Osteotomy around the knee in children.when and why?ROBERT ELBAUM
Osteotomy around the knee in children is sometimes needed to correct complex knee deformities that cannot be addressed through epiphysiodesis alone. Indications for osteotomy include constitutional angular deformities, secondary deformities from conditions like rickets or trauma, and rotational malalignments affecting the patella. While osteotomy can restore knee anatomy, the procedure carries risks of complications in over 60% of cases, including loss of correction, fractures, infections and vascular issues. Careful pre-operative planning is needed to determine if osteotomy is truly required and to minimize potential complications.
Planovalgus foot, also known as flatfoot, is characterized by a low or absent medial longitudinal arch and hindfoot valgus. The document discusses the anatomy and development of the foot arches, causes of pediatric and adult flatfoot including posterior tibial tendon dysfunction, and treatment options ranging from orthotics to surgery. Surgical procedures discussed include calcaneal osteotomies, tendon lengthening/transfer, and arthrodesis. Complications and special flatfoot conditions like tarsal coalition and congenital vertical talus are also summarized.
Femoro Acetabular Impingement
School for FM Alexander Studies
2015
Video links:
Ultimate frisbee highlights: https://www.youtube.com/watch?v=HhUays2ehyI
Ultimate frisbee throwing: https://www.youtube.com/watch?v=r0xNV5AYfCA
FAI surgery: https://www.youtube.com/watch?v=KgU_dOeQLQM
Osteotomy around the knee in children.when and why?ROBERT ELBAUM
Osteotomy around the knee in children is sometimes needed to correct complex knee deformities that cannot be addressed through epiphysiodesis alone. Indications for osteotomy include constitutional angular deformities, secondary deformities from conditions like rickets or trauma, and rotational malalignments affecting the patella. While osteotomy can restore knee anatomy, the procedure carries risks of complications in over 60% of cases, including loss of correction, fractures, infections and vascular issues. Careful pre-operative planning is needed to determine if osteotomy is truly required and to minimize potential complications.
Planovalgus foot, also known as flatfoot, is characterized by a low or absent medial longitudinal arch and hindfoot valgus. The document discusses the anatomy and development of the foot arches, causes of pediatric and adult flatfoot including posterior tibial tendon dysfunction, and treatment options ranging from orthotics to surgery. Surgical procedures discussed include calcaneal osteotomies, tendon lengthening/transfer, and arthrodesis. Complications and special flatfoot conditions like tarsal coalition and congenital vertical talus are also summarized.
Femoro Acetabular Impingement
School for FM Alexander Studies
2015
Video links:
Ultimate frisbee highlights: https://www.youtube.com/watch?v=HhUays2ehyI
Ultimate frisbee throwing: https://www.youtube.com/watch?v=r0xNV5AYfCA
FAI surgery: https://www.youtube.com/watch?v=KgU_dOeQLQM
This document discusses femoro-acetabular impingement (FAI), which occurs when there is reduced range of motion of the hip due to uneven surfaces of the femoral head or acetabulum. It can be caused by congenital or acquired factors. FAI is classified into cam, pincer, and mixed types. Cam FAI involves a bump on the femoral head-neck junction, while pincer FAI is due to overcoverage of the acetabulum. Clinical features include groin pain exacerbated by activity. Imaging can identify bone abnormalities, and treatments range from activity modification to surgical procedures like arthroscopy or osteotomy.
This document discusses femoro-acetabular impingement (FAI), which occurs when the femoral head and neck abnormally contact the acetabular rim, causing early hip degeneration. FAI has three types based on anatomy: cam, pincer, and mixed. Diagnosis involves clinical exams, x-rays to detect bone abnormalities, and MRI to view soft tissues. Conservative treatment provides temporary relief while surgery corrects the underlying impingement through osteoplasty or labral repair. Both open surgery and hip arthroscopy are effective surgical options for FAI.
This document discusses the anatomy, causes, classification, symptoms, diagnosis, and treatment of hip fractures. It focuses on fractures of the femoral neck. The hip joint is supported by ligaments and supplied by arteries. Femoral neck fractures most commonly occur in older patients due to falls and osteoporosis. They are classified based on displacement and stability. Treatment depends on the fracture type and patient age or health, and may involve closed or open reduction, internal fixation with screws or plates, or replacement arthroplasty. Complications can include nonunion, avascular necrosis, and failure of internal fixation.
This document discusses tuberculosis of the hip joint. It begins by describing the causative organism, Mycobacterium tuberculosis, which is an acid-fast bacillus. It then covers the pathophysiology of tuberculosis infection in the hip, including the formation of tubercles and caseation necrosis. The document outlines the clinical presentation of TB of the hip and its radiographic appearance. It discusses the different stages of TB arthritis in the hip and associated radiographic findings. The document concludes by covering treatment approaches for TB of the hip including chemotherapy, traction, arthroplasty, arthrodesis and osteotomy.
1. Clubfoot, or congenital talipes equino varus (CTEV), is a birth defect affecting the foot and ankle. It involves four main deformities: equinus, hindfoot varus, forefoot supination, and midfoot cavus.
2. The Ponseti method is currently the standard treatment for clubfoot. It involves serial casting and manipulation to gradually correct the deformity, often culminating in an Achilles tenotomy.
3. Proper casting is essential to the Ponseti method. It immobilizes the foot in the corrected position to allow tight tissues to stretch between manipulations. The goal is to achieve 50-60 degrees of abduction in younger children and 30
Hallux valgus is a deformity of the big toe characterized by lateral deviation of the toe and medial deviation of the first metatarsal. It is caused by both intrinsic and extrinsic factors and can cause pain, difficulty wearing shoes, and cosmetic issues. Treatment involves conservative measures like wider shoes initially, with surgical correction considered for more severe or symptomatic cases. Surgery aims to correct angles, realign the joint, and restore normal mechanics, and may involve soft tissue procedures, osteotomies, or arthrodesis in severe cases. Proper patient selection and technique are important for achieving good outcomes.
Ankle sprains are common injuries that can range from mild to severe depending on the ligament damage. The most common type is a lateral ankle sprain caused by foot inversion. Treatment involves RICE (rest, ice, compression, and elevation) followed by rehabilitation exercises and bracing. For severe or recurrent sprains, surgery may be considered to repair ruptured ligaments and reduce instability. Proper rehabilitation is important to aid recovery and prevent chronic issues.
This document discusses the pathogenesis and treatment of cavus foot deformity. It notes that cavus deformity can be caused by weakness of the intrinsics, overactivity of the intrinsics, or weakness of the tibialis anterior muscle. Treatment options range from conservative measures like metatarsal bars for mild deformities to various surgical procedures depending on the severity and rigidity of the deformity, including plantar fasciotomies, osteotomies, tendon transfers, and fusions. Radiographs are important for surgical planning to assess the apex of deformity and involvement of the hindfoot, midfoot, and forefoot.
painful hip in adults active person either male or female. limitation in hip movement, In FAI, bone overgrowth — called bone spurs — develop around the femoral head and/or along the acetabulum.
Perthes disease is a childhood condition characterized by avascular necrosis of the femoral head. It most commonly affects children between the ages of 4-10 years old. The condition is caused by interruption of the blood supply to the femoral head, which leads to bone death. This can result in deformity and distortion of the femoral head over time if not properly contained. Treatment depends on the stage and severity, and may involve symptomatic care, bracing, or corrective osteotomies to contain the femoral head within the acetabulum and prevent further deformity. Prognosis is generally better in younger children with less involvement of the femoral head.
Tarsal coalition is a congenital condition caused by abnormal fusion of two or more tarsal bones, most commonly the calcaneus and navicular. It is usually asymptomatic but can cause a flatfoot deformity or recurrent ankle sprains. Imaging such as x-rays, CT, or MRI is used to identify the specific bones fused and determine if the coalition is fibrous, cartilaginous, or bony. Treatment options include conservative management or surgical resection or fusion of the bones.
The extensor mechanism of the knee involves four quadriceps muscles that connect the femur to the tibia via the patella. The quadriceps muscles include the rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis. They originate on the femur and connect to the patella. The patella then connects to the tibia via the patellar tendon. This mechanism improves the efficiency of knee extension by increasing the lever arm of the quadriceps muscles. It functions via a "screw home mechanism" where the tibia rotates internally at the end of knee extension, maximally stabilizing the knee joint.
Approach to hip joint pain in childhoodaminpakdaman
This document provides an overview of common causes of hip pain in children, including septic arthritis, congenital coxa vara, transient synovitis, juvenile idiopathic arthritis, Legg-Calvé-Perthes disease, and slipped capital femoral epiphysis. It describes the anatomy of the hip joint and bones. For each condition, it covers typical presentation, diagnostic approach, treatment options, and important clinical signs. The document emphasizes taking a thorough history and physical exam to differentiate between infectious, inflammatory, orthopedic, and neoplastic etiologies of hip pain in children.
This document provides an overview of the anatomy of the ankle joint and ankle arthrodesis (fusion). It describes the bones and ligaments that make up the ankle joint, including the tibia, fibula, and talus. It discusses the indications, contraindications, surgical technique, and postoperative care of ankle arthrodesis, which is performed to treat ankle arthritis and pain. The optimal position for fusion is slight dorsiflexion with mild hindfoot valgus and external rotation. Preoperative planning involves assessing bone quality, alignment, and arthritis in other joints like the subtalar.
This document discusses femoro-acetabular impingement (FAI), which occurs when the femoral head and neck abnormally contact the acetabular rim, causing damage. There are two main types: cam impingement from an abnormal femoral head-neck junction; and pincer impingement from acetabular overcoverage. Accurate diagnosis using clinical exams and imaging of the alpha angle and offset ratios is important for determining treatment, which may include hip arthroscopy, osteochondroplasty, or periacetabular osteotomy. FAI is commonly seen in young, active individuals and certain athletic activities increase risk.
This document discusses femoro-acetabular impingement (FAI), which occurs when there is reduced range of motion of the hip due to uneven surfaces of the femoral head or acetabulum. It can be caused by congenital or acquired factors. FAI is classified into cam, pincer, and mixed types. Cam FAI involves a bump on the femoral head-neck junction, while pincer FAI is due to overcoverage of the acetabulum. Clinical features include groin pain exacerbated by activity. Imaging can identify bone abnormalities, and treatments range from activity modification to surgical procedures like arthroscopy or osteotomy.
This document discusses femoro-acetabular impingement (FAI), which occurs when the femoral head and neck abnormally contact the acetabular rim, causing early hip degeneration. FAI has three types based on anatomy: cam, pincer, and mixed. Diagnosis involves clinical exams, x-rays to detect bone abnormalities, and MRI to view soft tissues. Conservative treatment provides temporary relief while surgery corrects the underlying impingement through osteoplasty or labral repair. Both open surgery and hip arthroscopy are effective surgical options for FAI.
This document discusses the anatomy, causes, classification, symptoms, diagnosis, and treatment of hip fractures. It focuses on fractures of the femoral neck. The hip joint is supported by ligaments and supplied by arteries. Femoral neck fractures most commonly occur in older patients due to falls and osteoporosis. They are classified based on displacement and stability. Treatment depends on the fracture type and patient age or health, and may involve closed or open reduction, internal fixation with screws or plates, or replacement arthroplasty. Complications can include nonunion, avascular necrosis, and failure of internal fixation.
This document discusses tuberculosis of the hip joint. It begins by describing the causative organism, Mycobacterium tuberculosis, which is an acid-fast bacillus. It then covers the pathophysiology of tuberculosis infection in the hip, including the formation of tubercles and caseation necrosis. The document outlines the clinical presentation of TB of the hip and its radiographic appearance. It discusses the different stages of TB arthritis in the hip and associated radiographic findings. The document concludes by covering treatment approaches for TB of the hip including chemotherapy, traction, arthroplasty, arthrodesis and osteotomy.
1. Clubfoot, or congenital talipes equino varus (CTEV), is a birth defect affecting the foot and ankle. It involves four main deformities: equinus, hindfoot varus, forefoot supination, and midfoot cavus.
2. The Ponseti method is currently the standard treatment for clubfoot. It involves serial casting and manipulation to gradually correct the deformity, often culminating in an Achilles tenotomy.
3. Proper casting is essential to the Ponseti method. It immobilizes the foot in the corrected position to allow tight tissues to stretch between manipulations. The goal is to achieve 50-60 degrees of abduction in younger children and 30
Hallux valgus is a deformity of the big toe characterized by lateral deviation of the toe and medial deviation of the first metatarsal. It is caused by both intrinsic and extrinsic factors and can cause pain, difficulty wearing shoes, and cosmetic issues. Treatment involves conservative measures like wider shoes initially, with surgical correction considered for more severe or symptomatic cases. Surgery aims to correct angles, realign the joint, and restore normal mechanics, and may involve soft tissue procedures, osteotomies, or arthrodesis in severe cases. Proper patient selection and technique are important for achieving good outcomes.
Ankle sprains are common injuries that can range from mild to severe depending on the ligament damage. The most common type is a lateral ankle sprain caused by foot inversion. Treatment involves RICE (rest, ice, compression, and elevation) followed by rehabilitation exercises and bracing. For severe or recurrent sprains, surgery may be considered to repair ruptured ligaments and reduce instability. Proper rehabilitation is important to aid recovery and prevent chronic issues.
This document discusses the pathogenesis and treatment of cavus foot deformity. It notes that cavus deformity can be caused by weakness of the intrinsics, overactivity of the intrinsics, or weakness of the tibialis anterior muscle. Treatment options range from conservative measures like metatarsal bars for mild deformities to various surgical procedures depending on the severity and rigidity of the deformity, including plantar fasciotomies, osteotomies, tendon transfers, and fusions. Radiographs are important for surgical planning to assess the apex of deformity and involvement of the hindfoot, midfoot, and forefoot.
painful hip in adults active person either male or female. limitation in hip movement, In FAI, bone overgrowth — called bone spurs — develop around the femoral head and/or along the acetabulum.
Perthes disease is a childhood condition characterized by avascular necrosis of the femoral head. It most commonly affects children between the ages of 4-10 years old. The condition is caused by interruption of the blood supply to the femoral head, which leads to bone death. This can result in deformity and distortion of the femoral head over time if not properly contained. Treatment depends on the stage and severity, and may involve symptomatic care, bracing, or corrective osteotomies to contain the femoral head within the acetabulum and prevent further deformity. Prognosis is generally better in younger children with less involvement of the femoral head.
Tarsal coalition is a congenital condition caused by abnormal fusion of two or more tarsal bones, most commonly the calcaneus and navicular. It is usually asymptomatic but can cause a flatfoot deformity or recurrent ankle sprains. Imaging such as x-rays, CT, or MRI is used to identify the specific bones fused and determine if the coalition is fibrous, cartilaginous, or bony. Treatment options include conservative management or surgical resection or fusion of the bones.
The extensor mechanism of the knee involves four quadriceps muscles that connect the femur to the tibia via the patella. The quadriceps muscles include the rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis. They originate on the femur and connect to the patella. The patella then connects to the tibia via the patellar tendon. This mechanism improves the efficiency of knee extension by increasing the lever arm of the quadriceps muscles. It functions via a "screw home mechanism" where the tibia rotates internally at the end of knee extension, maximally stabilizing the knee joint.
Approach to hip joint pain in childhoodaminpakdaman
This document provides an overview of common causes of hip pain in children, including septic arthritis, congenital coxa vara, transient synovitis, juvenile idiopathic arthritis, Legg-Calvé-Perthes disease, and slipped capital femoral epiphysis. It describes the anatomy of the hip joint and bones. For each condition, it covers typical presentation, diagnostic approach, treatment options, and important clinical signs. The document emphasizes taking a thorough history and physical exam to differentiate between infectious, inflammatory, orthopedic, and neoplastic etiologies of hip pain in children.
This document provides an overview of the anatomy of the ankle joint and ankle arthrodesis (fusion). It describes the bones and ligaments that make up the ankle joint, including the tibia, fibula, and talus. It discusses the indications, contraindications, surgical technique, and postoperative care of ankle arthrodesis, which is performed to treat ankle arthritis and pain. The optimal position for fusion is slight dorsiflexion with mild hindfoot valgus and external rotation. Preoperative planning involves assessing bone quality, alignment, and arthritis in other joints like the subtalar.
This document discusses femoro-acetabular impingement (FAI), which occurs when the femoral head and neck abnormally contact the acetabular rim, causing damage. There are two main types: cam impingement from an abnormal femoral head-neck junction; and pincer impingement from acetabular overcoverage. Accurate diagnosis using clinical exams and imaging of the alpha angle and offset ratios is important for determining treatment, which may include hip arthroscopy, osteochondroplasty, or periacetabular osteotomy. FAI is commonly seen in young, active individuals and certain athletic activities increase risk.
The document summarizes a presentation on insights into diabetic foot and ankle injuries from Dr. Tahir Ögüt from Istanbul University. It notes that diabetes impairs bone healing and increases healing times for fractures. It outlines risks of complications for diabetic patients, including infection, delayed healing, and Charcot neuroarthropathy. The presentation discusses guidelines for nonoperative and operative treatment of fractures in diabetic patients, emphasizing immobilization, restricted weight bearing, soft tissue management, and rigid fixation to reduce complication rates. It presents several case studies in diabetic foot fracture treatment.
Pes Planus by Dr. Mohammad Azhar ud din Darokhanimazhardarokhan
This document discusses flat feet (pes planus) and its evaluation and treatment. It begins by defining flat feet and describing the anatomical changes that occur, including collapse of the longitudinal arch, hindfoot valgus, and forefoot abduction. It then covers the evaluation of flat feet using physical examination and radiographic measurements. Treatment options for flexible flat feet include arch supports, braces, heel inserts, and shoe modifications, with the goal of relieving symptoms without changing the underlying foot structure. Conservative treatment is recommended initially before considering surgical options.
Akut batin-sendromu (fazlası için www.tipfakultesi.org)
Erişkin Düz Tabanlık
1. 8. CERRAHPAŞA LOKOMOTOR SİSTEM GÜNLERİ
4 ARALIK 2010
ERİŞKİN EDİNİLMİŞ PES PLANUS
Dr. Tahir ÖĞÜT
İ.Ü.
CERRAHPAŞA TIP FAKÜLTESİ
ORTOPEDİ ve TRAVMATOLOJİ ANABİLİM DALI
TİBİALİS POSTERİOR TENDİNOPATİSİ Tahir Öğüt
2. TİBİALİS POSTERİOR TENDONU
•Orta ayak primer invertörüdür
•Medial longitudinal arkı dinamik olarak destekler ve kaldırır.
•İndirekt olarak ayak ardını da destekler
ERİŞKİN PES PLANUS Tahir ÖĞÜT
3. Yetersiz kaldığında
Ön ayak pronasyon ve abduksiyonu ile birlikte
Erişkin edinilmiş düz tabanlık
ERİŞKİN PES PLANUS Tahir ÖĞÜT
4. Zamanla,
Tendon yapışma yerinde uzama, TN eklem kapsülü ve
Spring ligamanda rüptür gelişebilir
Topukta valgus
Kalkaneusta dış rotasyon
Aşil tendonunda kontraktür
ERİŞKİN PES PLANUS Tahir ÖĞÜT
6. Çok ilerlemiş veya ihmal edilmiş olgularda,
Deltoid bağ da yetersizleşeceğinden
Ayak bileğinde valgus tilti görülebilir
ERİŞKİN PES PLANUS Tahir ÖĞÜT
7. ETİYOLOJİ
•Eversiyon yaralanması
•Atletik aktivitede ani artış
•Steroid enjeksiyonu
•Ayakta dizilim bozukluğu:
Hiperpronasyon + Aşil gerginliği
ERİŞKİN PES PLANUS Tahir ÖĞÜT
8. TANI
Ayak bileği mediali veya orta ayak plantar medialinde
hassasiyet, şişlik ve ağrı
FİZİK MUAYENE
Özellikle tendonun en distal kısmı üzerinde hassasiyet ve
ağrı, ödem (dirençli inversiyonda ağrı)
ERİŞKİN PES PLANUS Tahir ÖĞÜT
9. FİZİK MUAYENE
“Too many toes sign”
Tek ayak parmak ucuna kalkma testinde zorlanma
ERİŞKİN PES PLANUS Tahir ÖĞÜT
12. MR
Nadiren gerekli
Tendonda fibröz longitudinal hipertrofi veya
Bulböz genişleme
Spring ligaman
ERİŞKİN PES PLANUS Tahir ÖĞÜT
13. AYIRICI TANI •Medial malleol stres kırığı
•Naviküler stres kırığı
•Talar koalisyon
•Medial talar domda OKL
•Medial ayak bileği artriti
•Deltoid bağ rüptürü ve medial
instabilite
•Tarsal tünel sendromu
•FHL tendiniti
ERİŞKİN PES PLANUS Tahir ÖĞÜT
14. EVRELEME ve TEDAVİ
EVRE 1
•Peritendinit ve / veya tendon dejenerasyonu (tendinoz)
•Deformite yoktur
•Tendon boyu normaldir
•Ayak bileği mediali veya orta ayak plantar medialinde
hassasiyet, şişlik ve ağrı
ERİŞKİN PES PLANUS Tahir ÖĞÜT
15. EVRE 1 Tedavisi
KONSERVATİF
•Birkaç hafta alçı veya rijid breysleme
•Tolere edilebildiği kadar basmasına izin verilir
•Kişiye özel yapılmış ark takviyeleri
•Aktivite modifikasyonu, darbelerden korunma
• Cross training (Bisiklet, yüzme, belki yürüme egzersizleri)
•Aşil germe egzersizleri
•Kilo verme
ERİŞKİN PES PLANUS Tahir ÖĞÜT
16. EVRE 1 Tedavi
CERRAHİ
•Tenosinovektomi + 3 hafta alçılama
•İnterstisyel rüptürün tamiri + 3 hafta alçılama
•Postop 3 ay kişiye özel ark destekli spor ayakkabı
•Spora dönüş: Postop 3 ay
Mc Cormack et al, Foot Ankle Int, 2000.
ERİŞKİN PES PLANUS Tahir ÖĞÜT
17. EVRE 2
•Hafif, esnek deformite ile birlikte
•Yetersiz veya uzamış tendon
ERİŞKİN PES PLANUS Tahir ÖĞÜT
18. EVRE 2 Tedavisi
KONSERVATİF
•Evre 1 ile aynı
•UCBL tabanlık
ERİŞKİN PES PLANUS Tahir ÖĞÜT
19. EVRE 2 Tedavisi
CERRAHİ
Tendonda kısaltma yaparak navikülere tespit edilmesi önerilir
Myerson MS, J Bone Joint Surg A, 1996.
ERİŞKİN PES PLANUS Tahir ÖĞÜT
28. EVRE 3
Bulgular önceki evrelerde olduğu gibidir.
Farklı olarak daha ilerlemiş ve rijid deformite vardır.
Topuktaki valgus deformitesi sabittir.
ERİŞKİN PES PLANUS Tahir ÖĞÜT
