Figure 2 Plain radiograph taken at two years following accessory lower limb disarticulation and reconstruction of the pelvic bone. The wires were used to fixate both ischial bones, forming new symphysis pubis.

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  Figure 3 (A) Plain radiograph taken at 11 years of age shows good acetabular coverage and joint congruency in both hip joints. (B) The radiograph included both weight bearing whole lower limbs taken at 11 years of age. Extension-block knee brace and syme amputation prosthesis are shown. (C) The latest follow-up radiograph taken at 18 years of age.

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