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Paediatric Orthopaedics

Mercy
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Paediatric Orthopaedics

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    1. Paediatric Orthopaedics Phase III Teaching University of Edinburgh

    3. Congenital Dislocation of Hip Incidence: 1 or 2 per 1000 infants Girls are more commonly affected First born Association with breech presentation Left hip is more often affected Family history Other congenital abnormalities

    4. Assessment for CDH Specific tests for CDH Galeazzi sign Barlows test Ortolani maneuver Loss of abduction U/S examination X-ray Screening for CDH

    5. Loss of abduction

    6. Barlow/Ortolani tests

    7. CDH

    8. Management of CDH Newborn Splintage in abduction (Pavlik harness) 6 - 18 months Closed reduction - Traction Splintage Open reduction and Splintage Late diagnosed dislocations Persistent dislocation in adults

    9. Perthess Disease Necrosis of the bony nucleus of the proximal femoral epiphyses and impairment of the growth of the physis, with subsequent remodelling of regenerated bone in the paediatric patient

    11. Prognostic factors in the Perthes disease Age Gender Clinical Signs Radiological predictors

    12. Management of Perthes disease The goal of treatment is a spherical, well-covered femoral head with a range of motion in the hips that approaches normal. The principles of treatment include maintenance of range of motion and containment of the femoral head.

    13. Slipped proximal femoral epiphyses Presenting complaint is a painful hip, sometimes referred pain to the knee may be the presenting complaint Affects adolescents Boys are affected twice as frequently as girls Bilateral in 30% Aetiology Hormonal imbalance Trauma

    14. S.U.F.E

    15. Management of SUFE Preserve the blood supply to the femoral head Stabilize the physis Correction of residual deformity

    16. SUFE - Complications Chronic loss of range of motion Osteonecrosis Chondrolysis Degenerative arthritis

    17. Club foot - CTEV Incidence: 1 in 1000 Male to female ratio of approximately 2:1 Bilateral in one third of cases

    18. CTEV - Pathologic anatomy Hindfoot is in equinus and varus Talus is also in equinus and medially rotated Midfoot and forefoot are adducted and plantar-flexed Calf muscles are shortened

    19. C.T.E.V

    20. C.T.E.V

    21. CTEV - Management Corrective manipulation and strapping or casting Surgical release for resistant feet

    22. Other foot problems in the childhood Flat feet Metatarsus Adductus Toe walkers Kohlers/ Severs disease

    23. Flat feet mobile or fixed

    24. Metatarsus adductus

    25. Intoeing Femoral anteversion Femoral torsion Tibial torsion MTV

    26. Fractures in children Salter - Harris Classification of epiphyseal injuries Type 1 - Separation of epiphysis Type 2 - Fracture through physis and metaphysis Type 3 - Intra-articular fracture of the epiphysis Type 4 - Splitting of physis and epiphysis Type 5 - Crushing of physis

    27. Cerebral palsy Nonprogressive insult of the central nervous system during the perinatal period. Classification Diplegic Hemiplegic Paraplegic Quadriplegic Tetraplegic

    28. Leg lengthening

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