1 / 32

PAEDIATRIC ORTHOPAEDICS

PAEDIATRIC ORTHOPAEDICS. ORTHO - PAEDICS. Children are not small Adults. Anatomic differences. Centers of ossification Radiolucent growth plate Thicker and stronger periosteum. Biomechanic differences.

christophergramirez
Download Presentation

PAEDIATRIC ORTHOPAEDICS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. PAEDIATRIC ORTHOPAEDICS

  2. ORTHO - PAEDICS

  3. Children are not small Adults

  4. Anatomic differences • Centers of ossification • Radiolucent growth plate • Thicker and stronger periosteum

  5. Biomechanic differences • Osteoid of a child’s bone is not significantly less calcified,but the density of a young’s bone is certainly less • Pores prevent the extension of a fracture line • Porous nature allows failure in compression • Growth remodeling based in asymmetric growth of physis and periosteum

  6. Clinical examination-The grate Art Children never lie Children cry Listen to the mother Congenital deformities Family history Abused child

  7. Congenital deformities • Infantile hip Dysplasia or Congenital dislocation of the Hip • Coxa Vara-Coxa Valga • Paediatric Foot

  8. C.D.H-Incidence • 1-6\1000 births • Left hip is affected about twice as frequently as the right • Highest risk for first born girls • Family history • Scoliosis[10 times grater incidence]

  9. Etiology • Familiar tendency • Joint laxity • Acetabular dysplasia • Mechanical factors • Deficiency in growth of the labrum[limbus] • Hormonal abnormalities

  10. Physical Assessment • Apparent limb’s shortening • Ortolani’s test • Barlow’s test • Limited abduction[no more than half way] • Assymetrical skin creases • Perineal gap • Late walking,waddling gait

  11. Radiologic assessment • Xrays • Ultrasonography • Computed tomography • Magnetic Resonance Imaging

  12. Treatment • Closed treatment:Pavlik harness,Von Rosen harness,Frejka pillow • Surgical procedures:Salter acetabular osteotomy,Chiari acetabular osteotomy,femoral osteotomies

  13. Slipped Capital Femoral Epiphysis

  14. Incidence • Boys age 12 to14, girls age 10 to 12 • Caucasian children 1 to 3 per 100.000 • Black males,higher incidence[7 to 8 per 100.000]

  15. Etiologic factors • Obesity • Rapid growth spurts • Endocrinopathies[hypothyroidism,renal rickets,hypogonadism] • Mechanical factors

  16. Clinical Presentation • Preslip • Acute slip • Chronic slip[3 weeks] • Acute on chronic slip

  17. Diagnostic Imaging • Lateral Head-shaft Angle[Southwick’ method] >60, 30-60,30> • Klein’s line • Epiphyseal height • Physeal widening • One third uncovered metaphysis,grade 1 • Two thirds,grade 2 • More than two thirds,grade 3

  18. Treatment • Manipulation • Pinning • Osteotomies

  19. Legg-Calve-Perthes’ Deasease

  20. Incidence • 1 in 10.000 • Particularly rare in black children • Usually 4-8 years old • Boys are affected 4 times as often as girls • Higher incidence in underprivileged communities

  21. Pathogenesis • Blood supply of femoral head:1/metaphyseal vessels which penetrate the growth disc 2/lateral epiphyseal vessels running in the retinacula 3/scanty vessels in the ligamentum teres • Between 4 and 7 years of age blood supply and venous drainage depends almost entirely on the lateral epiphyseal vessels

  22. Pathology • Stage 1: Ischaemia and bone death • Stage 2:Revascularizasion and repair • Stage 3: Distorsion and remodeling

  23. Treatment • Analgesia-? Skin traction • Supervised neglect • Containment:1/Hips widely abducted,in plasteror in removable splint 2/Varus osteotomy of femur or pelvis

  24. Fractures • Greenstick fractures • Injuries of physis

  25. Thank you

More Related