CTEV Vague term used to define a number of abnormalities in the foot.
CTEV-ETIOLOGY The true etiology of congenital clubfoot is unknown. Idiopathic Mechanical-intra uterine pressure Ischeamia of calf muscles genetic Secondary Paralyticdisorders Arthrogryposis multiplex congenita.
CTEV-PATHO ANATOMY Bones Smaller Talus faces downwards Calcaneum small Joints Ankle-equinus Subtalar-inversion Mid tarsal-Forefoot adduction and cavus Muscles and tendons Posteriorly- tendo achilles. Medially- TP, FDL, FHL Capsules and ligaments Capsules of ankle and sub talar joint, Medially-Talo navicular ligament, spring ligament, deltoid ligament Plantar fascia and ligaments
CTEV-CLINICAL FEATURES Detected at birth Brought during early infancy Brought during late infancy and early childhood Brought during late childhood Examination Normally-foot dorsiflexed to touch the chin of tibia Foot is smaller, in equinus, varus and adduction. Heel is small Deep skin creases on the back and medial side of foot Bony prominences and callosities on the lateral side of foot Outer side of the foot is convex.
SPINA BIFIDA A congenital disorder in which the two halves of the posterior vertebral arch fail to fuse at one or more levels.
SPINA BIFIDA-TYPES Occulta Mildest form Midline defect near the lamina Cystica More severe form Contents of the canal prolapse Meningocele Myelomeningocele-open, closed. hydrocephalus
SPINA BIFIDA-CLINICAL FEATURES Spina bifida occulta Usually nothing Midline dimple, tuft of hair, pigmented navus Neurological symptoms-enuresis, incontinence, weakness in the lower limbs Spina bifida cystica Saccular lesion in the lumbar region Hydrocephalous Equinovarus or calcaneo valgus of feet Recurvatum of knee Hip dislocation LMN type paralysis Loss of sphincter control
CDH-TREATMENT Aim-reduce by closed means. Methods of reduction Closed manipulation Traction followed by closed manipulation Open reduction Maintenance of reduction Plaster cast Splints-Von Rosen’s splint Acetabular procedures Salter’s osteotomy Chiari’s pelvic displacement osteotomy Pemberton’s pericapsular osteotomy
SPRENGEL’S SHOULDERCONGENITAL ELEVATION OF SCAPULA
SPRENGEL’S SHOULDER Failure of descent of the scapula, which is developmentally a cervial appendage.
SPRENGEL’S SHOULDER-CLINICAL FEATURES May be noticed at birth Shoulder on the affected side is elevated Smaller shoulder Occasionally both sides are affected(klippel feil syndrome) Shorter neck-associated with kyphosis or scoliosis Abduction and elevation restricted Xray-scapula may be elevated, associated vertebral anomalies.
MADELUNG DEFORMITY Defective growth of the distal radial epiphysis resulting in a deformity due to a comparative overgrowth of the ulna. Traumatic and congenital
MADELUNG DEFORMITY-CLINICAL FEATURES Lower end of radius curves forwards and ventrally Wrist is dislocated Lower end of ulna projects out May be isolated or a part of generalised dysplasia Deformity increases until growth ceases
PSEUDARTHROSIS OF TIBIA A birth defect in the lower end of tibia in children, where a fracture fails to unite.
PSEUDARTHROSIS OF TIBIA-PRESENTATION Usually diagnosed in early infany Child may be born with a fractured tibia or attenuated later in life. Leg is bowed anteriorly Xray Gap, marked thinning, sometimes fibula is also afffected