paediatric orthopaedics

Paediatric Orthopaedics

E.E.Fogarty

F.R.C.S.I, F.R.A.C.S

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Socrates

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

HEMLOCK

Hemlock was frequently administered to criminals

Is sedative and antispasmodic

Prescribed as a remedy in cases of undue nervous motor excitability

Overdose produces paralysis

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Limp

Normal gait

Causes of limp

Investigations

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Normal Gait

Bipedal

Rhythmic and effortless

Depends On a number of reflexes Intact locomotor system

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Gait Cycle

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Walking

Cruise before 1year

Walk at 14-18months

Develop a mature(adult) gait at 3years

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Limp

Is any disturbance of gait Is due to one or more of 3 general causes

Pain

Weakness

Structural abnormalities

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Types of Limp

Antalgic

Neuromuscular

Trendelenberg

Short leg gait

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Causes of Limp

Congenital Coxa vara, congenital short limb

Inflammatory Juvenile chronic arthritis,transient synovitis

Infectious Osteomyelitis,septic arthritis,discitis

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Causes of Limp

Developmental Scfe, Ddh, Perthes , acquired limb length

discrepancy Neoplastic

Benign Malignant Secondary tumours

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Causes of Limp

Traumatic Toddlers and stress fractures

Neuromuscular Metabolic Haematological Referred

Appendicitis

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Stress Fracture

Adolescent

Upper Tibia

Looks aggressive

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Stress Fracture

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Investigations

Plain x-rays

Scannogram plus wrist x-ray

MRI,CT scan, Bone scan

FBC,ESR

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Hip

Intoeing Transient synovitis Development dysplasia of the hip Perthes disease Slipped capital femoral epiphysis

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Intoeing

Common condition Large number of children May be simple or complex

Femur Tibia Foot

Familial tendency

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Line of progression

Foot progression angleQuickTime™ and a

YUV420 codec decompressorare needed to see this picture.

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Transient Synovitis

Inflammatory condition. Cause unknown. Peak incidence 3-6 years. Mild U.R.T.I. Pain and limp. Resolves in 48 hours. May need aspiration.

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Ultrasound

Femur

Capsule

Normal Effusion

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Joint Pain

Trauma

No

Arthrotomy

Cloudy fluidPositive gram stain

Aspiration

Fever>38.5ESR>40CRP>20

Aspiration

Transient Synovitis

Fever< 38.5ESR<40CRP<20

Yes

UltrasoundJoint Effusion

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Joint Fluid Aspiration

Normal JRA SA

Color yellow yellow Blood stained

Clarity clear cloudy turbid

Viscosity very high low very low

WBC count <200 15-20000 > 20000

PMN <20% 60-75% >75%

Gram’s stain -ve -ve +ve in 30-40%

Culture -ve -ve +ve in 50-60%

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Developmental Dysplasia of the Hip

Incidence 0.1% 4 times commoner in girls Risk factors

1st. Born Breech Oligohydramnios

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Diagnosis

Ortolani Barlow Asymmetrical folds Galeazzi sign Limp X-ray U/S

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Ortolani Test

Ortolani manoeuvre to determine if the hip is dislocated

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Barlow’s Test

the Barlow is a provocative test for a dislocatable hip

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Asymmetrical Folds

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Galeazzi Sign

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Ultrasound

The angle, which is a measurement of the slope of the superior aspect of the bony acetabulum, and the angle, which evaluates the cartilaginous component of the acetabulum

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Ultrasound

Indications for ultrasonography are not universally established

Overdiagnosis above the expected incidence of DDH

Not Cost–effective

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Treatment

0-6 months Pavlik

6-18 months Traction and casting

More than 18 months Open reduction Osteotomy

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Thoracic band

Shoulder straps

Stirrups

Ant. Post. Straps

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Perthes

Ischaemic necrosis Collapse and repair Peak incidence 4-9 yrs Limp no pain Classification

Lat.Pillar

Containment

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Knee

Genu varum

Genu valgum

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Genu Varum

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Genu Valgum

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Foot

Flatfoot

Metatarsus varus

Talipes equino-varus

Pes cavus

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Flatfoot

Mobile Infantile Postural Temporary

Spastic Neuromuscular

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Physiological Pes Planus

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Metatarsus Varus

Partly genetic Normal hindfoot Adducted forefoot Usually resolves May need stretching

and casting

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Talipes Equino-varus

1.2/1000 live births Stiff Smaller calf Deformities

Equinus Inversion Adduction

Stretching,strapping Surgery

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Pes Cavus

Neurological Pma Dysraphism Friedrich’s ataxia