Clinical History.—A 45-year-old woman was admitted to the hospital for elective minor surgery. Her developmental milestones had been normal. She was moderately short and had fork-like deformities of both wrists. The abnormal configuration of her wrists was first noted at 12 years of age. A roentgenogram taken at that time is seen in Fig 1. She had no pain and had no restricted motion of her wrists. Her maternal grandfather and aunt had similarly deformed wrists and were noticeably shorter than her other relatives. At the age of 24 years, she was described as a "borderline dwarf." When she was 30 years old, hypothyroidism was diagnosed after five spontaneous abortions, all at about six weeks' gestation. She has been well controlled on levothyroxine sodium.
Physical Examination.—Her height was 135 cm (less than the third percentile). She showed the classical findings of mesomelic dwarfism with bilateral Madelung's deformity of