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Paediatric Orthopaedics

Paediatric Orthopaedics. E.E.Fogarty F.R.C.S.I, F.R.A.C.S. Socrates. 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. Limp. Normal gait

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Paediatric Orthopaedics

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  1. Paediatric Orthopaedics E.E.Fogarty F.R.C.S.I, F.R.A.C.S

  2. Socrates

  3. 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

  4. Limp • Normal gait • Causes of limp • Investigations

  5. Normal Gait • Bipedal • Rhythmic and effortless • Depends • On a number of reflexes • Intact locomotor system

  6. Gait Cycle

  7. Walking • Cruise before 1year • Walk at 14-18months • Develop a mature(adult) gait at 3years

  8. Limp • Is any disturbance of gait • Is due to one or more of 3 general causes • Pain • Weakness • Structural abnormalities

  9. Types of Limp • Antalgic • Neuromuscular • Trendelenberg • Short leg gait

  10. Causes of Limp • Congenital • Coxa vara, congenital short limb • Inflammatory • Juvenile chronic arthritis,transient synovitis • Infectious • Osteomyelitis,septic arthritis,discitis

  11. Causes of Limp • Developmental • Scfe, Ddh, Perthes , acquired limb length discrepancy • Neoplastic • Benign • Malignant • Secondary tumours

  12. Causes of Limp • Traumatic • Toddlers and stress fractures • Neuromuscular • Metabolic • Haematological • Referred • Appendicitis

  13. Stress Fracture • Adolescent • Upper Tibia • Looks aggressive

  14. Stress Fracture

  15. Investigations • Plain x-rays • Scannogram plus wrist x-ray • MRI,CT scan, Bone scan • FBC,ESR

  16. Hip • Intoeing • Transient synovitis • Development dysplasia of the hip • Perthes disease • Slipped capital femoral epiphysis

  17. Intoeing • Common condition • Large number of children • May be simple or complex • Femur • Tibia • Foot • Familial tendency

  18. Line of progression • Foot progression angle

  19. 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.

  20. Ultrasound Effusion Normal Capsule Femur

  21. Joint Pain

  22. Joint Fluid Aspiration NormalJRASA 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%

  23. Developmental Dysplasia of the Hip • Incidence 0.1% • 4 times commoner in girls • Risk factors • 1st. Born • Breech • Oligohydramnios

  24. Diagnosis • Ortolani • Barlow • Asymmetrical folds • Galeazzi sign • Limp • X-ray • U/S

  25. Ortolani Test • Ortolani manoeuvre to determine if the hip is dislocated

  26. Barlow’s Test • the Barlow is a provocative test for a dislocatable hip

  27. Asymmetrical Folds

  28. Galeazzi Sign

  29. Ultrasound • The a angle, which is a measurement of the slope of the superior aspect of the bony acetabulum, and the b angle, which evaluates the cartilaginous component of the acetabulum

  30. Ultrasound • Indications for ultrasonography are not universally established • Overdiagnosis above the expected incidence of DDH • Not Cost–effective

  31. Treatment • 0-6 months • Pavlik • 6-18 months • Traction and casting • More than 18 months • Open reduction • Osteotomy

  32. Thoracic band • Shoulder straps • Stirrups • Ant. Post. Straps

  33. Perthes • Ischaemic necrosis • Collapse and repair • Peak incidence 4-9 yrs • Limp no pain • Classification • Lat.Pillar • Containment

  34. Knee • Genu varum • Genu valgum

  35. Genu Varum

  36. Genu Valgum

  37. Foot • Flatfoot • Metatarsus varus • Talipes equino-varus • Pes cavus

  38. Flatfoot • Mobile • Infantile • Postural • Temporary • Spastic • Neuromuscular

  39. Physiological Pes Planus

  40. Metatarsus Varus • Partly genetic • Normal hindfoot • Adducted forefoot • Usually resolves • May need stretching and casting

  41. Talipes Equino-varus • 1.2/1000 live births • Stiff • Smaller calf • Deformities • Equinus • Inversion • Adduction • Stretching,strapping • Surgery

  42. Pes Cavus • Neurological • Pma • Dysraphism • Friedrich’s ataxia

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