Congenital deformities

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Congenital deformities

  1. 1. CONGENITAL DEFORMITIESPresenters: Dr.A.Prakash, Dr. C. Arun Prasath.Institution: Annamalai University. Date:12.2.2013.
  2. 2. CONGENITAL TALIPES EQUINO VARUS (CTEV)
  3. 3. CTEV Vague term used to define a number of abnormalities in the foot.
  4. 4. 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.
  5. 5. 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
  6. 6. 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.
  7. 7. CTEV-CLINICAL FEATURES
  8. 8. CTEV-DIAGNOSIS Xrays- reduced talo calcaneal angle.  Normal-more than 35 degrees.
  9. 9. CTEV-TREATMENT Non-operative  Manipulation  Manipulation and corrective plaster Operative  Postero-medial soft tissue release(TURCO’S)-<3 years  Limited soft tissue release  Tendon transfers  Dwyer’s osteotomy  Dilwyn-Ewan’s procedure- 4 to 8 years  Wedge tarsectomy- 8 to 11 years  Triple arthrodesis- >11 years  Illizarov’s technique- recurrent.
  10. 10. CTEV-MAINTANANCE Ctev splints Denis-Brown splint CTEV shoes
  11. 11. SPINA BIFIDA
  12. 12. SPINA BIFIDA A congenital disorder in which the two halves of the posterior vertebral arch fail to fuse at one or more levels.
  13. 13. 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
  14. 14. 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
  15. 15. SPINA BIFIDA-CLINICAL FEATURES
  16. 16. SPINA BIFIDA-CLINICAL FEATURES
  17. 17. SPINA BIFIDA- DIAGNOSIS Xray CT MRI
  18. 18. SPINA BIFIDA-TREATMENT Wound care Poper closure of defect Hydrocephalous- ventriculo-peritoneal shunt, if necessary for 5 to 6 years. Physiotherapy and splinting
  19. 19. CONGENITAL DISLOCATION OF HIP (CDH)
  20. 20. CDH Spontaneous disloation of the hip occuring before, during or shortly after birth.
  21. 21. CDH-AETIOLOGY Not well understood Hereditary predisposed to joint laxity Hormone induced joint laxity Breech presentation Hereditary faulty development of acetabulum.
  22. 22. CDH-PATHOLOGY Femoral head is dislocated upwards- small capital epiphysis Femoral neck- anteverted Acetabulum-shallow Ligamentum teres-hypertrophied. Fibrocartilaginous labrum- folded limbus. Streched capsule Muscles-shortened
  23. 23. CDH-CLINICAL FEATURES At birth-from pediatrician Early child hood-asymmetry of groin creases, limitation of hip movements, click Older children-peculiar gait.
  24. 24. CDH-CLINICAL FEATURES
  25. 25. CDH-DIAGNOSIS Barlow’s test Ortolani’s test Galeazzi’s sign Telescopy test Trendelenburg’s test Xray-shallow acetabulum, break in shenton’s line, small head Ultrasound
  26. 26. CDH-DIAGNOSIS
  27. 27. 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
  28. 28. SPRENGEL’S SHOULDERCONGENITAL ELEVATION OF SCAPULA
  29. 29. SPRENGEL’S SHOULDER Failure of descent of the scapula, which is developmentally a cervial appendage.
  30. 30. 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.
  31. 31. SPRENGEL’S SHOULDER-CLINICAL FEATURES
  32. 32. SPRENGEL’S SHOULDER-TREATMENT Mild- left alone Children younger than 6 years-scapula an be repositioned by release of the muscles, exision of the supraspinous portion of the scapula.
  33. 33. MADELUNG DEFORMITY RADIAL CLUB HAND
  34. 34. MADELUNG DEFORMITY Defective growth of the distal radial epiphysis resulting in a deformity due to a comparative overgrowth of the ulna. Traumatic and congenital
  35. 35. 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
  36. 36. MADELUNG DEFORMITY-CLINICAL FEATURES
  37. 37. MADELUNG DEFORMITY-TREATMENT Exision of the lower end of ulna Exision of the damaged physis
  38. 38. RADIO ULNAR SYNOSTOSIS
  39. 39. RADIO ULNAR SYNOSTOSIS Synostosis-abnormal fusion of bones
  40. 40. RADIO ULNAR SYNOSTOSIS-CLINICAL FEATURES Postero lateral dislocation of radial head Complete loss of supination and pronation
  41. 41. RADIO ULNAR SYNOSTOSIS-TREATMENT Exision of the bony bridge- unsuccessful. Change the resting position of the limb to supination by tendon transfers.
  42. 42. CONGENITAL PSEUDARTHROSIS OF TIBIA
  43. 43. PSEUDARTHROSIS OF TIBIA A birth defect in the lower end of tibia in children, where a fracture fails to unite.
  44. 44. 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
  45. 45. PSEUDARTHROSIS OF TIBIA-PRESENTATION
  46. 46. PSEUDARTHROSIS OF TIBIA-PRESENTATION
  47. 47. PSEUDARTHROSIS OF TIBIA-PRESENTATION
  48. 48. PSEUDARTHROSIS OF TIBIA-TREATMENT Simple immobilisation-fails ORIF with bone grafting-succeeds occasionally Excision of the affected segment and slowly closing the gap.

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