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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

Paediatric Orthopaedics

E.E.Fogarty

F.R.C.S.I, F.R.A.C.S

hemlock
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
slide4
Limp
  • Normal gait
  • Causes of limp
  • Investigations
normal gait
Normal Gait
  • Bipedal
  • Rhythmic and effortless
  • Depends
    • On a number of reflexes
    • Intact locomotor system
walking
Walking
  • Cruise before 1year
  • Walk at 14-18months
  • Develop a mature(adult) gait at 3years
slide8
Limp
  • Is any disturbance of gait
  • Is due to one or more of 3 general causes
    • Pain
    • Weakness
    • Structural abnormalities
types of limp
Types of Limp
  • Antalgic
  • Neuromuscular
  • Trendelenberg
  • Short leg gait
causes of limp
Causes of Limp
  • Congenital
    • Coxa vara, congenital short limb
  • Inflammatory
    • Juvenile chronic arthritis,transient synovitis
  • Infectious
    • Osteomyelitis,septic arthritis,discitis
causes of limp1
Causes of Limp
  • Developmental
    • Scfe, Ddh, Perthes , acquired limb length discrepancy
  • Neoplastic
    • Benign
    • Malignant
    • Secondary tumours
causes of limp2
Causes of Limp
  • Traumatic
    • Toddlers and stress fractures
  • Neuromuscular
  • Metabolic
  • Haematological
  • Referred
    • Appendicitis
stress fracture
Stress Fracture
  • Adolescent
  • Upper Tibia
  • Looks aggressive
investigations
Investigations
  • Plain x-rays
  • Scannogram plus wrist x-ray
  • MRI,CT scan, Bone scan
  • FBC,ESR
slide16
Hip
  • Intoeing
  • Transient synovitis
  • Development dysplasia of the hip
  • Perthes disease
  • Slipped capital femoral epiphysis
intoeing
Intoeing
  • Common condition
  • Large number of children
  • May be simple or complex
    • Femur
    • Tibia
    • Foot
  • Familial tendency
slide18
Line of progression
  • Foot progression angle
transient synovitis
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.
ultrasound
Ultrasound

Effusion

Normal

Capsule

Femur

joint fluid aspiration
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%

developmental dysplasia of the hip
Developmental Dysplasia of the Hip
  • Incidence 0.1%
  • 4 times commoner in girls
  • Risk factors
    • 1st. Born
    • Breech
    • Oligohydramnios
diagnosis
Diagnosis
  • Ortolani
  • Barlow
  • Asymmetrical folds
  • Galeazzi sign
  • Limp
  • X-ray
  • U/S
ortolani test
Ortolani Test
  • Ortolani manoeuvre to determine if the hip is dislocated
barlow s test
Barlow’s Test
  • the Barlow is a provocative test for a dislocatable hip
ultrasound1
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
ultrasound2
Ultrasound
  • Indications for ultrasonography are not universally established
    • Overdiagnosis above the expected incidence of DDH
    • Not Cost–effective
treatment
Treatment
  • 0-6 months
    • Pavlik
  • 6-18 months
    • Traction and casting
  • More than 18 months
    • Open reduction
    • Osteotomy
slide35
Thoracic band
  • Shoulder straps
  • Stirrups
  • Ant. Post. Straps
perthes
Perthes
  • Ischaemic necrosis
  • Collapse and repair
  • Peak incidence 4-9 yrs
  • Limp no pain
  • Classification
    • Lat.Pillar
  • Containment
slide37
Knee
  • Genu varum
  • Genu valgum
slide40
Foot
  • Flatfoot
  • Metatarsus varus
  • Talipes equino-varus
  • Pes cavus
flatfoot
Flatfoot
  • Mobile
      • Infantile
      • Postural
      • Temporary
  • Spastic
  • Neuromuscular
metatarsus varus
Metatarsus Varus
  • Partly genetic
  • Normal hindfoot
  • Adducted forefoot
  • Usually resolves
  • May need stretching and casting
talipes equino varus
Talipes Equino-varus
  • 1.2/1000 live births
  • Stiff
  • Smaller calf
  • Deformities
      • Equinus
      • Inversion
      • Adduction
  • Stretching,strapping
  • Surgery
pes cavus
Pes Cavus
  • Neurological
    • Pma
    • Dysraphism
    • Friedrich’s ataxia