orthopedics.Cerebral palsy.(dr.baxtyar rasul)
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orthopedics.Cerebral palsy.(dr.baxtyar rasul)

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    orthopedics.Cerebral palsy.(dr.baxtyar rasul) orthopedics.Cerebral palsy.(dr.baxtyar rasul) Presentation Transcript

    • Cerebral palsy
    • Group of disorders which result from non-progressive brain damage during early development
    • Incidence : 2/ 1000 lives
    • Causal factors: 1- Prematurity 2- Perinatal anoxia 3- Kernicterus 4- Post-natal brain infection 5- Post-natal injury
    • Early Diagnosis 1- perinatal difficulty 2- Stiff Baby
    • 3- Dribbling at the mouth
    • 2- Difficulty in sucking and swallowing
    • 5- Developmental milestones delayed ( Normally holds head up at 3 months Sits up at 6 months Walking at 12 months
    • Later Diagnosis 3 typs: Spastic Paresis(% 60) Spasticity Weakness Brisk reflexes Babiniski sign (+ve) Normal sensation ± Fits ± Impaired intelligence
    •  
    • Appear as (1) Hemiplegia( One side of body) (2) Diplegia ( Both lower limbs) (3) Total body paresis( Usually low IQ) (4) Isolated asymmetrical paresis
    • Athetosis Continous , involuntary writhing movements
    • Ataxia Muscular incoordination during voluntary movements
    • Characteristic deformities Elbow flexion Wrist flxion Fingers flexion Hip adduction( scissor posture) Knee flexion Ankle equinus
    • Treatment
    • Medication: Fits and Hyperactivity
    • Physiotherapy: 1st year of life
    • Splintage: (1) To counteract spastic deformitie (2) Hold position after surgery
    • Botulinum A toxine: to decrease muscle tone
    • Surgery: (1) Spastic postures which cannot be controlled by conservative Measures. (2) Fixed deformities (3) Secondary complications ( Bone deformity, Hip dislocation, Joint instability)
    • Principles and Guidelines of Treatment (1) Hemiplegia = Good response to conservative or surgical treatment Will be able to walk unaided. Diplegia = More difficult but will be able to walke Total body involvement: Poor prognosis for walking (2) Surgery at 6 years age( Unless fixed deformity threatening)
    • (3) Surgical options: (a) Tight muscles are released OR Their tendons lengthened
    • (b) Nerve transaction when severe spasticity
    • (c) Correction of fixed deformities by: (1) Osteotomy (2) Joint fusion (3) Arthroplasty