congenital deformities
TRANSCRIPT
CONGENITAL DEFORMITIESPresenters: Dr.A.Prakash, Dr. C. Arun Prasath.Institution: Annamalai University. Date:12.2.2013.
CONGENITAL TALIPES EQUINO VARUS(CTEV)
CTEV
Vague term used to define a number of abnormalities in the foot.
CTEV-ETIOLOGY
The true etiology of congenital clubfoot is unknown.
Idiopathic Mechanical-intra uterine pressure Ischeamia of calf muscles genetic
Secondary Paralytic disorders Arthrogryposis multiplex congenita.
CTEV-PATHO ANATOMY
Bones Smaller Talus faces downwards Calcaneum small
Joints Ankle-equinus Subtalar-inversion Mid tarsal-Forefoot adduction and cavus
Muscles and tendons Posteriorly- tendo achilles. Medially- TP, FDL, FHL
Capsules and ligaments Capsules of ankle and sub talar joint, Medially-Talo navicular ligament, spring ligament, deltoid
ligament Plantar fascia and ligaments Interosseous ligaments.
CTEV-CLINICAL FEATURES
Detected at birth Brought during early infancy Brought during late infancy and early childhood Brought during late childhood Examination
Normally-foot dorsiflexed to touch the chin of tibia Foot is smaller, in equinus, varus and adduction. Heel is small Deep skin creases on the back and medial side of foot Bony prominences and callosities on the lateral side of
foot Outer side of the foot is convex.
CTEV-CLINICAL FEATURES
CTEV-DIAGNOSIS
Xrays- reduced talo calcaneal angle. Normal-more than 35 degrees.
CTEV-TREATMENT Non-operative
Manipulation Manipulation and corrective plaster
Operative Postero-medial soft tissue release(TURCO’S)-<3
years Limited soft tissue release Tendon transfers Dwyer’s osteotomy Dilwyn-Ewan’s procedure- 4 to 8 years Wedge tarsectomy- 8 to 11 years Triple arthrodesis- >11 years Illizarov’s technique- recurrent.
CTEV-MAINTANANCE
Ctev splints Denis-Brown splint CTEV shoes
SPINA BIFIDA
SPINA BIFIDA
A congenital disorder in which the two halves of the posterior vertebral arch fail to fuse at one or more levels.
SPINA BIFIDA-TYPES Occulta
Mildest form Midline defect near the lamina
Cystica More severe form Contents of the canal prolapse
Meningocele Myelomeningocele-open, closed. hydrocephalus
SPINA BIFIDA-CLINICAL FEATURES Spina bifida occulta
Usually nothing Midline dimple, tuft of hair, pigmented navus Neurological symptoms-enuresis, incontinence,
weakness in the lower limbs Spina bifida cystica
Saccular lesion in the lumbar region Hydrocephalous Equinovarus or calcaneo valgus of feet Recurvatum of knee Hip dislocation LMN type paralysis Loss of sphincter control
SPINA BIFIDA-CLINICAL FEATURES
SPINA BIFIDA-CLINICAL FEATURES
SPINA BIFIDA- DIAGNOSIS
Xray CT MRI
SPINA BIFIDA-TREATMENT
Wound care Poper closure of defect Hydrocephalous- ventriculo-peritoneal
shunt, if necessary for 5 to 6 years. Physiotherapy and splinting
CONGENITAL DISLOCATION OF HIP (CDH)
CDH
Spontaneous disloation of the hip occuring before, during or shortly after birth.
CDH-AETIOLOGY
Not well understood Hereditary predisposed to joint laxity Hormone induced joint laxity Breech presentation Hereditary faulty development of
acetabulum.
CDH-PATHOLOGY
Femoral head is dislocated upwards- small capital epiphysis
Femoral neck- anteverted Acetabulum-shallow Ligamentum teres-hypertrophied. Fibrocartilaginous labrum- folded limbus. Streched capsule Muscles-shortened
CDH-CLINICAL FEATURES
At birth-from pediatrician Early child hood-asymmetry of groin
creases, limitation of hip movements, click
Older children-peculiar gait.
CDH-CLINICAL FEATURES
CDH-DIAGNOSIS
Barlow’s test Ortolani’s test Galeazzi’s sign Telescopy test Trendelenburg’s test Xray-shallow acetabulum, break in
shenton’s line, small head Ultrasound
CDH-DIAGNOSIS
CDH-TREATMENT Aim-reduce by closed means. Methods of reduction
Closed manipulation Traction followed by closed manipulation Open reduction
Maintenance of reduction Plaster cast Splints-Von Rosen’s splint Acetabular procedures
Salter’s osteotomy Chiari’s pelvic displacement osteotomy Pemberton’s pericapsular osteotomy
SPRENGEL’S SHOULDERCONGENITAL ELEVATION OF SCAPULA
SPRENGEL’S SHOULDER
Failure of descent of the scapula, which is developmentally a cervial appendage.
SPRENGEL’S SHOULDER-CLINICAL FEATURES
May be noticed at birth Shoulder on the affected side is elevated Smaller shoulder Occasionally both sides are affected(klippel feil
syndrome) Shorter neck-associated with kyphosis or
scoliosis Abduction and elevation restricted Xray-scapula may be elevated, associated
vertebral anomalies.
SPRENGEL’S SHOULDER-CLINICAL FEATURES
SPRENGEL’S SHOULDER-TREATMENT
Mild- left alone Children younger than 6 years-scapula
an be repositioned by release of the muscles, exision of the supraspinous portion of the scapula.
MADELUNG DEFORMITYRADIAL CLUB HAND
MADELUNG DEFORMITY
Defective growth of the distal radial epiphysis resulting in a deformity due to a comparative overgrowth of the ulna.
Traumatic and congenital
MADELUNG DEFORMITY-CLINICAL FEATURES
Lower end of radius curves forwards and ventrally
Wrist is dislocated Lower end of ulna projects out May be isolated or a part of generalised
dysplasia Deformity increases until growth
ceases
MADELUNG DEFORMITY-CLINICAL FEATURES
MADELUNG DEFORMITY-TREATMENT
Exision of the lower end of ulna Exision of the damaged physis
RADIO ULNAR SYNOSTOSIS
RADIO ULNAR SYNOSTOSIS
Synostosis-abnormal fusion of bones
RADIO ULNAR SYNOSTOSIS-CLINICAL FEATURES
Postero lateral dislocation of radial head
Complete loss of supination and pronation
RADIO ULNAR SYNOSTOSIS-TREATMENT Exision of the bony bridge-
unsuccessful. Change the resting position of the limb
to supination by tendon transfers.
CONGENITAL PSEUDARTHROSIS OF TIBIA
PSEUDARTHROSIS OF TIBIA
A birth defect in the lower end of tibia in children, where a fracture fails to unite.
PSEUDARTHROSIS OF TIBIA-PRESENTATION
Usually diagnosed in early infany Child may be born with a fractured tibia
or attenuated later in life. Leg is bowed anteriorly Xray
Gap, marked thinning, sometimes fibula is also afffected
PSEUDARTHROSIS OF TIBIA-PRESENTATION
PSEUDARTHROSIS OF TIBIA-PRESENTATION
PSEUDARTHROSIS OF TIBIA-PRESENTATION
PSEUDARTHROSIS OF TIBIA-TREATMENT Simple immobilisation-fails ORIF with bone grafting-succeeds
occasionally Excision of the affected segment and
slowly closing the gap.