orthopedics.Cerebral palsy.(dr.baxtyar rasul)

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orthopedics.Cerebral palsy.(dr.baxtyar rasul)

  1. 1. Cerebral palsy
  2. 2. Group of disorders which result from non-progressive brain damage during early development
  3. 3. Incidence : 2/ 1000 lives
  4. 4. Causal factors: 1- Prematurity 2- Perinatal anoxia 3- Kernicterus 4- Post-natal brain infection 5- Post-natal injury
  5. 5. Early Diagnosis 1- perinatal difficulty 2- Stiff Baby
  6. 6. 3- Dribbling at the mouth
  7. 7. 2- Difficulty in sucking and swallowing
  8. 8. 5- Developmental milestones delayed ( Normally holds head up at 3 months Sits up at 6 months Walking at 12 months
  9. 9. Later Diagnosis 3 typs: Spastic Paresis(% 60) Spasticity Weakness Brisk reflexes Babiniski sign (+ve) Normal sensation ± Fits ± Impaired intelligence
  10. 11. Appear as (1) Hemiplegia( One side of body) (2) Diplegia ( Both lower limbs) (3) Total body paresis( Usually low IQ) (4) Isolated asymmetrical paresis
  11. 12. Athetosis Continous , involuntary writhing movements
  12. 13. Ataxia Muscular incoordination during voluntary movements
  13. 14. Characteristic deformities Elbow flexion Wrist flxion Fingers flexion Hip adduction( scissor posture) Knee flexion Ankle equinus
  14. 15. Treatment
  15. 16. Medication: Fits and Hyperactivity
  16. 17. Physiotherapy: 1st year of life
  17. 18. Splintage: (1) To counteract spastic deformitie (2) Hold position after surgery
  18. 19. Botulinum A toxine: to decrease muscle tone
  19. 20. Surgery: (1) Spastic postures which cannot be controlled by conservative Measures. (2) Fixed deformities (3) Secondary complications ( Bone deformity, Hip dislocation, Joint instability)
  20. 21. 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)
  21. 22. (3) Surgical options: (a) Tight muscles are released OR Their tendons lengthened
  22. 23. (b) Nerve transaction when severe spasticity
  23. 24. (c) Correction of fixed deformities by: (1) Osteotomy (2) Joint fusion (3) Arthroplasty

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