1. ORTHOPEDIC DISORDERS
By
Livson Thomas
MSc (N) 1st Year
CMC, Ldh

2. CLUB FOOT

3. DEFINITION
 Club Foot is a complex deformity of foot, result of
complicated inter- relationships between bone ligaments
and muscles.

4. CAUSES
 Defective gene – Hereditary
 Excessive pressure of amniotic fluid
 Uterine compression
 Arrested fetal development
 Circulatory failure
 Irradiation (maternal)

6. CLASSIFICATION
1. Talipus Equinovarus

7. 2. Talipus Calcaneovagus

8. 3. Talipus Varus

9. 4. Talipus Vagus

10. 5. Talipus Equinovalgus

11. 6. Talipus Calcaneovarus

13. PATHOPHYSIOLOGY
PRE DISPOSING FACTORS
DISTAL LIMB AMNIOTIC BANDING DEFECTIVE CARTILAGENOUS
ANLAGE
AMNION FORMS CONSTRICTIVE
BANDS AROUND A LIMB IN UTERO. RESULTING IN FURTHER
ABNORMAL OR ARRESTED
DEVELOPMENT
CUTTING OF CIRCULATION TO
LIMB
ARREST OF FETAL DEVELOPMENT IN
THE FIBULAR STAGE

14. MEDICAL MANAGEMENT
1. CORRECTION
a) Stretching and casting (PONSETI METHOD)

15. b) Stretching and Taping ( French Method)

16. c) Dennis - Brown Brace

17. NSAIDs

18. SURGERY

20. DEFINITION
 Juvenile rheumatoid arthritis ( JRA) is a chronic
systemic inflammatory disease involving connective
tissue of one or more joints.

21. PATHOPHYSIOLOGY
CHRONIC INFLAMMATION OF THE SYNOVIUM
JOINT EFUSION
EROSION, DISTORTION AND FIBROSIS OF THE ARTICULAR
CARTILAGE
FIBROUS ANKYLOSIS WITH SUBLUXATION AND
DISTORTION OF THE AFFECTED JOINT

22. GRANULATION TISSUE BECOMES HARD, TOUGH AND FIBROUS
AND CONVERTED TO SCAR TISSUE
INHIBITION OF JOINT MOVEMENTS

23. CLASSIFICATION
1. Pauciarticular onset

24. 2. Polyarticular Onset

25. 3. Systemic Onset

27. CLINICAL MANIFESTATIONS
1. Involvement of both small and large joints
2. Joints are tender, swollen and warm
3. Reduced mobility
4. Prolonged fever
5. Muscle aches

28. C/M …
6. Weight loss
7. Subcutaneous nodules
8. Hepatosplenomegaly
9.Pericarditis, myocarditis
10. Pneumonia

29. MEDICAL MANAGEMENT
1. NSAIDs
2. Methotrexate
3. Physiotherapy

30. NURSING MANAGEMENT
 RELIEVE PAIN
 PROMOTE GENERAL HEALTH
 ENCOURAGE EXERCISE
 GIVE HOT BATH
 PSYCHOLOGICAL SUPPORT
 HEALTH EDUCATION

31. HIP DISPLACEMENT

33. DEFINITION
 Hip displacement is referred to a condition in which
the femoral head and the acetabulum are improperly
aligned in which the ball of the femur is outside the
hip socket.

34. TYPES
1. Hip dislocation or preluxation or
acetabular dysplasia
2. Instability of hip or subluxation
3. Dislocation or subluxation of hip

36. PATHOPHYSIOLOGY
1. Physiologic factors
2. Mechanical factors
3. Genetic factors

37. CLINICAL MANIFESTATIONS
 Laxity of ligaments
 Assymetry of gluteal fold
 Limited ROM
 Apparent shorter femur on affected side

38. C/M …
 Variation in gait
 Extra fold at thighs and groins
 Difference in length of limbs
 Wading gait

40. MEDICAL MANAGEMENT
 Pavlik harness

41. 2. SKIN TRACTION

42. 3. SURGERY AND CAST

43. NURSING MANAGEMENT
 Teach parents regarding care and application of pavlik
maneuver.
 Feeding and bathing the child.
 Skin care.
 Assess warmth and color of feet.
 Evaluate for any complication of cast.

44. NSG MNGMT…
 Child not to be left unattended.
 Assess for s/s of infection.
 Proper diet.
 Follow up.
 Psychological support.
 Prevent complications due to immobility.

45. FRACTURES

46. DEFINITION
 A fracture is defined as a break in the continuity of a
bone. This can occur either in the long bones as is
most common or in flat bones such as skulls or pelvis.

48. HEALING OF FRACTURE
HEMATOMA FORMATION AT FRACTURED END OF
BONE
IN GROWTH OF CAPILLARIES AND FIBROBLAST KNOWN AS
GRANULATION TISSUE
GRANULATION REPLACES HEMATOMA
CHANGES IN GRANULATION TISSUE FORMATION OF CARTILAGE
CELLS AND OSTEOBLASTS

49. FORMATION OF CARTILAGINOUS INTERWOVEN BONE
BONE HEAL WITH STABILITY
MATURITY OF BONE OCCURS

51. CLINICAL FEATURES
 Pain
 Pallor
 Paralysis
 Generalized Swelling
 Bruising
 Tenderness
 Deformity
 Severe muscle rigidity

52. MEDICAL MANAGEMENT
1. CLOSED REDUCTION

53. 2. OPEN REDUCTION

54. 3. TRACTION

55. NURSING MANAGEMENT
 Prepare child for surgery.
 Keep affected part immobilized.
 Proper application of traction.
 Maintain hygiene of the child.
 Prevent infections.

56. NSG MANGMT…
 The child with cast observed for :
a) Prevention of circulatory, neurologic or respiratory
distress.
b) Maintain normal body temperature.
c) Maintain skin integrity.
d) Improve muscle activity.
e) Provide comfort measures.
f) Prevent urinary stasis and constipation.
g) Health education of parents.

57. OSTEOMYELITIS

58. DEFINITION
 Osteomyelitis is a bacterial infection of the bone
involving the cortex and/ or the bone marrow.

59. TYPES
 ACUTE OSTEOMYELITIS
 CHRONIC OSTEOMYELITIS

60. ETIOLOGY
 Caused by micro-organisms.
 Endogenous sources.
 Exogenous sources.

62. PATHOPHYSIOLOGY
OCCUR MOSTLY AT THE METAPHYSEAL REGION OF
LONG BONES, ESPECIALLY FEMUR AND TIBIA
BACTERIA ENTERS THROUGH OSEOUS
CIRCULATION TO METAPHYSIS
PUS FORMATION AND MEDULLARY CANNAL &
CORTEX GET AFFECTED

63. NECROSIS AND DEVASCULARIZATION OF THE CORTEX
NECROSIS AND DETACHMENT
CHRONIC OR ACUTE
OSTEOMYELITIS

64. CLINICAL MANIFESTATIONS
 Pain
 Swelling
 Tenderness
 Erythema
 Limited ROM
 Systemic – fever & lethargy

65. MANAGEMENT
 Antibiotic therapy
 Complete bed rest
 Immobilization
 Regular blood check up
 Wound care
 Skin assessment
 Asepsis
 Home care

66. KYPHOSIS

67. DEFINITION
 It is the deformity of the spine.
 The term kyphosis refers to an enhanced angulations
in the thoracic or thoraco-lumbar spine in the
saggital plane or a round back deformity.

68. CAUSES
 It can develop due to defective posture.
 Rickets
 May be congenital or secondary to
compression fracture.
 Malignancy
 Juvenile Rheumatoid Arthritis

69. MANAGEMENT
 Orthotic devices
 Orthopaedic surgery
 Pre and post operative care
 Psychological support

70. SCOLIOSIS

71. DEFINITION
 It is a lateral or side curvature of spine due to
abnormality in alignment of spine.
 Scoliosis develops two curves – one is original
abnormal curve and second a compensatory curve in
the opposite direction.

72. CAUSES
 Idiopathic
 Defective embryonic development of the spine.
 Neuromuscular paralysis
 Cerebral palsy
 Post polio
 Rickets
 Fractures
 Disease of hip and spine.

73. CLINICAL MANIFESTATIONS
 Leg length discrepancy
 Shoulder asymmetry in breast size
 Uneven waist line
 Scapular prominence
 Bone pain
 Poor posture

74. MANAGEMENT
 Orthotic devices
 Surgery
 Pre and post op casting
 Psychological support
 Health education
 Exercise
 Counseling of parents

75. LORDOSIS
 It is an abnormally increased forward curvature of
lumbar spine.
 It is also called sway back or saddle back.

77. BOW LEG (Genu Varum)
 the term bow leg refers lateral angulation of knee
joints because of inward deviation of longitudinal
axis of tibia and femur.

78. CAUSES
 Rickets
 Traumatic
 Developmental anomalies
 Physiological

79. MANAGEMENT
 Early detection of condition.
 Orthopedic intervention
 Surgical corrections

80. KNOCK KNEE ( Genu Valgum)
 Knock knee is abnormal convergent of knee with
divergent ankles.
 This occurs due to outward deviation of longitudinal
axis of both tibia and femur

81. CAUSES
 Pathological : rickets, JRA.
 Cerebral palsy
 Fractures
 Neoplastic disease

82. MANAGEMENT
 Early detection
 Orthopedic intervention
 Correction using orthopedic devices.

83. POLYDACTYLY
 It is defined as an extra finger or toe.
 Usually occurs at metacarpophalangeal joints of little
finger or thumb.

84. CAUSES
 Carpenter syndrome
 Trisomy 13
 Mekhel gruber syndrome
 Isolated trait

85. SYNDACTYLY
 It is fussion of digits and toes.

86. CAUSES
 Isolated trait
 Compound of certain syndrome
a) carpenter syndrome
b) trisomy 21, 13 & 18

87. THANK YOU