اضطرابات الاطراف السفليه عند الاطفال - pediatric lower limb...
TRANSCRIPT
Fre
ih A
bu
Hass
an
Jordan University
Freih Odeh AbuHassan,
F.R.C.S.(Eng.),F.R.C.S.(Tr.& Orth.)
Professor of Orthopedics
The University of Jordan
Fre
ih A
bu
Hass
an
Jordan University
*Hip =Anteversion
=Retroversion
=Internal rotation
=External rotation
*Knee =Varus
=Valgus
Fre
ih A
bu
Hass
an
Jordan University
*Ankle = Equinus (Plantar flexion)
= Calcaneus (Dorsiflexion)
= Varus
= Valgus
*Subtalar Joint = Inversion
= Eversion
*Foot = Adduction
= Supination
= Pronation
Fre
ih A
bu
Hass
an
Jordan University
Knee & leg disorders1-Angular deformity
=Bow legs =Knock knees
2-Rotational deformity
3-Tibial bowing=Congenital bowing
=Cong. pseudoarthrosis of tibia
=Tibial hemimelia
=Fibular hemimelia
Fre
ih A
bu
Hass
an
Jordan University
Bowlegs Knock knees
Varum Valgum
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
= Physiological
= Pathological
Fre
ih A
bu
Hass
an
Jordan University
N. up to 3 Y old
Common 3 - 7 Y
RESOLVE by 8-10 Y
Fre
ih A
bu
Hass
an
Jordan University
1- Metabolic e.g rickets, renal.
2- Skeletal dysplasia, M.P.
3- Blount’s
3- Growth disturbance injury or
infection.
4- Tumors: Osteochondroma,
Olliers, neurofibromatosis
Fre
ih A
bu
Hass
an
Jordan University
Rickets
Fre
ih A
bu
Hass
an
Jordan University
Skeletal dysplasiaM D
Fre
ih A
bu
Hass
an
Jordan University
Tibia vara (Blount’s dis.)
Fre
ih A
bu
Hass
an
Jordan University
= Shoe modifications
= Exercises to correct deformity
= Manipulation and encouraged
posture for sitting
= Orthosis
Fre
ih A
bu
Hass
an
Jordan University
The occurrence of the physiological
variations at that time was considered
as a manifestations of serious disease
= Correction of the deformity.
= Delighted family
= The physician impressed
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Shoe wedges
Fre
ih A
bu
Hass
an
Jordan University
KAFO = Long leg braces
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
No relation between bowlegs & O.A
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Intoe gait
Fre
ih A
bu
Hass
an
Jordan University
*<1y Metatarsus A
*1-3 y Med.tibial T.
*3-10 y Med.femoral T.
Fre
ih A
bu
Hass
an
Jordan University
Metatarsus Adductus Dx: Medial deviation of the forefoot or
metatarsals ,on neutral Hind foot.
(I.U malposition)
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Mangement
1- 90% resolve at walking age.
(no value of straight or reverse shoes)
2- Stretching + Cast.
*For failure of correction after 1Y.
*Rigid adductus 10%(Deep med. crease).
3- Soft tissue surgery at 5y.
4- Bony surgery after 8y.
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Tibial torsion
Treatment•Spontaneous correction
•No value of Denis-browne bar,
heel wedges or any orthosis
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Femoral Torsion
*>in girls, prefers to sit W position
*On standing & walking the
patella pointing inwards
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Mangement
*No R/ < 8-10 years of age.
*Spontaneous correction
*Rarely surgical corrections
needed (<0.001%)
*No value of using twisting
cables , night splints Or
inverted shoes.
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
*Bilat.
1.Lat. torsion of the hip secondary
to I.U. position--Tight Ext. rot.
2.Bilat. Calcaneovalgus.
3.Ext. tibial torsion.
Out-toeing
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
= Congenital bowing
= Cong. pseudoarthrosis of
tibia
= Tibial hemimelia
= Fibular hemimelia
Fre
ih A
bu
Hass
an
Jordan University
1-Cong.Post.med angulation
of the T&F - Kyphosis
Calcaneo valgus foot.
Congenital bowing
Fre
ih A
bu
Hass
an
Jordan University
= Calcaneus position of the foot.
= Dorsiflexion contracture of the
ankle.
= Calcaneo valgus foot.
= Limited plantar flexion of foot.
= Small Calf.
At birth
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
2-Cong. Ant.lat.
ang. of the T&F
- Lordosis.
Cal. varus foot
Fre
ih A
bu
Hass
an
Jordan University
Cong. pseudoarthrosis of tibia
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
1-Calcaneovalgus deformity
2-Metatarsus adductus
3-Cong. talipus equinovarus
4-Flat feet
5-Neurogenic foot
-C.P -Polio. -Spinal diseases
Feet disorders
Fre
ih A
bu
Hass
an
Jordan University
Calcaneovalgus deformity
Fre
ih A
bu
Hass
an
Jordan University
CTEV
Fre
ih A
bu
Hass
an
Jordan University
• Incidence: 1 in 1000
• M:F ratio 2:1
• Bilateral in 1/3 of cases
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Flat Feet
No Longitudinal arch of the foot
Fre
ih A
bu
Hass
an
Jordan University
Types
Physiological Pathological
* Very common. * Rare
* Flexible. * Stiff.
* Asymptomatic. *
Symptomatic!!
* > 99%. * < 1%.
Fre
ih A
bu
Hass
an
Jordan University
How to assess flat feet?.
* Observe the feet standing, tip toes,
sitting.
* Check flexibility.
-Dorsiflexion! (T.A.).
-Inversion and Eversion.
-Pronation & Supination.
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Physiological flat feet.
*Nearly all infants.
*Most children.
*15% of normal adult.
JBJS-A, 1987, Staheli.
Fre
ih A
bu
Hass
an
Jordan University
P.F to Physiological flat
feet
*Hereditary.(Familial)
*Genu valgum.
*Limb torsion.
*Generalized laxity.
*Over weight.
Fre
ih A
bu
Hass
an
Jordan University
Low arch feet & high
arch feet.
*Less stress inj. with low arch.
*High arch more stress inj.
*Low arch better than high arch
for military recruits.
Giladi etal 1985.
Fre
ih A
bu
Hass
an
Jordan University
Pathological flat feet
1.Congenital : CVT.
2.Painless :-Tight T.A.
-Paralytic (C.P,Spina B.)
3.Painful or peroneal spasmodic flat feet.
- Tarsal coalition
- Accessory navicular bone
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Prospective
controlled
study
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Neurogenic disorders
The real indications
for Orthosis
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Nerve injury
Fre
ih A
bu
Hass
an
Jordan University
AppliancesDeformityML-paralysed
AFO + inside bar
&Outside T strap
InversionEvertors1-Foot
AFO + 90 / foot
drop stop
Foot dropDorsiflexors2-Ankle
AFO + reverse 90/
stop
CalcanecusPlantar Flexors
AFO + limited
motion ankle joint
Flail foot All muscles 3-Ankle
&Foot
KAFO +back knee
support
Genu
Recurvatum
Extensor:
quadriceps4- Knee
Fre
ih A
bu
Hass
an
Jordan University
Orthosis used only for
abnormal child or child
with chronic problem
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University
Normal child needs
normal shoes
Fre
ih A
bu
Hass
an
Jordan University
12
3
Fre
ih A
bu
Hass
an
Jordan University
Severe
Family
History
Unilat.
Short
stature
Fre
ih A
bu
Hass
an
Jordan University
Fre
ih A
bu
Hass
an
Jordan University