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Acquired Bone Deformities


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Acquired Bone Deformities

  1. 1. Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Dr. Mohammed A Abbas
  2. 2. Definitions <ul><li>Acquired : adjective; arising in response to the action of the environment on the organism. It is opposite to congenital, familial, genetic & hereditary. It develops after birth. </li></ul><ul><li>Bone : noun; the hard part of the skeleton. Functions as supportive, locomotive & protective as well as manufacturing blood cells and homeostasis. </li></ul><ul><li>See pictures of bones . </li></ul><ul><li>Deformity : noun; d eviation from normal form. </li></ul>
  3. 10. Types of Acquired Bone Deformities (1) <ul><li>Torsional deformity : The bone is twisted medially (inwards, internally), </li></ul><ul><li>e.g. intoeing gait in lower limb. see pic . </li></ul><ul><li>tip position in upper limb </li></ul><ul><li>or laterally (outwards, externally), </li></ul><ul><li>e.g. outtoeing gait in LL </li></ul><ul><li>external rotational deformity in UL </li></ul>
  4. 11. <ul><li>Pictures of internal ( inwards ) torsional deformities </li></ul>
  5. 16. <ul><li>Pictures of external ( outward ) torsional deformities </li></ul>
  6. 18. Types of Acquired Bone Deformities (2) <ul><li>Angular deformity : The bone is seen angulated in 2 planes, </li></ul><ul><li>1. Sagittal plane ( Antero / posterior ). </li></ul><ul><li>e.g. anteriorly ; anterior bowing. </li></ul><ul><li>posteriorly ; posterior bowing. see pic. </li></ul><ul><li>2. Coronal plane ( Medio / laterally ). </li></ul><ul><li>e.g. medially ; varus deformity. </li></ul><ul><li>laterally ; valgus deformity. </li></ul>
  7. 19. <ul><li>Pictures of angular deformity in the sagittal plane ( anterior / posterior ) </li></ul>
  8. 23. <ul><li>Pictures of angular deformity in the coronal plane ( medial / lateral ), i.e. towards or away from midline </li></ul>
  9. 32. Causes of Acquired Bone Deformities <ul><li>Traumatic. </li></ul><ul><li>Inflammatory. </li></ul><ul><li>Degenerative. </li></ul><ul><li>Infectious. </li></ul><ul><li>Tumours. </li></ul><ul><li>Dietary. </li></ul><ul><li>Miscellaneous. </li></ul>
  10. 33. Rickets A condition producing all types of deformities <ul><li>Softening of bone in childhood due to lack of mineralization. </li></ul><ul><li>Due to vitamin D deficiency which leads to Calcium & Phosphorus deficiency. </li></ul><ul><li>Types : </li></ul><ul><li>1. Dietary deficiency. </li></ul><ul><li>2. Secondary to liver ( biliary ), renal and intestinal diseases. </li></ul><ul><li>3. Hereditary, sex-linked, vit - D resistant. </li></ul>
  11. 34. <ul><li>Pictures of rickets with all types of deformities </li></ul>
  12. 45. Scoliosis torsional and angular deformities in the spine <ul><li>See pictures </li></ul>
  13. 49. Investigations <ul><li>Bone profile ; calcium, phosphate, alkaline phosphatase. </li></ul><ul><li>Serum level of vitamin D. </li></ul><ul><li>X-rays. </li></ul><ul><li>Urinary excretion of calcium and phosphate. </li></ul><ul><li>Bone biopsy. </li></ul><ul><li>Bone densitometry. </li></ul>
  14. 50. General Outline of Treatment <ul><li>Medically : treat the primary causes plus supplement of deficient factors. </li></ul><ul><li>Surgically : to correct the deformities. </li></ul><ul><li>Supportive measures : orthoses and prostheses to control deformities. </li></ul><ul><li>Physical therapy. </li></ul><ul><li>Occupational therapy. </li></ul>
  15. 51. Case report <ul><li>A 5 years old boy who presents with bowing in both lower extremities. This has been progressive and he takes a poor diet. Family history is negative for a similar case and no history of trauma exists. </li></ul><ul><li>Examination shows increased inte-rcondylar distance with varus deformity of both legs. </li></ul><ul><li>How do you approach this case ? </li></ul>
  16. 52. Answer <ul><li>History : proper, detailed, precise and accurate. </li></ul><ul><li>Examination : SOAP </li></ul><ul><li>S = Subjective </li></ul><ul><li>O = Objective </li></ul><ul><li>A = Assessment ( working/or definitive Dx.) </li></ul><ul><li>P = Plan ( investigations and treatment ) </li></ul>
  17. 53. Requirements & Expectations <ul><li>Sound knowledge. </li></ul><ul><li>Build up skills of communication with patients, taking a proper history, conducting a proper examination, reading x-rays and other investigatory tests. </li></ul><ul><li>Intellectuality and cognitive ability are required for best achievement. </li></ul><ul><li>Attitudes and good behavior are mandatory. </li></ul><ul><li>Ending up with a safe and a competent medical practitioner. </li></ul>
  18. 54. The END