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Musculoskeletal disorders Part 8 Congenital skeletal malformations
 

Musculoskeletal disorders Part 8 Congenital skeletal malformations

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Musculoskeletal Disorders Part 8

Musculoskeletal Disorders Part 8
Congenital skeletal malformations: Talipes (Clubfoot), Congenital Hip Dislocation.

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    Musculoskeletal disorders Part 8 Congenital skeletal malformations Musculoskeletal disorders Part 8 Congenital skeletal malformations Presentation Transcript

    • Maria Carmela L. Domocmat, RN, MSNIntructorNorthen Luzon Adventist College 1
    • TalipesCongenital hip dysplasia
    • a congenital deformity in which the foot istwisted out of shape or position;Aka: clubfootDorlands Medical Dictionary for Health Consumers. © 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved. Maria Carmela L. Domocmat, RN, MSN 4
    • dorsiflexion - t. calca´neusplantar flexion - t. equi´nusabducted and everted -t.val´gus or flatfootabducted and inverted - t. va´rusvarious combinations t. calcaneoval´gus t. calcaneova´rus t. equinoval´gus t. equinova´rus Dorlands Medical Dictionary for Health Consumers. © 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved. Maria Carmela L. Domocmat, RN, MSN 5
    • t. calcaneoval´gus the foot is turned outwards with the toes pointing upwardst. calcaneova´rus the foot points inwards and upt. equinoval´gus the foot points outwards and downt. equinova´rus most common type foot is fixed in plantar flexion (downward) and deviated medially (inward) Maria Carmela L. Domocmat, RN, MSN 6
    • http://img.tfd.com/dorland/thumbs/talipes.jpgMaria Carmela L. Domocmat, RN, MSN 7
    • http://www.abdn.ac.uk/~gen155/graphics/clubfoot.jpeg http://www.fpnotebook.com/_media/Ortho PedsFootCF.jpg Maria Carmela L. Domocmat, RN, MSN 8
    • http://1.bp.blogspot.com/_IZV_l47MkXQ/TRpGEJogmHI/AAAAAAAAAGw/X1VQqODtJG4/s1600/child_foot_clubfoot_intro01.jpg Maria Carmela L. Domocmat, RN, MSN 9
    • o The true etiology of congenital clubfoot is unknowno Extrinsic associations include Teratogenic agents (eg, sodium aminopterin) Oligohydramnios Congenital constriction rings Maria Carmela L. Domocmat, RN, MSN 10
    • o Genetic associations include o mendelian inheritance (eg, diastrophic dwarfism; o autosomal recessive pattern of clubfoot inheritance). o Cytogenetic abnormalities (eg, congenital talipes equinovarus [CTEV]) can be seen in syndromes involving chromosomal deletion. Maria Carmela L. Domocmat, RN, MSN 11
    • o Talipes may be positional or structural. Positional talipes is caused by abnormal pressures compressing the foot while its developing, as a result of its position in the womb. Structural talipes is a more complex condition and probably caused by a combination of factors, such as a genetic predisposition http://www.bbc.co.uk/health/physical_health/conditions/talipes2.shtml Maria Carmela L. Domocmat, RN, MSN 12
    • o deformity is readily apparent at birtho can be detected antenatally during the routine development ultrasound scan around 20 weeks.o X-rays may be needed to confirm diagnosis. Maria Carmela L. Domocmat, RN, MSN 13
    • o treatment is most successful when started early in infancy because delay causes muscles and bones of legs to develop abnormally, with shortening of tendons Maria Carmela L. Domocmat, RN, MSN 14
    • gentle, manipulation of foot with casting done every few days for 1 to 2 weeks then at 1- to 2-week intervalsPonseti’s Method of treatment Maria Carmela L. Domocmat, RN, MSN 15
    • Maria Carmela L. Domocmat, RN, MSN 16
    • involves serial manipulation and plaster casting of theclubfoot.The ligaments and tendons of the foot are gentlystretched with weekly, gently manipulations.A plaster cast is then applied after each weeklysessions to retain the degree of correction obtainedand to soften the ligaments. Thereby, the displacedbones are gradually brought into the correctalignment.Four to five long leg (from the toes to the hip) areapplied with the knee at a right angle. Maria Carmela L. Domocmat, RN, MSN 17
    • LONG LEG CAST DENNIS BROWN SPLINThttp://www2.massgeneral.org/ORTHO/BabyCast.gif http://www2.massgeneral.org/ORTHO/DennisBrownBrace.gif Maria Carmela L. Domocmat, RN, MSN 18
    • Maria Carmela L. Domocmat, RN, MSN 19
    • Making A Difference: Caring For Clubfoot atthe Sinai Hospital of Baltimore athttp://www.youtube.com/watch?v=RmkrrvwMH4A&feature=player_embedded#! Maria Carmela L. Domocmat, RN, MSN 20
    • done if nonsurgical treatment not effectivetight ligaments releasedtendons lengthened or transplantedOther surgical treatments - circumferential release: "cincinati incision" - Goldner four quadrant approach: - medial release - posterior release - posteromedial release - tendon transfers Maria Carmela L. Domocmat, RN, MSN 21
    • extended medical supervision is required bcoz there is a tendency for this deformity to recur (considered cured when the child is able to wear normal shoes and walk properly)care emphasizes muscle reeducation (bymanipulation) and proper walking Maria Carmela L. Domocmat, RN, MSN 22
    • heels and soles of braces or shoesprescribed following correction must bekept in repaircorrective shoes may have sole and heel liftson lateral border to maintain properpositioning Maria Carmela L. Domocmat, RN, MSN 23
    • • Approximately 50-60% of club feet in newborns can be corrected non-operatively.• About 20% of infants requiring surgery need further surgery at a later stage. Maria Carmela L. Domocmat, RN, MSN 24
    • Maria Carmela L. Domocmat, RN, MSN 25
    • Maria Carmela L. Domocmat, RN, MSN 26
    • • imperfect development of hip –can affect femoral head, acetabulum, or both• head of femur does not lie deep enough within the acetabulum and slips out on movement• occurs in females 7 times more often than males Maria Carmela L. Domocmat, RN, MSN 27
    • Maria Carmela L. Domocmat, RN, MSN 28
    • o acetabular dysplasia mildest form femoral head remains in acetabulumo subluxation most common form femoral head partially displacedo dislocation femoral head not in contact with acetabulum displaced posteriorly and superiorly Maria Carmela L. Domocmat, RN, MSN 29
    • o limitation in abduction of leg on affected sideo asymmetry of gluteal, popliteal, and thigh foldso Waddling gait and lordosis when child begins to walk Maria Carmela L. Domocmat, RN, MSN 30
    • Maria Carmela L. Domocmat, RN, MSN 31
    • With child in asupine position,the right kneeon the side ofthe subluxationappears lowerthan the leftbecause ofmalposition ofthe femur head. Maria Carmela L. Domocmat, RN, MSN 32
    • infant on a supine position.Doctor abducts the hips by moving the benthips and knees apart.If the hip feels like it can be pushed out theback of the socket, this is consideredabnormal.This is called a positive Barlows Test and is asign of instability in the hip. Maria Carmela L. Domocmat, RN, MSN 33
    • As the hip is abducted further, the doctormight feel the ball portion (the femoral head)slide forward as it slips back into the socket.Or audible click when abducting andexternally rotating hip on affected side: Maria Carmela L. Domocmat, RN, MSN 34
    • Maria Carmela L. Domocmat, RN, MSN 35
    • directed toward enlarging and deepening theacetabulum by placing the head of femur within theacetabulum and applying constant pressureproper positioning: legs slightly flexed and abductedSurgical Ix Maria Carmela L. Domocmat, RN, MSN 36
    • o proper positioning: legs slightly flexed and abducted Pavlik harness Frejka pillow: a pillow splint that maintains abduction of legs Bryant’s traction Spica cast Closed reduction Maria Carmela L. Domocmat, RN, MSN 37
    • Hip abduction splint holds the hips in anabduction position,forcing the femurhead into theacetabulum. Maria Carmela L. Domocmat, RN, MSN 38
    • Maria Carmela L. Domocmat, RN, MSN 39
    • http://www.orthopediatrics.com/binary/org/ORTHOPEDIATRICS/images/hi pimages/child_hip_devel_dysp_treatment01.jpgMaria Carmela L. Domocmat, RN, MSN 40
    • http://www.lpch.org/media/images/c onditions/ei_0239.gifMaria Carmela L. Domocmat, RN, MSN 41
    • Maria Carmela L. Domocmat, RN, MSN 42
    • A hip abduction cast for correction ofsubluxation of the hip. Maria Carmela L. Domocmat, RN, MSN 43
    • Maria Carmela L. Domocmat, RN, MSN 44
    • Maria Carmela L. Domocmat, RN, MSN 45
    • http://isakssonsgummifabrik.com/pics/babyfront.jpgMaria Carmela L. Domocmat, RN, MSN 46
    • open reduction with castingderotational osteotomyPelvic osteotomies Maria Carmela L. Domocmat, RN, MSN 47
    • femur is cut and rotated to make it easier tokeep the femoral head inside the acetabulum.When this procedure is done, the soft tissuesloosen up and the forces of the muscles tend tokeep the femoral head reduced.Once again, the child is put in a spica cast forseveral months while the bone heals.A CT scan may be used to confirm successfulreduction before removing the cast. Maria Carmela L. Domocmat, RN, MSN 48
    • Maria Carmela L. Domocmat, RN, MSN 49
    • for children older than 18 months which may requireadditional surgery to change the acetabulum(socket) in addition to the femur (thighbone) The problem has been present longer and the anatomy has grown more distorted over the longer period of time. Maria Carmela L. Domocmat, RN, MSN 50
    • Maria Carmela L. Domocmat, RN, MSN 51
    • Several different types of osteotomies are used totilt the acetabulum in a more horizontal angle to thefloor. By doing this, the femoral head is less likely toslide up and out of the socket with weightbearing.Types : Steele osteotomy; Salter osteotomy;Pemberton osteotomy Maria Carmela L. Domocmat, RN, MSN 52
    • This can stop the femoral head from slidingup and out of the socket.Over time this shelf of bone above theacetabulum remodels and forms a deeperacetabulum.the bone of the pelvis just above theacetabulum is cut to allow the bone to slideout and form a new roof over the hip joint. Maria Carmela L. Domocmat, RN, MSN 53
    • Maria Carmela L. Domocmat, RN, MSN 54
    • uses a bone graft placed just above the hipjoint to create a new, wider roof, or shelf overthe acetabulum.This keeps the femoral head from sliding upand out of the socket and, as it heals, makes alarger weightbearing surface to spread outthe weight that needs to be transferred fromthe femoral head to the acetabulum andpelvis. Maria Carmela L. Domocmat, RN, MSN 55
    • Maria Carmela L. Domocmat, RN, MSN 56
    • not as commonthe entire acetabulum is cut free of the pelvisand moved or dialed at the best angle andthen allowed to heal in that position. Maria Carmela L. Domocmat, RN, MSN 57
    • o Same with other clients with cast and braces; pre- and post-op careo Transportation and positioning use wagon or stroller with back flat or mechanic’s creeper protect child from falling when positioned never pick up child by the bar between the legs of cast (use two people to provide adequate body support if necessary) Maria Carmela L. Domocmat, RN, MSN 58
    • A patients guide to developmental dysplasia of the hip in childrenretrieved on September 4, 2011 athttp://www.orthopediatrics.com/docs/Guides/dysplasia.html Massachusets General Hospital. Pediatric orthopaedic ailments:Clubfoot. Retrieved on September 4, 2011 athttp://www2.massgeneral.org/ORTHO/ClubFoot.htm Saxton, Nugent, and Pelikan. (2006). Mosby’s comprehensivereview of nursing [18th ed]. St. Louis: MosbyTalipes Equinovarus. Retrieved on September 4, 2011 athttp://www.patient.co.uk/doctor/Club-Foot.htmWheeless’ Textbook of Orthopaedics. Talipesequinovarus/Clubfoot Retrieved on September 4, 2011 athttp://www.wheelessonline.com/ortho/talipes_equinovarus_clubfoot Maria Carmela L. Domocmat, RN, MSN 59