This document discusses congenital dislocation of the hip (CDH). It describes the etiology as being hereditary joint laxity and relaxin causing relaxation of female fetal ligaments. Clinical features include asymmetry of thigh creases, limb shortening, and a Trendelenburg gait. Diagnosis involves tests like Barlow's and Ortolani's, with radiological features of a sloped acetabulum. Treatment is closed or open reduction, sometimes with acetabular reconstruction procedures like Salter or Chiari osteotomies. The aim is to achieve and maintain reduction until the hip stabilizes.
The hip joint is a ball and socket joint that provides stability through its articulating surfaces and surrounding ligaments. The acetabulum faces outward at a 30 degree angle. Dislocations of the hip can be posterior, anterior, or central fracture-dislocations. Posterior dislocations are the most common and result from force along the femur with the hip flexed. Anterior dislocations occur when the legs are forcibly abducted and externally rotated. Reduction of dislocations is an emergency to prevent avascular necrosis, and closed reduction is usually possible. Complications can include sciatic or femoral nerve injury, avascular necrosis, arthritis, and myositis ossificans.
1. Septic arthritis is a bacterial infection of the joints that is more common in children and males. Staphylococcus aureus is often the causative organism, which can spread via the bloodstream, nearby bone infections, wounds, or medical procedures.
2. Symptoms include severe joint pain, swelling, fever, and inability to use the affected limb. Diagnosis involves blood tests, joint fluid analysis, and imaging. Treatment requires antibiotics for 6 weeks and immobilizing the joint.
3. Complications can include joint deformity, dislocation, and osteoarthritis if not properly treated. Septic arthritis of the hip in infants can destroy the femoral head, leading to a short, unstable leg if not addressed
This document contains multiple pages of content from Dreamz Learning Innovations related to orthopedic questions and answers. It provides definitions and descriptions of various orthopedic procedures, injuries, and conditions. For each question, it lists the possible answer choices and then reveals the correct answer on the following page with a brief explanation or definition. The questions cover topics like fractures, amputations, osteomyelitis, tuberculosis of the spine, and ligament tears.
The document discusses two types of bone tumors - giant cell tumor (GCT) and osteosarcoma. GCT is a benign tumor but tends to recur after removal. It consists of spindle cells and multinucleated giant cells, commonly affecting bones around the knee. Treatment involves wide excision or curettage with cryotherapy. Osteosarcoma is the second most common bone tumor and highly malignant. It commonly affects long bones in teenagers and young adults, presenting with pain and swelling. Radiographs show irregular destruction with new bone formation and intense periosteal reaction.
A cervical rib is an additional rib that arises from the 7th cervical vertebra. It is usually unilateral and more common on the right side. In 90% of cases, a cervical rib causes no symptoms. However, it can produce neurological or vascular symptoms after age 30, especially in females. These include tingling and numbness in the forearm and hand, as well as pain from compression of the subclavian artery. Differential diagnoses include carpal tunnel syndrome and cervical spine lesions. Treatment involves conservative measures like exercises or surgery to remove the rib.
This document provides information on congenital muscular torticollis and its treatment. It describes how congenital muscular torticollis is caused by fibromatosis in the sternocleidomastoid muscle. Conservative treatment including stretching is recommended during infancy. Surgery may be needed if deformity persists beyond age 1. The goal of surgery before age 6-8 is to allow remodeling and prevent facial asymmetry.
Growth prediction (2) /certified fixed orthodontic courses by Indian dental a...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Growth & development /certified fixed orthodontic courses by Indian dental a...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
The hip joint is a ball and socket joint that provides stability through its articulating surfaces and surrounding ligaments. The acetabulum faces outward at a 30 degree angle. Dislocations of the hip can be posterior, anterior, or central fracture-dislocations. Posterior dislocations are the most common and result from force along the femur with the hip flexed. Anterior dislocations occur when the legs are forcibly abducted and externally rotated. Reduction of dislocations is an emergency to prevent avascular necrosis, and closed reduction is usually possible. Complications can include sciatic or femoral nerve injury, avascular necrosis, arthritis, and myositis ossificans.
1. Septic arthritis is a bacterial infection of the joints that is more common in children and males. Staphylococcus aureus is often the causative organism, which can spread via the bloodstream, nearby bone infections, wounds, or medical procedures.
2. Symptoms include severe joint pain, swelling, fever, and inability to use the affected limb. Diagnosis involves blood tests, joint fluid analysis, and imaging. Treatment requires antibiotics for 6 weeks and immobilizing the joint.
3. Complications can include joint deformity, dislocation, and osteoarthritis if not properly treated. Septic arthritis of the hip in infants can destroy the femoral head, leading to a short, unstable leg if not addressed
This document contains multiple pages of content from Dreamz Learning Innovations related to orthopedic questions and answers. It provides definitions and descriptions of various orthopedic procedures, injuries, and conditions. For each question, it lists the possible answer choices and then reveals the correct answer on the following page with a brief explanation or definition. The questions cover topics like fractures, amputations, osteomyelitis, tuberculosis of the spine, and ligament tears.
The document discusses two types of bone tumors - giant cell tumor (GCT) and osteosarcoma. GCT is a benign tumor but tends to recur after removal. It consists of spindle cells and multinucleated giant cells, commonly affecting bones around the knee. Treatment involves wide excision or curettage with cryotherapy. Osteosarcoma is the second most common bone tumor and highly malignant. It commonly affects long bones in teenagers and young adults, presenting with pain and swelling. Radiographs show irregular destruction with new bone formation and intense periosteal reaction.
A cervical rib is an additional rib that arises from the 7th cervical vertebra. It is usually unilateral and more common on the right side. In 90% of cases, a cervical rib causes no symptoms. However, it can produce neurological or vascular symptoms after age 30, especially in females. These include tingling and numbness in the forearm and hand, as well as pain from compression of the subclavian artery. Differential diagnoses include carpal tunnel syndrome and cervical spine lesions. Treatment involves conservative measures like exercises or surgery to remove the rib.
This document provides information on congenital muscular torticollis and its treatment. It describes how congenital muscular torticollis is caused by fibromatosis in the sternocleidomastoid muscle. Conservative treatment including stretching is recommended during infancy. Surgery may be needed if deformity persists beyond age 1. The goal of surgery before age 6-8 is to allow remodeling and prevent facial asymmetry.
Growth prediction (2) /certified fixed orthodontic courses by Indian dental a...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Growth & development /certified fixed orthodontic courses by Indian dental a...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
This document discusses various destructive operations that can be performed on a dead fetus to facilitate delivery through the birth canal when the fetus is too large to pass intact. It defines destructive operations and describes their purposes. It then discusses different procedures like craniotomy, decapitation, evisceration, cleidotomy, and spondylectomy. For each procedure, it provides indications, prerequisites, steps to perform the procedure, and risks. It notes that most destructive operations are no longer recommended and have been replaced by caesarean section for safety reasons.
This document discusses shoulder dislocations and humeral fractures. It provides details on the mechanism, physical exam findings, imaging, and management of anterior shoulder dislocations. Anterior dislocations are the most common type, accounting for 95-97% of cases. The document describes three common techniques for reducing an anterior shoulder dislocation: Stimson's method, scapular manipulation, and external rotation. It highlights key steps for each technique and notes their advantages and disadvantages.
Congenital hip dislocation (CHD) occurs when the femoral head spontaneously dislocates from the acetabulum before or shortly after birth. It is caused by hereditary joint laxity, maternal relaxin hormone exposure, or breech positioning in the womb. Clinically, CHD presents with leg length discrepancy, an abnormal gait, or limited hip movement. Treatment involves closed or open reduction of the femoral head and maintenance with casting or splinting, especially in younger patients. For older patients or those with severe deformity, acetabular reconstruction procedures like Salter's osteotomy may be needed. The goal is to achieve a stable reduction and encourage acetabular remodeling.
The document discusses the management of peri-articular fractures through a span-scan-plan approach. It emphasizes using spanning external fixation initially to stabilize the fracture and joint, allowing time for soft tissue healing and improved radiographic evaluation through CT scanning. This helps formulate an optimal surgical plan to address the fracture based on its characteristics, available techniques, implants, and patient factors. Proper planning is important for achieving desired objectives like anatomical reduction while preserving soft tissues.
Dr. Kelsey Lena’s CMC Pediatric Orthopedic X-Ray Mastery Project: January CasesSean M. Fox
Dr. Kelsey Lena is Emergency Medicine Resident and interested in pediatric emergency medicine and medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, and supervision of Dr. Danielle Sutton, a Pediatric Emergency Medicine specialist, and Dr. Virginia Casey, a Pediatric Orthopedic Surgeon, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Clavicle Fractures
The document provides instructions for positioning clients in bed, specifically turning a client to the lateral position. It involves assessing the client's physical abilities and needs, determining any equipment or assistance required, explaining the procedure to the client, and then using proper body mechanics and movement to roll the client onto their side. The checklist ensures all steps are followed, any issues are documented, and the client's response is recorded to evaluate the process.
This document discusses principles and techniques for safe patient handling, with a focus on bariatric patients. It describes natural movement patterns and compensatory patterns for tasks like standing up, sitting back in a chair, and crossing legs in bed. It also discusses biomechanics of lifting patients using slings in supine and seated positions. Additionally, it addresses using two motors on one track for an automatically adapting crossbar, sleeping on slings, and turning patients with hoists.
The document discusses various destructive operations that can be performed on a fetus to facilitate delivery, including craniotomy, decapitation, eviceration, and cleidotomy. Craniotomy involves making a perforation in the fetal skull to evacuate contents and extract the fetus. Decapitation severs the fetal head from the trunk. Eviceration removes abdominal/thoracic contents through an opening. Cleidotomy divides the clavicles to reduce shoulder width. The operations aim to reduce fetal bulk and allow delivery in difficult cases where the fetus is dead. Complications can include injury, hemorrhage, shock, and infection.
Adult Orthopedic Imaging Series: Presentation #2 Native Hip DislocationsSean M. Fox
Drs. Carrie Bissell, Aaron Fox, and Kendrick Lim are Emergency Medicine Residents at Carolinas Medical Center and are interested in emergency medicine and medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine and Dr. Laurence Kempton, an Orthopedic Surgeon, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides that focus on Adult Orthopedic cases. This set will cover:
- Hip Dislocations
This document discusses angular deformities of the lower limbs, specifically genu varum (bowlegs) and genu valgum (knock knees). Genu varum can be physiological in infants and young children but may also be caused by conditions like Blount's disease, rickets, or injuries. Treatment depends on the cause but may include observation, bracing, or osteotomies. Genu valgum is also often physiological but can be caused by diseases like rickets. Mild cases are often observed but more severe or progressive cases may require hemiepiphysiodesis or osteotomies to correct alignment. Both conditions are generally assessed clinically and through measurement of limb alignment and deformity angles on
Pediatric musculoskeletal nurs 3340 spring 2017Shepard Joy
This document discusses alterations in musculoskeletal function in children. It begins with objectives related to describing pediatric variations in the musculoskeletal system and planning nursing care for related disorders. It then provides an overview of the musculoskeletal system, including bones, cartilage, joints, and muscles. Specific pediatric musculoskeletal disorders discussed include metatarsus adductus, clubfoot, genu varum/valgum, and developmental dysplasia of the hip. Treatment options like casting, bracing, and surgery are described. The document emphasizes nursing assessments and interventions for related nursing diagnoses.
Chronic osteomyelitis is a persistent bone infection that can develop after an initial bout of acute osteomyelitis is inadequately treated, allowing bacteria to remain in the bone. It is characterized by the formation of dead bone (sequestra) surrounded by infected granulation tissue, as well as abnormal thickening and irregularity of the bone. Chronic osteomyelitis is diagnosed based on symptoms like a discharging sinus, examination findings revealing irregular thickened bone, and confirmation via imaging tests showing features like sequestra and bone cavities. Treatment involves surgical removal of infected and dead bone along with antibiotics to eliminate the infection.
Physiotherapy in Developmental Dysplasia of HipSreeraj S R
This document provides information on developmental dysplasia of the hip (DDH), including definition, risk factors, incidence, etiology, physical examination findings, conservative treatment options like the Pavlik harness, and complications. DDH is a partial or complete displacement of the femoral head from the acetabular cavity present since birth. Risk factors include breech presentation and family history. Treatment for infants under 6 months often involves applying a Pavlik harness to maintain the hip in flexion and abduction to facilitate reduction of the femoral head into the acetabulum. Complications of harness treatment can include femoral nerve palsy, skin breakdown, and bone necrosis.
A 30-year-old man presented with a progressively painful mass around his left knee for 5 months. X-rays showed periosteal reaction and disrupted cortex of the distal femur. This is most likely osteosarcoma, which will be further investigated with MRI, biopsy, and staging. The principles of open biopsy aim to obtain a representative sample without compromising treatment. After diagnosis and staging, treatment options include neoadjuvant chemotherapy, wide surgical excision, and adjuvant chemotherapy. Prognostic indicators include tumor stage, grade, size, location, and response to neoadjuvant chemotherapy.
Myology related to prosthodontics/certified fixed orthodontic courses by In...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses reconstruction of eyelid defects. It begins by describing the anatomy and functions of the eyelids. Eyelid defects can be anatomical, involving the structure of the eyelid, or functional, affecting eyelid movement. The objectives of reconstruction are to restore anatomical integrity, physiological function, and acceptable cosmetic appearance. Various surgical techniques are described for reconstructing different types and sizes of defects in the upper and lower eyelids. Key principles include documenting the defect, avoiding tension, and using similar tissue when possible. The timing, planning and postoperative care of reconstruction are also outlined.
A contracted pelvis is one where the pelvic diameters are reduced below normal limits, potentially interfering with labor. Causes include developmental factors, malnutrition, trauma, and diseases affecting the bones. Diagnosis involves history, examination assessing pelvic and spinal abnormalities, and pelvimetry to measure diameters. In labor, the fetus's head may pass through a contracted pelvis via molding, asynclitic descent, or an altered rotation pattern depending on the type of contraction. Management ranges from a trial of vaginal delivery for minor issues to cesarean section for more severe disproportion.
Indian Dental Academy: will be one of the most relevant and exciting training
center with best faculty and flexible training programs for dental
professionals who wish to advance in their dental practice,Offers certified
courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
Prosthetic Dentistry, Periodontics and General Dentistry.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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This document discusses various destructive operations that can be performed on a dead fetus to facilitate delivery through the birth canal when the fetus is too large to pass intact. It defines destructive operations and describes their purposes. It then discusses different procedures like craniotomy, decapitation, evisceration, cleidotomy, and spondylectomy. For each procedure, it provides indications, prerequisites, steps to perform the procedure, and risks. It notes that most destructive operations are no longer recommended and have been replaced by caesarean section for safety reasons.
This document discusses shoulder dislocations and humeral fractures. It provides details on the mechanism, physical exam findings, imaging, and management of anterior shoulder dislocations. Anterior dislocations are the most common type, accounting for 95-97% of cases. The document describes three common techniques for reducing an anterior shoulder dislocation: Stimson's method, scapular manipulation, and external rotation. It highlights key steps for each technique and notes their advantages and disadvantages.
Congenital hip dislocation (CHD) occurs when the femoral head spontaneously dislocates from the acetabulum before or shortly after birth. It is caused by hereditary joint laxity, maternal relaxin hormone exposure, or breech positioning in the womb. Clinically, CHD presents with leg length discrepancy, an abnormal gait, or limited hip movement. Treatment involves closed or open reduction of the femoral head and maintenance with casting or splinting, especially in younger patients. For older patients or those with severe deformity, acetabular reconstruction procedures like Salter's osteotomy may be needed. The goal is to achieve a stable reduction and encourage acetabular remodeling.
The document discusses the management of peri-articular fractures through a span-scan-plan approach. It emphasizes using spanning external fixation initially to stabilize the fracture and joint, allowing time for soft tissue healing and improved radiographic evaluation through CT scanning. This helps formulate an optimal surgical plan to address the fracture based on its characteristics, available techniques, implants, and patient factors. Proper planning is important for achieving desired objectives like anatomical reduction while preserving soft tissues.
Dr. Kelsey Lena’s CMC Pediatric Orthopedic X-Ray Mastery Project: January CasesSean M. Fox
Dr. Kelsey Lena is Emergency Medicine Resident and interested in pediatric emergency medicine and medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, and supervision of Dr. Danielle Sutton, a Pediatric Emergency Medicine specialist, and Dr. Virginia Casey, a Pediatric Orthopedic Surgeon, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
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This document discusses principles and techniques for safe patient handling, with a focus on bariatric patients. It describes natural movement patterns and compensatory patterns for tasks like standing up, sitting back in a chair, and crossing legs in bed. It also discusses biomechanics of lifting patients using slings in supine and seated positions. Additionally, it addresses using two motors on one track for an automatically adapting crossbar, sleeping on slings, and turning patients with hoists.
The document discusses various destructive operations that can be performed on a fetus to facilitate delivery, including craniotomy, decapitation, eviceration, and cleidotomy. Craniotomy involves making a perforation in the fetal skull to evacuate contents and extract the fetus. Decapitation severs the fetal head from the trunk. Eviceration removes abdominal/thoracic contents through an opening. Cleidotomy divides the clavicles to reduce shoulder width. The operations aim to reduce fetal bulk and allow delivery in difficult cases where the fetus is dead. Complications can include injury, hemorrhage, shock, and infection.
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- Hip Dislocations
This document discusses angular deformities of the lower limbs, specifically genu varum (bowlegs) and genu valgum (knock knees). Genu varum can be physiological in infants and young children but may also be caused by conditions like Blount's disease, rickets, or injuries. Treatment depends on the cause but may include observation, bracing, or osteotomies. Genu valgum is also often physiological but can be caused by diseases like rickets. Mild cases are often observed but more severe or progressive cases may require hemiepiphysiodesis or osteotomies to correct alignment. Both conditions are generally assessed clinically and through measurement of limb alignment and deformity angles on
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This document discusses alterations in musculoskeletal function in children. It begins with objectives related to describing pediatric variations in the musculoskeletal system and planning nursing care for related disorders. It then provides an overview of the musculoskeletal system, including bones, cartilage, joints, and muscles. Specific pediatric musculoskeletal disorders discussed include metatarsus adductus, clubfoot, genu varum/valgum, and developmental dysplasia of the hip. Treatment options like casting, bracing, and surgery are described. The document emphasizes nursing assessments and interventions for related nursing diagnoses.
Chronic osteomyelitis is a persistent bone infection that can develop after an initial bout of acute osteomyelitis is inadequately treated, allowing bacteria to remain in the bone. It is characterized by the formation of dead bone (sequestra) surrounded by infected granulation tissue, as well as abnormal thickening and irregularity of the bone. Chronic osteomyelitis is diagnosed based on symptoms like a discharging sinus, examination findings revealing irregular thickened bone, and confirmation via imaging tests showing features like sequestra and bone cavities. Treatment involves surgical removal of infected and dead bone along with antibiotics to eliminate the infection.
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A 30-year-old man presented with a progressively painful mass around his left knee for 5 months. X-rays showed periosteal reaction and disrupted cortex of the distal femur. This is most likely osteosarcoma, which will be further investigated with MRI, biopsy, and staging. The principles of open biopsy aim to obtain a representative sample without compromising treatment. After diagnosis and staging, treatment options include neoadjuvant chemotherapy, wide surgical excision, and adjuvant chemotherapy. Prognostic indicators include tumor stage, grade, size, location, and response to neoadjuvant chemotherapy.
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These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
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These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
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Are you looking for a long-lasting solution to your missing tooth?
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3. Dreamz Learning Innovations_____________________________________________ Page 3
• Congenital dislocation of
hip
o a spontaneous dislocation
of the hip
o can occur before, during
or shortly after birth.
o Why is it uncommon in
India (MCQ)
n In Indian culture ,mother
carries the child on the
side of her waist with the
hips of the child abducted
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o Aetiology
n Hereditary predisposition to joint laxity(MCQ)
n Why CDH is 3-5 times more common in
females(MCQ)
• maternal relaxin that crosses the placental
barrier cause relaxation of ligaments if the
foetus is a female (MCQ)
10. Page 10
172. Breech presentation is a risk factor for the
following condition- (PGMEE 2015)
a. CTEV
b. SCFE
c. DDH
d. Perthes disease
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o Pathology
n Changes seen in a dislocated joint
• Femoral head
o dislocated upwards and laterally(MCQ) its
epiphysis is small and ossifies late.
• Femoral neck is excessively anteverted.
(MCQ)
• Acetabulum is shallow, with a steep sloping
roof.
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• Ligamentum teres is hypertrophied. (MCQ)
• Fibro-cartilaginous labrum of the acetabulum
(limbus) may be folded into the cavity of the
acetabulum (inverted limbus). (MCQ)
• Capsule of the hip joint is stretched.
• Adductors of hip, undergo adaptive
shortening. (MCQ)
16. Page 16
182. Primary pathology in CDH- (PGMEE
2012)
a. Large head of femur
b. Everted limbus
c. Excessive retroversion
d. Shallow acetabulum
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o Clinical features
n In 1/3 of all cases both hips are affected.
n At birth: Routine screening of all newborns is
necessary
n Early childhood:
• asymmetry of creases of the groin (MCQ)
• limitation of movements of the affected hip
• a click everytime the hip is moved. (MCQ)
n Older child:
• child walks with a 'peculiar gait' though there
is no pain. (MCQ)
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o Examination
o Barlow's test: The test has two parts(MCQ)
o First part of test
n What is the aim : to adduct knee and feel the
dislocation of femoral head from acetabulum
n Procedure
• the surgeon faces the child's perineum
• He grasps the upper part of each thigh, with his
fingers behind on the greater trochanter and
thumb in front
• The child's knees are fully flexed and the hips
flexed to a right angle
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• The hip is now gently adducted.
• As this is being done, gentle pressure is
exerted by the examining hand in a proximal
direction while the thumb tries to 'push out' the
hip.
• As the femoral head rolls over the posterior lip
of the acetabulum, it may, if dislocatable (but
not, if dislocated) slip out of the acetabulum.
• One feels an abnormal posterior movement,
appreciated by the fingers behind the greater
trochanter.
• There may be a distinct 'clunk'.
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o Second part of the test
n What is the aim : to abduct an adducted knee and
feel the relocation of femoral head into acetabulum
n Procedure
• with the hips in 90° flexion and fully adducted, thighs
are gently abducted
• The examiner's hand tries to pull the hips while the
fingers on the greater trochanter exert pressure in a
forward direction, as if one is trying to put back a
dislocated hip.
• If the hip is dislocated, either because of the first part
of the test or if it was dislocated to start with, a 'clunk'
will be heard and felt, indicating reduction of the
dislocated hip.
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n Interpretation :
• If nothing happens
o the hip may be normal
o it is an irreducible dislocation.
• Normal vs irreducible dislocation – How do
we know what is the correct diagnosis
(MCQ)
o In a normal hip , it is possible to abduct the
hips till the knee touches the couch.
n In the irreducible dislocation., there will be
limitation of hip abduction.
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o Ortolani's test (MCQ)
n This test is similar to the second part of
Barlow's test.
n The hips and knees are held in a flexed
position and gradually abducted
n A 'click of entrance' will be felt as the femoral
head slips into the acetabulum from the
position of dislocation.
36. Page 36
176. Ortoiani test is positive when the examiner
hears the- (PGMEE 2015)
a. Clunk of entry on abduction and flexion of hip
b. Clunk of entry on extension and adduction of
hip
c. Click of exit on abduction and flexion of hip
d. Click of exit on extension and adduction of hip
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o Clinical findings in in an older child: (MCQ)
n Limitation of abduction of the hip.
n Asymmetrical thigh folds
n Higher buttock fold on the affected side.
n Galenzzi's sign(MCQ)
• The level of the knees are compared in a
child lying with hip flexed to 70° and knees
flexed
• There is a lowering of the knee on the
affected side
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n Ortolani's test may be positive.
n Trendelenburg's test is positive:
• The child is asked to stand on the affected
side
• The opposite Anterior Superior Iliac spine -
ASIS (that of the normal side) dips down
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n The limb is short and slightly externally
rotated. (MCQ)
n There is lordosis of the lumbar spine. (MCQ)
n Telescopy positive(MCQ)
• In a case of a dislocated hip, it will be
possible to produce an up and down piston-
like movement at the hip.
• This can be appreciated by feeling the
movement of the greater trochanter under
the fingers
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n Gait in CDH
• A child with unilateral dislocation (MCQ)
o exhibits a typical gait in which the body
lurches to the affected side as the child
bears weight on it (Trendelenburg's gait).
• In a child with bilateral dislocation(MCQ)
o there is alternate lurching on both sides
[waddling gait).
45. Page 45
173. Congenital dislocation of hip in older child
most common sign appreciated is- (PGMEE
2015)
a. Barlow test
b. Ortoiani test
c. Painful ROM
d. Limited abduction of Lower Limb
46. Page 46
174. Patients with bilateral CDH walk with the
following gait- (PGMEE 2015)
a. Waddling
b. Stumbling
c. Knock knee
d. Antalgic
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o Radiological features
n Why is it difficult to diagnose a dislocated hip
on plain X-rays of the pelvis of an infant ?
(MCQ)
• In a child below the age of 1 year, the
epiphysis of the femoral head is not ossified,
49. Ultrasound examination is useful in early diagnosis at
birth. (MCQ)
n In an older child, important X-ray findings: (MCQ)
• Delayed appearance of the ossification centre of the
head of the femur.
• Retarded development of the ossification centre of
the head of the femur.
• Sloping acetabulum.
• Lateral and upward displacement of the ossification
centre of the femoral head.
• A break in Shenton's line
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50. ULTRASOUND
• ALPHA & BETA ANGLES MEASURED
FOR DDH ON ULTRASOUND
• APLHA ANGLE DECREASES AND
BETA ANGLE INCREASES WITH AGE
AND SEVERITY OF DDH
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H = a horizontal line drawn between the two triradiate cartilage centers of
the hips defines a horizontal planne and an approximation to flexion axis
of the hips. Hilgenreiner's Line P = a perpendicular line to the
horizontal line drawn at the edge of the boney part of the socket (there's
more in cartilage that can't be seen). Perkin's Line
58. Page 58
175. Perkin's Hoe on X-ray is used for diagnosis
of- (PGMEE 2015)
a. Perthe's disease
b. CDH
c. CTEV
d. AVNHip
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• Treatment
o Aim of treatment
n to achieve reduction of the head into the
acetabulum
n maintain head until the
• hip becomes clinically stable
• a 'round' acetabulum covers the head.
o In most cases, it is possible to reduce the hip
by closed means
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o Once the head is inside the acetabulum, in
younger children, under the mould-like effect
of the head, it develops into a round
acetabulum.
o If reduction has been delayed for more than
2 years, acetabular remodelling may not
occur even after the head is reduced for a
long time. Hence, in such cases, surgical
reconstruction of the acetabulum may be
required. (MCQ)
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• Methods of reduction:
o Closed manipulation
n It is sometimes possible in younger children to reduce
the hip by gentle closed manipulation under general
anaesthesia.
o Traction followed by closed manipulation:
n In cases where the manipulative reduction requires a
great deal of force or if it fails, the hip is kept in
traction for some time, and is progressively abducted.
n As this is done, it may be possible to reduce the
femoral head easily under general anaesthesia.
n An adductor tenotomy is often necessary in some
cases to allow the hip to be fully abducted.
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o Open reduction:
n This is indicated if closed reduction fails
n Reasons of failure of closed reduction
• presence of fibro-fatty tissue in the
acetabulum
• a fold of capsule and acetabular labrum
(inverted limbus) between the femoral head
and the superior part of the acetabulum.
n In such situations, the hip is exposed, the
soft tissues obstructing the head excised or
released, and the head repositioned in the
acetabulum.
72. Splint:
n Some form of splint such as Von Rosen's
splint(MCQ)
n External splints can be removed once the
acetabulum develops to a round shape.
n The hip is now mobilised, and kept under
observation for a period of 2-3 years for any
recurrence.
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o Acetabular reconstruction procedures:
n Salter's osteotomy: (MCQ)
• This is an osteotomy of the iliac bone, above
the acetabulum
• The roof of the acetabulum is rotated with
the fulcrum at the pubic symphysis, so that
the acetabulum becomes more horizontal,
and thus covers the head
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n Chiari's pelvic displacement osteotomy:
(MCQ)
• The iliac bone is divided almost
transversely immediately above the
acetabulum
• lower fragment (bearing the acetabulum) is
displaced medially
• The margin of the upper fragment provides
additional depth to the acetabulum
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n Pemberton's pericapsular osteotomy: (MCQ)
• A curved osteotomy is made.
• The roof of the acetabulum is deflected
downwards over the femoral head, with the
fulcrum at the triradiate cartilage of the
acetabulum.
89. Page 89
181. Sailer's pelvic osteotomy is done for
treatment of- (PGMEE 2013)
a. CTEV
b. SCFE
c. DDH
d. None
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n a varus derotation osteotomy(MCQ)
• Indication : If reduction of the hip is possible
only in extreme abduction or internal rotation
of the thigh
• done at the sub-trochanteric region
• The distal fragment is realigned and the
osteotomy fixed with a plate.
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• Treatment plan: (A Very High yield area for
MD Entrance often tested in Exam)
o Birth to 6 months: (MCQ)
n The femoral head is reduced into the
acetabulum by closed manipulation
n maintained with plaster cast or splint.
o 6 months to 6 years: (MCQ)
n Upto 2 years
• It may be possible up to 2 years to reduce
the head into the acetabulum by closed
methods.
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n After 2 years, (MCQ)
• it is difficult and also unwise to attempt
closed reduction.
o Reasons
n when the head has been out for some time,
the soft tissues around the hip become tight
n Such a hip, if reduced forcibly into the
acetabulum, develops avascular necrosis of
the femoral head.
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• In these cases, reduction is achieved by
open methods, and an additional femoral
shortening may be required.
• In older children, an acetabular
reconstruction may be performed at the
same time or later.
• Salter's osteotomy is preferred by most
surgeons.
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o 6-20 years: (MCQ)
n The first question to be adressed in children at this
age is whether or not to treat the dislocation at all.
n Bilateral dislocations
• No treatment may be indicated for children with
bilateral dislocations because of the following
reasons:
o The limp is less noticeable.
o Although having some posture and gait
abnormalities, these patients tend to live
o normal lives until their 40's or 50's.
o Results of treatment are unpredictable and a series
of operations may be required.
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o 11 years onwards: (MCQ)
n Indication for treatment in these patients is
pain.
n If only one hip is affected, a total hip
replacement may be practical once
adulthood is reached.
n Sometimes, arthrodesis of the hip may be a
reasonable choice.
100. Page 100
178. 2 year old child with congenital dislocation
of hip treatment of choice- (PGMEE 2014)
a. Closed reduction
b. Hip spica
c. Open reduction
d. Acetabular osteotomy