Clinical Features of Gollop-Wolfgang Complex in North Africa: A Case Study

Abstract

Gollop-Wolfgang Complex (GWC) is a rare congenital musculoskeletal anomaly marked by distal femoral duplication and tibial aplasia. While often linked with other systemic defects like those in the VACTERL association, our case uniquely presents an isolated manifestation of this complex. The exact genetic cause of GWC isn't fully understood, highlighting a gap in our knowledge of limb development disorders. Treatment typically involves early surgical intervention, such as knee disarticulation and prosthetic fitting, though limb salvage procedures are also recognized. Despite its global rarity (fewer than 200 reported cases), GWC is rarely documented in Africa. This report details a case of GWC from North Africa, offering insights into its presentation and management within this demographic. We present a 14-year-old Moroccan male, the third of three siblings, who presented with a right lower limb deformity evident since birth. Clinically, he showed a characteristic Y-shaped distal thigh due to palpable femoral bifurcation, a fixed knee flexion deformity, and apparent absence of the tibia. Radiographs confirmed a bifurcated right distal femur and right tibial hemimelia (Jones Type Ia). Notably, our patient had no associated upper limb, cardiac, neurological, or renal deformities, nor ectrodactyly or absent radii, distinguishing his presentation from many reported cases. Prenatal diagnosis wasn't established due to a lack of antenatal ultrasound follow-up. Despite thorough counseling on surgical options, including amputation for prosthetic fitting, the patient declined intervention due to fears of postoperative pain and complications. Consequently, we initiated a conservative management plan focused on rehabilitation, crutch use, unipodal balance exercises, and gait training to optimize his functional independence. This case report underscores the diagnostic challenges of GWC and highlights the critical role of patient autonomy in treatment decisions, particularly when conventional surgical approaches are met with patient refusal. Our experience suggests that a dedicated, non-surgical rehabilitation pathway can be a viable alternative, even in complex skeletal anomalies. This unique case contributes valuable clinical data, expanding the limited global understanding of GWC and emphasizing the need for comprehensive documentation of rare conditions to refine personalized management strategies.

Keywords: femoral bifurcation; gollop-wolfgang complex (gwc); knee disarticulation; prenatal detection; tibial aplasia.

Figure 1. Visible deformity of the right lower limb, including shortening and the triangular configuration of the distal femur, indicative of GWC

GWC: Gollop-Wolfgang complex

Figure 2. Anteroposterior radiograph of the right lower limb showing a duplicated distal femur (bifurcated femur) and complete tibial aplasia, consistent with GWC

GWC: Gollop-Wolfgang complex

Figure 3. Lateral radiograph of the right lower limb demonstrating abnormal distal femoral morphology and absence of the tibia, characteristic of GWC

GWC: Gollop-Wolfgang complex