WELCOME

1. WELCOME

2. ORTHOPEDIC DISORDERS

3. CLUB FOOT

4. definition Club Foot is a complex deformity of foot, result of complicated inter- relationships between bone ligaments and muscles. Broadening and thickening of the foot due to contraction of muscles and tendons

5. INCIDENCE One in 700 to one in 1000 live births.

6. causes • Defective gene – Hereditary • Excessive pressure of amniotic fluid • Uterine compression • Arrested fetal development • Circulatory failure • Radiation (maternal)

7. types • TALIPES VARUS: Bending of foot inward.

8. types TALIPUS VALGUS: Bending of foot outward.

9. TALIPES EQUINES: The toes are lower than the heel. The toes touch the ground but not heel.

10. TALIPES CALCANEUS: The toes are higher than the heel. The heel alone touches the ground on standing.

11. TALIPES EQUINOVARUS: The toes are lower than the heel. The foot is fixed in plantar flexion and deviates medially.

12. TALIPES CALCANEOVALGUS: The foot is dorsi flexed and deviate laterally. Foot is turned outward from the midline of the body.

13. PATHOPHYSIOLOGY ENVIRONMENTAL FACTOR • ABNORMAL POSITION IN UTERO RESTRICTED MOVEMENT IN UTERO GENETIC FACTOR ARRESTED DEVELOPMENT OF EMBRYO IN EARLY STAGES UNILATERAL OR BILATERAL DEFORMITY OF FOOT AND ANKLE

14. TALIPES CALCANEOVALGUS FOOT POINTED UPWARD AND OUTWARD (DORSIFLEXION AND EVERSION) TALIPES EQUINOVARUS (MOST COMMON) FOOT POINTED DOWNWARD PERSISTENT TYPE EASY TYPE SURGICAL CORRECTION AND CASTING MANIPULATION AND TAPING

15. DIAGNOSTIC FINDINGS • History collection. • Physical examination. • Radiologic examination.

16. MEDICAL MANAGEMENT CORRECTION Infants grow rapidly, so the cast may be changed every 1 to 2 weeks. a) STRETCHING AND CASTING (PONSETI METHOD) It  is a manipulative technique that corrects congenital clubfoot without invasive surgery.

17. b) Stretching and Taping ( French Method)

18. The French method, also called the functional physical therapy method, is a combination of physiotherapy, splinting and surgery. The French functional physical therapy method consists of daily manipulations of the newborn's clubfoot by a specialized physical therapist, stimulation of the muscles around the foot and temporary immobilization of the foot with elastic and nonelastic adhesive taping.

19. Dennis - Brown Braces Babies often need to wear a special brace (medically called an orthosis). The Dennis Browne Bar (DB Bar) is one type of brace used to treat club foot. The DB Bar has cuffs that go around the thighs and are attached to a bar. This holds the hips and knees up (flexed) with the legs apart (abducted).  This position allows contact between the thigh and hip bones and helps the muscles and ligaments to strengthen while the hip is developing.

20. c) Dennis - Brown Brace

21. nsaids

22. surgery

23. HIP DISPLACEMENT

25. DEFINITION • Hip displacement is referred to a condition in which the femoral head and the acetabulum are improperly aligned in which the ball of the femur is outside the hip socket.

26. types • Hip dislocation or preluxation or acetabular dysplasia • Instability of hip or subluxation • Dislocation or subluxation of hip

28. Clinical manifestations • Laxity of ligaments • Assymetry of gluteal fold • Limited ROM • Apparent shorter femur on affected side

29. c/m … • Variation in gait • Extra fold at thighs and groins • Difference in length of limbs • Wading gait

31. The Barlow Maneuver is done by guiding the hips into mild adduction and applying a slight forward pressure with the thumb. If the hip is unstable, the femoral head will slip over the posterior rim of the acetabulum, again producing a palpable sensation of subluxation or dislocation.

32. The Ortolani Test: The examiner’s hands are placed over the child’s knees with his/her thumbs on the medial thigh and the fingers placing a gentle upward stress on the lateral thigh and greater trochanter area. With slow abduction, a dislocated and reducible hip will reduce with a described palpable “clunk.”

33. Medical management • Pavlik harness

34. 2. Skin traction

35. 3. Surgery and cast

36. Nursing management • Teach parents regarding care and application of pavlik maneuver. • Feeding and bathing the child. • Skin care. • Assess warmth and color of feet. • Evaluate for any complication of cast.

37. Nsgmngmt… • Child not to be left unattended. • Assess for s/s of infection. • Proper diet. • Follow up. • Psychological support. • Prevent complications due to immobility.

38. fractures

39. definition • A fracture is defined as a break in the continuity of a bone. This can occur either in the long bones as is most common or in flat bones such as skulls or pelvis.

42. CLINICAl features • Pain • Pallor • Paralysis • Generalized Swelling • Bruising • Tenderness • Deformity • Severe muscle rigidity

43. Medical management • CLOSED REDUCTION

44. 2. OPEN REDUCTION

45. 3. TRACTION

46. NURSING MANAGEMENT • Prepare child for surgery. • Keep affected part immobilized. • Proper application of traction. • Maintain hygiene of the child. • Prevent infections.

47. Nsgmangmt… • The child with cast observed for : • Prevention of circulatory, neurologic or respiratory distress. • Maintain normal body temperature. • Maintain skin integrity. • Improve muscle activity. • Provide comfort measures. • Prevent urinary stasis and constipation. • Health education of parents.

48. Osteogenesisimperfecta

49. OsteogenesisImperfecta (OI) is a rare inherited condition affecting 1:10,000 to 1:20,000 births • It is caused by a mutation to the gene that controls the production of collagen, which gives strength to the structure of bone and connective tissue and is found in bone, muscle, ligaments, skin, eyes, ears and heart muscle. • It causes lifelong brittle bones and fractures.