We report two male sibs and two female sibs from separate families, both with normal parents, who had a lethal condition with features of the YunisVaron syndrome and radiological signs of severe osteodysplasty. Autosomal recessive inheritance is likely in both families. The additional features described represent further delineation of the phenotype of the Yunis-Varon syndrome.The Yunis-Varon syndrome was recently reviewed by Hennekam and Vermeulen-Meiners' who added a further case to the seven reported previously. The condition was first described in 1980 when Yunis and Varon2 reported five patients from three Columbian families with cleidocranial dysostosis, severe micrognathia, bilateral absence of the thumbs and first metatarsal bones, and distal aphalangia. They all died before 10 weeks of age. The presence of consanguinity in three of the families reported and the lack of sex predilection were thought to be consistent with autosomal recessive inheritance.The four patients whom we describe had similar hands and feet and similar facial features to those described in the Yunis-Varon syndrome. However, our cases did not have absent clavicles and one pair of sibs reported here had pathological fractures. All (fig 1) with prominent eyes and indentation of the temples. The corneal membrane over the outer part of the iris was opaque. The ears were low set with absent lobes, the nose was small, and the palate high arched. The chest was long and the liver and spleen were palpable. The kidneys were easily palpable but were normal on ultrasound examination. The testes were descended but the scrotum was bifid and there was coronal hypospadias. The hands and feet were particularly abnormal. The left thumb was absent, the right vestigial, and the fingers were short with very small nails (fig 2). The big toes were absent and the remaining toes short with poorly formed nails. The hips did not abduct fully. TORCH screen was negative and there was a normal male chromosome complement, 46,XY. CT scan showed a small mass thought to be a haematoma in the right parietal region.The radiographs (figs 3 to 6) showed the following features. The iliac wings were flared and there were constrictions in the supra-acetabular regions, producing notching of the lateral borders. The acetabula were short and sloping and there was coxa valga with bilateral hip dislocation (fig 3). The scapulae were abnormal, with constrictions adjacent to the glenoid fossae. The metaphyses of the long bones were flared. The long bone diaphyses and ribs were slender, with irregular, thickened cortices. In the hands (fig 4) and feet ( fig 5) the first metatarsals and metacarpals were absent, as were the phalanges of the thumbs and big toes. The distal phalanges of all the digits were absent, and the middle phalanges were absent or hypoplastic. There was an unusual coarse and stellate trabecular pattern of ossification in the parietal and occipital bones (fig 6).The baby had breathing difficulties initially and required oxygen for several days. At 3 mo...