Freih Odeh AbuHassanFreih Odeh AbuHassan,F.R.C.S.(Eng.), F.R.C.S.(Tr.& Orth.)( g ), ( )

Professor of OrthopedicsUniversity of Jordan

1/19/2011 1Professor Freih Abuhassan -University of Jordan

Cervical SpineCervical Spine

Torticollis1/19/2011 2Professor Freih Abuhassan -

University of Jordan

ShoulderShoulder

Sprengle’s deformity

1/19/2011 3Professor Freih Abuhassan -University of Jordan

Spinep

1/19/2011 4Professor Freih Abuhassan -University of Jordan

L t d i ti t f th= Lat. deviation or curvature of the spinep

= G > Boys= Uknown cause

St t l St t l= Structural or non Structural

1/19/2011 5Professor Freih Abuhassan -University of Jordan

• Non Str ct ral• Non Structural– Poor posturePoor posture– LLD– Disc

• Structural• Structural– CONGENITALCONGENITAL– IDIOPATHIC – N.M

1/19/2011 6Professor Freih Abuhassan -University of Jordan

1/19/2011 7Professor Freih Abuhassan -University of Jordan

1/19/2011 8Professor Freih Abuhassan -University of Jordan

1/19/2011 9Professor Freih Abuhassan -University of Jordan

=Observe ---10 -20 degree=Observe ---10 -20 degree

= Brace= BraceMILWAUKEE TLSOMILWAUKEE , TLSO ,CHARLESTONCHARLESTON30 40 degree30 - 40 degree

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1/19/2011 11Professor Freih Abuhassan -University of Jordan

=SurgeryPost spinal fusionp40 - 45 degree40 45 degree

1/19/2011 12Professor Freih Abuhassan -University of Jordan

1/19/2011 13Professor Freih Abuhassan -University of Jordan

Congenital Scoliosis

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1/19/2011 15Professor Freih Abuhassan -University of Jordan

Congenital KyphosisCongenital Kyphosis

1/19/2011 16Professor Freih Abuhassan -University of Jordan

Brachial plexus injuryac a p e us ju y

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* 2 per 1000 Live birth* 2 per 1000 Live birth* 80 - 90 % Spontanous improvep p* Increasing > birth wt.*S*Surgeryif biceps not recovered by 3 mif biceps not recovered by 3 m

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1/19/2011 19Professor Freih Abuhassan -University of Jordan

Congenital Hand Deformity

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1/19/2011 22Professor Freih Abuhassan -University of Jordan

1/19/2011 23Professor Freih Abuhassan -University of Jordan

1/19/2011 24Professor Freih Abuhassan -University of Jordan

Causes of DDHCauses of DDHCauses of DDHCauses of DDH

* Li t l it H* Li t l it H* Ligaments laxity : Horm.* Ligaments laxity : Horm.* Mal position : Extended Br* Mal position : Extended Br* Mal position : Extended Br.* Mal position : Extended Br.* Genetic.* Genetic. Genetic. Genetic.* Post natal.* Post natal.

1/19/2011 25Professor Freih Abuhassan -University of Jordan

Risk factors for DDHRisk factors for DDHRisk factors for DDHRisk factors for DDH

11. . FFemale emale

22. . FFamily historyamily history

FF33. . FFirst born irst born breech.breech.

44.. FFeet def. : C.Valgus.eet def. : C.Valgus.44. . FFeet def. : C.Valgus.eet def. : C.Valgus.

55. . FFull term or Premature.ull term or Premature.

66. . FFaulty habitsaulty habits

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Pathology of DDH

1/19/2011 27Professor Freih Abuhassan -University of Jordan

CDHCDHCDHCDH

* Chromosomal disease : * Chromosomal disease : 4545x.x.* Malformation : Sacral agenesis* Malformation : Sacral agenesis* Malformation : Sacral agenesis.* Malformation : Sacral agenesis.* Syndromes : * Syndromes : yy

1/19/2011 28Professor Freih Abuhassan -University of Jordan

Diagnosis of DDHDiagnosis of DDHDiagnosis of DDHDiagnosis of DDH

*< *< 33m.m.-- Clunk sign of Ortolani.Clunk sign of Ortolani.

** 33 1212 monthsmonths 3 3 --1212 months.months.-- Limited abduction. Limited abduction.

S iS i -- Shortening.Shortening.* * After After 1212 months.months.

-- Limping. Limping. -- Shortening.Shortening.

1/19/2011 29Professor Freih Abuhassan -University of Jordan

Galliazzi

Professor Freih Abuhassan -University of Jordan

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1/19/2011 32Professor Freih Abuhassan -University of Jordan

Investigation for DDHInvestigation for DDHInvestigation for DDHInvestigation for DDH

# Ult d ft# Ult d ft 99 kk# Ultrasound after # Ultrasound after 99 weeks.weeks.

# X# X--ray after ray after 33--4 4 months months ## ay a teay a te 33 o t so t s-- Abduction Abduction 30 30 degree.degree.-- IR IR 15 15 degree.degree.

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1/19/2011 34Professor Freih Abuhassan -University of Jordan

1/19/2011 35Professor Freih Abuhassan -University of Jordan

1/19/2011 36Professor Freih Abuhassan -University of Jordan

Poor orthosis

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Flexition

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1/19/2011 39Professor Freih Abuhassan -University of Jordan

LEGGLEGG CALVE’CALVE’ PERTHE’SPERTHE’SLEGG LEGG -- CALVE’ CALVE’ -- PERTHE’S PERTHE’S

AVN h d f th f= AVN head of the femur= Children bet 2 13 Y= Children bet. 2-13 Y= Presentation= PresentationPain in the groin thigh kneePain in the groin, thigh, knee

1/19/2011 40Professor Freih Abuhassan -University of Jordan

1/19/2011 41Professor Freih Abuhassan -University of Jordan

1/19/2011 42Professor Freih Abuhassan -University of Jordan

Poor orthosisPoor orthosis

Old method of treatementOld method of treatement

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S C F EPIPHYSISS C F EPIPHYSIS

=Displaced med. & post=Femoral H is held by lig.

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1/19/2011 45Professor Freih Abuhassan -University of Jordan

P t tiP t tiPresentation Presentation Painful hip Painful hip ------Painful knee Painful knee

Affects adolescentsAffects adolescents–– Boys are affected twice as girlsBoys are affected twice as girls–– Boys are affected twice as girlsBoys are affected twice as girls–– Bilateral in Bilateral in 3030%%–– AetiologyAetiology

Hormonal imbalanceHormonal imbalance•• Hormonal imbalanceHormonal imbalance•• TraumaTrauma

1/19/2011 46Professor Freih Abuhassan -University of Jordan

1/19/2011 47Professor Freih Abuhassan -University of Jordan

1/19/2011 48Professor Freih Abuhassan -University of Jordan

Angular deformitiesAngular deformities1/19/2011 49Professor Freih Abuhassan -

University of Jordan

Bowlegs Knock kneesBowlegs Knock knees

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N l t 3 Y ldNormal up to 3 Y old

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Common 3 - 6 YRESOLVE by 7 - 10 Yy

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Genu

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1/19/2011 54Professor Freih Abuhassan -University of Jordan

Poor orthosis

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No relation between bowlegs & O.ANo relation between bowlegs & O.A1/19/2011 56Professor Freih Abuhassan -

University of Jordan

S U il tSevere Unilat.

Family ShortstatureHistory stature

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1/19/2011 58Professor Freih Abuhassan -University of Jordan

Intoe gaitIntoe gait

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Metatarsus Metatarsus adductusadductus1/19/2011 60Professor Freih Abuhassan -

University of Jordan

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CTEVCTEV

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•• Incidence: Incidence: 11 in in 10001000M l t f l tiM l t f l ti 22 11•• Male to female ratio Male to female ratio 22::11Bil t l iBil t l i 11//33 ff•• Bilateral in Bilateral in 11//3 3 of casesof cases

1/19/2011 65Professor Freih Abuhassan -University of Jordan

1/19/2011 66Professor Freih Abuhassan -University of Jordan

Flat FeetFlat Feet

No Longitudinal arch of the footNo Longitudinal arch of the footgg1/19/2011 67Professor Freih Abuhassan -

University of Jordan

1/19/2011 68Professor Freih Abuhassan -University of Jordan

Historical treatmentHistorical treatment

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University of Jordan

ProspectiveProspective controlled Professor Freih Abuhassan -

University of Jordan

study 1/19/2011 71

1/19/2011 72Professor Freih Abuhassan -University of Jordan

Normal child needsnormal shoes

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Special shoes or inserts fonly for abnormal

hild N M dichildren e.g N.M. dis.

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1/19/2011 75Professor Freih Abuhassan -University of Jordan