Weismann-Netter-Stuhl Syndrome

A syndrome characterized by dwarfism, bowed legs, saber shins, mental retardation, mild involvement of the arms, and dural calcification.

Anterior Bowing of the Legs with Dwarfism; Toxopachyosteose Diaphysaire Tibio-Peroniere (French).

Unknown but rare. A total of 47 cases had been reported in the literature between 1954 and 2000.

Presumed autosomal or X-linked dominant inheritance. Most cases appear to have been sporadic and the relatively small number of familial cases suggests incomplete penetrance.

The pathogenesis is unknown. Assumed to be a primary metabolic abnormality of bone.

Clinical features consistent with the syndrome. Radiological examination is characteristic (anterior bowing of tibiae and fibulae, with cortical hyperostosis on the concave side of the curvature, slight bowing of the radius, ulna and humerus). Inconsistent radiological findings include squaring of the iliac wings, low position of the fifth lumbar vertebra in relation to the ilia, horizontal sacrum, kyphoscoliosis, and dural calcification. Alkaline phosphatase is normal or raised; bone biopsy is normal.

Short stature is the most constant manifestation (males averaging 151 cm [59.4 inches] and females 142 cm [56 inches]). Features include anterior bowing of tibiae (saber shins) and lateral bowing of femora (usually bilateral), occasional mild bowing of ulna, radius, and humerus, and delayed ambulation in childhood. Of those affected, 20% have mental retardation of variable severity. Kyphoscoliosis is present in approximately 30% of cases. Age at diagnosis has ranged from 2 weeks to 94 years. The skeletal deformities do not seem to progress during adult life. Normal life expectancy.

Detailed clinical history and physical examination must be performed to determine the progression of the syndrome and assess the presence of unrelated medical conditions. Evaluate pulmonary function if kyphoscoliosis present (chest radiography, spirometry, arterial blood gases).

Careful patient positioning and transfer from the stretcher to the operating room table (patients seem to have an increased propensity to bone fracture following minor trauma). If the kyphoscoliosis is significant, the use of regional anesthetic technique may not be applicable. Technical difficulties may be experienced because of lower spinal abnormalities and the risk of dural puncture is increased. The laryngeal inlet may be smaller than normal for age. A range of endotracheal tubes of sizes smaller than normal should be available.

Sedative premedication may be beneficial in patients with mental retardation. No specific pharmacological considerations.

Maffucci Syndrome: Rare disorder characterized by skeletal dysplasia. The age of onset can be at birth or not until early childhood. It primarily affects long bones and cartilage. Limb shortening, bowing of the long bones, and/or short stature may occur.

Camptomelic Syndrome: A congenital disorder characterized by short stature along with bowing and an unusual angular shape of the legs. The shoulder and the pelvic skeletal structures are often abnormal. Individuals affected with this syndrome usually present with 11 pairs of ribs instead of 12. Two forms have been described: the long-limbed and the short-limbed form. It is inherited as an autosomal recessive trait.

Vitamin D Deficiency Rickets: A rare disorder that appears during infancy and childhood. The clinical features include restlessness, delayed motor development and growth, abnormal development of teeth, and/or bowed legs.

Congenital Syphilis: A rare acquired chronic infectious disorder characterized by low birth weight, fever, rash, and/or saber shins. Other clinical features may include hardening of the umbilical cord, hypercholesterolemia in infancy, anemia, hepatosplenomegaly and mental retardation. It is caused by the Treponema pallidum bacteria. Fetal syphilis acquired from the mother may be apparent at birth or during early infancy, however, in many individuals, several years may pass before symptoms are recognized.