student+paediatric+ortho

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student+paediatric+ortho

  1. 1. Paediatric Orthopaedics Phase III Teaching University of Edinburgh
  2. 2. Approach to the limping child <ul><li>Measure limb length </li></ul><ul><li>Check the foot </li></ul><ul><ul><li>Splinter? Injury? </li></ul></ul><ul><ul><li>Swollen ankle: Infection? Arthritis </li></ul></ul><ul><li>Examine the knee </li></ul><ul><ul><li>Swelling: Infection? Arthritis? Tumour </li></ul></ul><ul><ul><li>Tenderness: Injury? Infection? </li></ul></ul><ul><li>Examine the hip </li></ul><ul><ul><li>Septic arthritis </li></ul></ul><ul><ul><li>Dislocation? Subluxation? Coxa vara? </li></ul></ul><ul><ul><li>Transient synovitis? Perthes’ disease? </li></ul></ul>
  3. 3. Congenital Dislocation of Hip <ul><li>Incidence: 1 or 2 per 1000 infants </li></ul><ul><li>Girls are more commonly affected </li></ul><ul><li>First born </li></ul><ul><li>Association with breech presentation </li></ul><ul><li>Left hip is more often affected </li></ul><ul><li>Family history </li></ul><ul><li>Other congenital abnormalities </li></ul>
  4. 4. Assessment for CDH <ul><li>Specific tests for CDH </li></ul><ul><ul><li>Galeazzi sign </li></ul></ul><ul><ul><li>Barlow’s test </li></ul></ul><ul><ul><li>Ortolani maneuver </li></ul></ul><ul><ul><li>Loss of abduction </li></ul></ul><ul><li>U/S examination </li></ul><ul><li>X-ray </li></ul><ul><li>Screening for CDH </li></ul>
  5. 5. Loss of abduction
  6. 6. Barlow/Ortolani tests
  7. 7. CDH
  8. 8. Management of CDH <ul><li>Newborn </li></ul><ul><ul><li>Splintage in abduction (Pavlik harness) </li></ul></ul><ul><li>6 - 18 months </li></ul><ul><ul><li>Closed reduction - Traction </li></ul></ul><ul><ul><li>Splintage </li></ul></ul><ul><ul><li>Open reduction and Splintage </li></ul></ul><ul><li>Late diagnosed dislocations </li></ul><ul><li>Persistent dislocation in adults </li></ul>
  9. 9. Perthes’s Disease <ul><li>Necrosis of the bony nucleus of the proximal femoral epiphyses and impairment of the growth of the physis, with subsequent remodelling of regenerated bone in the paediatric patient </li></ul>
  10. 11. Prognostic factors in the Perthes’ disease <ul><li>Age </li></ul><ul><li>Gender </li></ul><ul><li>Clinical Signs </li></ul><ul><li>Radiological predictors </li></ul>
  11. 12. Management of Perthes’ disease <ul><li>The goal of treatment is a spherical, well-covered femoral head with a range of motion in the hips that approaches normal. </li></ul><ul><li>The principles of treatment include maintenance of range of motion and containment of the femoral head. </li></ul>
  12. 13. Slipped proximal femoral epiphyses <ul><li>Presenting complaint is a painful hip, sometimes referred pain to the knee may be the presenting complaint </li></ul><ul><ul><li>Affects adolescents </li></ul></ul><ul><ul><li>Boys are affected twice as frequently as girls </li></ul></ul><ul><ul><li>Bilateral in 30% </li></ul></ul><ul><ul><li>Aetiology </li></ul></ul><ul><ul><ul><li>Hormonal imbalance </li></ul></ul></ul><ul><ul><ul><li>Trauma </li></ul></ul></ul>
  13. 14. S.U.F.E
  14. 15. Management of SUFE <ul><li>Preserve the blood supply to the femoral head </li></ul><ul><li>Stabilize the physis </li></ul><ul><li>Correction of residual deformity </li></ul>
  15. 16. SUFE - Complications <ul><li>Chronic loss of range of motion </li></ul><ul><li>Osteonecrosis </li></ul><ul><li>Chondrolysis </li></ul><ul><li>Degenerative arthritis </li></ul>
  16. 17. Club foot - CTEV <ul><li>Incidence: 1 in 1000 </li></ul><ul><li>Male to female ratio of approximately 2:1 </li></ul><ul><li>Bilateral in one third of cases </li></ul>
  17. 18. CTEV - Pathologic anatomy <ul><li>Hindfoot is in equinus and varus </li></ul><ul><li>Talus is also in equinus and medially rotated </li></ul><ul><li>Midfoot and forefoot are adducted and plantar-flexed </li></ul><ul><li>Calf muscles are shortened </li></ul>
  18. 19. C.T.E.V
  19. 20. C.T.E.V
  20. 21. CTEV - Management <ul><li>Corrective manipulation and strapping or casting </li></ul><ul><li>Surgical release for resistant feet </li></ul>
  21. 22. Other foot problems in the childhood <ul><li>Flat feet </li></ul><ul><li>Metatarsus Adductus </li></ul><ul><li>Toe walkers </li></ul><ul><li>Kohlers/ Severs disease </li></ul>
  22. 23. Flat feet mobile or fixed
  23. 24. Metatarsus adductus
  24. 25. Intoeing <ul><li>Femoral anteversion </li></ul><ul><li>Femoral torsion </li></ul><ul><li>Tibial torsion </li></ul><ul><li>MTV </li></ul>
  25. 26. Fractures in children <ul><li>Salter - Harris Classification of epiphyseal injuries </li></ul><ul><ul><li>Type 1 - Separation of epiphysis </li></ul></ul><ul><ul><li>Type 2 - Fracture through physis and metaphysis </li></ul></ul><ul><ul><li>Type 3 - Intra-articular fracture of the epiphysis </li></ul></ul><ul><ul><li>Type 4 - Splitting of physis and epiphysis </li></ul></ul><ul><ul><li>Type 5 - Crushing of physis </li></ul></ul>
  26. 27. Cerebral palsy <ul><li>Nonprogressive insult of the central nervous system during the perinatal period. </li></ul><ul><li>Classification </li></ul><ul><li>Diplegic </li></ul><ul><li>Hemiplegic </li></ul><ul><li>Paraplegic </li></ul><ul><li>Quadriplegic </li></ul><ul><li>Tetraplegic </li></ul>
  27. 28. Leg lengthening

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