Orthopaedic Issues in Vascular Malformations

James R. Kasser and Samantha A. Spencer

in Mulliken and Young's Vascular Anomalies

Published on behalf of Oxford University Press

Published in print August 2013 | ISBN: 9780195145052
Published online November 2013 | e-ISBN: 9780199357147 | DOI:
Orthopaedic Issues in Vascular Malformations

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  • Surgery
  • Histopathology
  • Trauma and Orthopaedic Surgery


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Orthopaedic surgeons have become “first-string” members of vascular anomalies teams. They are needed to manage limb overgrowth (either in length and/or girth), joint pain, osteoarthritis, bony dysplasia, and scoliosis. Treatment of leg length discrepancy is important to balance the pelvis and lumbar spine. Management ranges from shoe-lifts for axial differences under 2 cm to epiphysiodesis to slow growth in the longer limb versus shortening/lengthening osteotomies or even amputation in very large disparities. Limb and soft tissue overgrowth is managed with adaptive shoes and surgical debulking. In the feet and hands, operations include ray resection or amputation for massively enlarged tissues that are limiting function or causing cardiac failure. Pain in limbs may be due to a vascular malformation involving muscles and joints and causing contracture, muscular weakness or growth problems. Bleeding into joints damages articular cartilage leading to end-stage osteoarthritis. Vascular anomalies can also weaken bones. Treatment involves physical therapy, sclerotherapy, resection for intra-articular venous malformation and amputation for severely painful, non-functional limbs. Scoliosis is problematic in certain vascular malformative syndromes, such as CLOVES and Gorham-Stout disease, for which progression may require spinal fusion. Fibro-Adipose Vascular Anomaly (FAVA) is a newly recognized entity that mimics intramuscular venous malformation in the limbs; often an orthopaedic surgeon is consulted.

Chapter.  7445 words.  Illustrated.

Subjects: Surgery ; Histopathology ; Trauma and Orthopaedic Surgery

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