Lower limb deformities.pptx
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This document summarizes several lower limb deformities: Coxa vara is a hip deformity where the femoral neck angle is reduced below 120 degrees, causing limb shortening and limp. Coxa valga is the opposite deformity with an increased femoral neck angle. Femoral retroversion and hallux valgus (bunions) are also common deformities discussed. Treatment options ranged from observation to osteotomies and surgery depending on the severity of the case. Clubfoot (congenital talipes equinovarus) is often treated using the Ponseti method of manipulation and casting to correct deformity without surgery.
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P10 pediatric knee
This document discusses fractures and dislocations around the knee in pediatric patients. It notes that fractures of the distal femur and proximal tibia physes account for a majority of growth disturbances due to their irregular shapes and locations of strong muscular attachments. Treatment of displaced physeal fractures generally involves closed or open reduction and pin fixation to minimize growth arrest. Displaced fractures of the tibial tubercle or spine are also treated operatively to restore knee function. Recurrent patellar dislocations or knee dislocations may require surgery to address ligament laxity. Complications of physeal injuries can include leg length discrepancies and angular deformities if reduction and healing are not adequately achieved and maintained.
PATHOLOGY AND MGT OF CLUB FOOT.pptx
The document provides information on club foot (talipes equinovarus), including its incidence, classification, pathoanatomy, and management. It describes the Ponseti technique for nonoperative treatment of club foot, which involves serial casting and manipulation of the foot, often with Achilles tenotomy, followed by use of a foot abduction brace for several years to maintain correction and prevent recurrence of the deformity. Complications of nonoperative treatment include residual deformities like a rocker bottom foot or bean shaped foot, as well as potential fractures, pressure sores, failure to fully correct, or recurrence of the club foot deformity.
Hallux valgus
This document discusses hallux valgus, a deformity of the big toe. It begins by describing the clinical presentation and anatomy involved, including lateral deviation of the big toe, overriding of the other toes, and bunion formation. Radiographic findings like increased intermetatarsal angle are also detailed. Non-surgical treatments are outlined first, followed by indications for various surgical procedures to correct the deformity. Common procedures discussed include bunionectomy techniques like the McBride method as well as different osteotomies of the first metatarsal bone. Complications of recurrence and hallux varus are also mentioned.
Coxa Vara, Genu VArum & Valgum. Under Gradts.
This document describes several orthopedic deformities including coxa vara, genu varum, and genu valgum. Coxa vara is defined as a femoral neck-shaft angle of less than 120 degrees. It can be congenital or acquired through conditions like rickets or fractures. Genu varum and valgum refer to knock knees and bow legs, respectively. These are usually physiological in children but may require intervention if the intercondylar or intermalleolar distances are abnormally large. Treatment options include hemiepiphysiodesis, osteotomies, and joint replacements depending on the severity and underlying cause.
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blounts disease.pptx
Blount's disease is a progressive deformity of the knee characterized by bowing of the legs (genu varum). It is classified into infantile and adolescent types. Infantile Blount's disease presents between ages 2-5 and is often bilateral, while adolescent Blount's disease presents after age 10 and is usually unilateral. Radiographs show abnormalities of the proximal tibial epiphysis. Treatment involves bracing for mild cases and osteotomy or epiphysiodesis surgery for more severe deformities, with the goal of correcting the varus alignment through a valgus procedure. Prognosis is best when treated early before significant bony changes occur.
Atypical clubfoot, complex ctev, dx.pptx
atypical club foot, ctev, complex, congenital, paediatric ortho, treatment, rare cases, management protocol, line of treatment, clinical examination, clinical features, resistant ctev,
Proximal femur focal def
Proximal focal femoral deficiency (PFFD) is a rare congenital disorder characterized by a shortened femur with an apparent discontinuity between the femoral neck and shaft. The cause is unknown, though it is thought to result from factors affecting limb development between 4-6 weeks of gestation. Presentation includes limb length discrepancy, hip instability, and knee abnormalities. Treatment options depend on the severity and stability of the hip, and may include knee fusion/amputation with prosthesis, rotationplasty, or limb lengthening in milder cases. Classification systems aim to characterize the anatomical defects to guide management.
The hip in cerebral palsy part 2 of 2
This document provides an overview of hip deformities in cerebral palsy and various surgical procedures used to treat them. It discusses hip subluxation and dislocation, risk factors, and treatments like adductor releases and varus derotational osteotomies. It then describes the details of the combined one-stage correction procedure known as the "San Diego procedure", which involves a lateral femoral osteotomy and anterior pericapsular pelvic osteotomy to realign the hip. Diagrams illustrate the surgical steps of each approach. The goal of these interventions is to prevent progressive hip deformity and dislocation in cerebral palsy patients.
CTEV/ Clubfoot
This document provides information on congenital talipes equinovarus (clubfoot). It discusses the following key points:
- Clubfoot is a congenital deformity affecting the foot and ankle. It involves muscle, tendon, bone and skin abnormalities.
- Treatment involves serial casting and manipulation to gradually correct the deformity, often requiring Achilles tenotomy.
- Surgical release of soft tissues may be needed for resistant cases. Post-operatively, bracing is used to maintain correction.
- The goal of treatment is to achieve a plantigrade, supple foot that can function well. Relapse remains a challenge.
Hip dislocation class
Hip dislocations are caused by high-energy trauma and can damage the vascular supply to the femoral head. Closed reduction techniques like the Allis or Stimson maneuvers aim to reduce the dislocation in an emergency setting to restore blood flow. Associated injuries like fractures require imaging and may necessitate open reduction. Nonoperative treatment with traction and restricted motion
SPORTS INJURIES OF ANKLE AND FOOT original.pptx
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CTEV UG
This document provides an outline on clubfoot (CTEV), including its epidemiology, causes, anatomy, pathoanatomy, clinical features, imaging, and treatment. CTEV is a relatively common birth defect affecting 1-2 per 1000 births. It involves four deformities: cavus, adductus, varus, and equinus (CAVE). The causes are unknown but may involve genetic or positional factors. Treatment focuses on serial manipulation and casting, especially the Ponseti method, to gradually correct the deformities in a specific order and avoid the need for invasive surgery. The goal is to produce a functional, plantigrade foot.
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- 2. • Coxa vara Coxa vara is a deformity of the hip, whereby the angle between the head and the shaft of the femur is reduced to less than 120 degrees.
- 4. Features • shortening of limb • limp. • bilateral involvement….waddling gait • Restricted abduction and internal rotation Causes • Congenital • Pathological. metabolic bone diseases (e.g. Paget's disease of bone), post-Perthes deformity, osteomyelitis, • Traumatic
- 5. Diagnosis • X Ray HE angle
- 6. Treatment • HE angle of 45–60 degrees: observation and periodic follow up Indication for surgery • HE angle more than 60 degrees, progressive deformity, neckshaft angle <90 degrees, development of Trendelenburg gait
- 7. Surgery • subtrochanteric valgus osteotomy with adequate internal rotation of distal fragment to correct anteversion Complications • Recurrence
- 8. Coxa valga • Coxa valga describes a deformity of the hip where there is an increased angle between the femoral neck and femoral shaft. • Coxa valga is often associated with shallow acetabular angles and femoral head subluxation.
- 9. • Etiology bilateral • neuromuscular disorders, e.g. cerebral palsy • often have concurrent femoral anteversion • skeletal dysplasias, e.g. Turner syndrome, mucopolysaccharidoses unilateral • trauma causing growth plate arrest
- 10. • Diagnosis • X ray Treatment • Coxa valga can be treated with varus derotation osteotomy (VDRO) and angled blade-plate fixation
- 11. Femoral Retroversion • Common in early infancy • Unilateral, R side > L side • More common in obese children • apparent when the pre-walking child stands with his or her feet turned out to nearly 90 degrees ("Charlie Chaplin appearance") • It may gradually improve on its own during the first year of walking
- 13. Hallux valgus • Hallux valgus is deviation of the big toe away from the midline, i.e. towards the lesser toes, and is usually associated with a bunion. • affects women more than men • Often bilateral • Inherited • fully enclosed shoes accelerate the development
- 14. Complications 2nd MTP overloading and dislocations Treatment options. • Non-operative. Wider toe box and pressure relief. • Operative. I. Mild deformities. distal osteotomy (e.g. chevron)
- 15. I. II. Moderate deformities. Scarf or Ludloff, or a basal (proximal chevron or crescentic) osteotomy. III. Severe deformities. Osteotomies or fusion of 1st TM or MTP Joints
- 16. Complications of surgery. • Infection • Cutaneous nerve damage • Recurrence or overcorrection of deformity • Stiffness and overload of the second MTP joint. • Arthritis
- 17. Hallux rigidus • Hallux rigidus is a painful condition of the hallux MTP joint • characterised by loss of motion especially in dorsiflexion. • osteophyte formation on the dorsum and sides of the joint.
- 19. • trauma or repetitive microtrauma (sport) • strong family history • Patients complain of stiffness and pain on weight bearing.
- 20. • Non-operative treatment. Provision of a stiff- soled shoe with a deep toe box or a rocker-soled shoe. • Surgical management. • injection/manipulation, • cheilectomy (a radical debridement and excision of the part of the joint blocking movement) • fusion • Arthroplasty (Keller’s-type procedure or silicon interposition)
- 21. Congenital talipes equinovarus (CTEV) (the ‘club foot’) • Multiplanar deformity: hindfoot equinus and varus, midfoot adductus and forefoot cavus • Incidence is 1–6 per 1000 live births, more common in boys and with a familial tendency • Most cases are idiopathic but neuromuscular causes include spina bifida and arthrogryposis • Scoring systems (Pirani/Dimeglio), are used to assess the severity
- 23. • The diagnosis of CTEV may be made during an antenatal ultrasound.
- 24. • Pathology
- 26. • Types • Postural • Idiopathic • Neuromuscular i.e Spina bifida; arthrogryposis; • Syndromic Trisomy 15
- 27. Treatment • PONSETI METHOD • corrects foot deformity in 95% of idiopathic cases without the need for a formal surgical release. • Manual repositioning • Series of well moulded above-knee plaster casts.
- 29. • Foot abduction orthosis (FAO) • Percutaneous Achilles tenotomy • Recurrent deformity can be treated with further plasters,but a tibialis anterior tendon transfer may be required around the age of 2.5–4
- 30. • Feet treated with the Ponseti method are less stiff, less likely to be painful and less subject to overcorrection than those treated surgically.
- 31. SURGICAL TREATMENT • When conservative treatment fails, surgical intervention is required, ideally before walking age. • sequential release of the pathologically tight structures via either a Turco incision or the Cincinnati incision.
- 33. • Stiffness and over or undercorrection are common complications
- 34. Talipes calcaneovalgus (TCV) • Calcaneovalgus Foot is a common acquired condition caused by intrauterine "packaging" seen in neonates that presents as a benign soft tissue contracture deformity of the foot characterized by hindfoot eversion and dorsiflexion.
- 36. • Diagnosis is made clinically • Treatment is usually observation with passive stretching and possible casting as the condition resolves spontaneously in 3-6 months.