Orthopedic Disorders Of Childhood Ppt

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Mutual Pediatric Orthopaedic Problems PowerPoint Presentation

Mutual Pediatric Orthopaedic Problems

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Mutual Pediatric Orthopaedic Problems

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1. Common Pediatric Orthopaedic Problems SelinaSilva, Physician UNM Carrie Tingley Hospital

2. Mutual Issues • Intoeing/ Outoeing • Bowlegged/ knock-kneed • Flexible Flatfeet • Growing Pains • Septic Joints • Legg-Calve-Perthes • DDH • SCFE • Scoliosis • Back Pain

3. "my child is dove-toed!!" • 3 sources of intoeing • Femoral anteversion • Internal tibial torsion • Metatarsus adductus

4. Intoeing • Femoral Anteversion • Normal is for children to be built-in with 30 degrees and with growth this normalizes to 10 degrees as an adult. • Women take more than femoral anteversion than men • Ofttimes familial • Mensurate the amount of IR and ER of the hip • Greater than 70 degrees IR is considered astringent

5. Intoeing • Internal Tibial Torsion • Common for one leg to accept more than the other • As well externally rotates with growth to about fifteen degrees equally an adult • Measure the thigh-foot angle • 5 degrees IR to 15 degrees ER is normal

6. Intoeing • Metatarsus Adductus • Most mutual congenital foot deformity • Forefoot metatarsals are medially rotated on cuneiforms • Hindfoot is normal • Flexible and resolves on its ain 85% of the fourth dimension

7. Outoeing • Deformity in femur or tibia • Usually does non improve with growth or worsens • Less tolerated and and so treated surgically more often • If asymmetric, need to rule out other problems • SCFE

8. Evaluation of Femur

9. Evaluation of Tibia

10. Treatment • Toeing out unremarkably corrected effectually the age of seven-10 if symptomatic • Toeing in often resolves near normal • Therefore requite more fourth dimension prior to offering surgical correction • Right severe cases, greater than lxx degrees • Corrected in early teen years if symptomatic • Forefoot adduction corrects 85% of the time on its own • Start with passive stretching by parents • Can do casting if not correcting • If rigid and non correcting, osteotomies can be washed around 5 yo

11. Pediatric Angular Alignment world wide web.pulsetoday.uk.co www.orthopediatrics.com

12. "my child'southward bowlegged!" • Physiologic between 1-3 • External rotation hip contractures • Internal tibial torsion

13. Dominion Out Blount's • Blounts: • Disturbance of proximal tibial physis • Often unilateral • Overweight kid, early walker vs. obese adolescent

14. Rule Out Rickets • Familial • Radiographic changes not limited to medial tibial physis • Notice bowing of femurs

15. Knock-Knees • Physiologic between ages iii-6 • Worry if unilateral • Ankles rolling in correct when the knees correct

16. When for Surgery? • Early teens may consider hemiepiphysiodesis • Indications: Mechanical centrality off and knee pain or patellar subluxation

17. Flexible Flatfeet • 20% of the population, variant of normal • When stand on toes there is an curvation • No treatment unless feet hurt • Orthotics for symptoms • Surgery for correction

18. Growing Pains • Commonly bilateral lower extremities • At dark or first thing in the morning • Goes abroad with massage/attention • Handling: Vitamin D3 and give 3-4 months of supplementation to actually see results • FLAGS: • Always same joint • Wakes them up in the heart of the night • Cease playing or doing sports because of pain

19. Septic Joint • Painful, bloated joint • Cherry and pain with centric load • Aspirate joint and send for gram stain, cell count, and culture prior to antibiotics • If septic, emergent incision and drainage is required • Sometimes difficult to differentiate from cellulitis

20. Developmental Hip Dysplasia • Risk Factors: • Beginning born, female, breech, family history • Physical Test: • Bank check Ortolani and Barlow • Asymetric Skin Creases • Cheque Galeazzi • Check for asymetric hip abduction

21. Developmental Hip Dysplasia • No Swaddling the legs, can still swaddle arms and go aforementioned effect • Ultrasound helpful after 1 mo of age • AP Pelvis at >4 months onetime • Can nowadays at limb length discrepancy in walking kid

22. Legg-Calve-Perthes • AVN of femoral head • Ages 4-eight, usually boys • Pain and limp, no fevers, worse with more than activity • AP/Frog Pelvis xray for diagnosis and send to Ortho

23. Slipped Capital Femoral Epiphysis • Patient contour • Obese preteen • Often c/o knee hurting • Affected leg may rotate outwards • Also seen with kids that have thyroid issues

24. Slipped Capital Femoral Epiphysis • Real danger is os death of femoral head • ALWAYS recollect of hips, when c/o human knee pain • Order AP Pelvis and Frog view Pelvis xrays • If positive, put on crutches, TDWB and send to Peds Ortho/ER immediately

25. SCFE is always a surgical problem Hight risk of AVN, which occurred in this patient

26. Scoliosis • Frontward bend test • Imbalance of shoulders or pelvis • Greater than 10 degree curve on Xray is scoliosis

27. Scoliosis • Sometimes presents as limb length inequality • Most accurate is standing posterior view: PSIS "dimples" • Become an MRI if thoracic curve is going to the left or neurologic findings

28. Scoliosis • Any patient with scoliosis nosotros need to run into and follow until they are xviii years of age • We follow about every half dozen months with Xrays • Caryatid at nigh 25 degrees • Surgery if quickly progressing or greater than 50 degrees • Scoliosis does non cause back pain

29. Back Pain • Kids with or without scoliosis and that have back pain are initially treated with dwelling house practise program • We have handout for this • If fail domicile practice/stretching plan volition send to formal concrete therapy • 1x per calendar week, for 12 weeks • Cadre strengthening, truncal stability and hamstring stretches • If fail therapy, then get MRI or Bone Scan • If whatever neurologic findings get MRI

Orthopedic Disorders Of Childhood Ppt,

Source: https://www.slideserve.com/falala/common-pediatric-orthopaedic-problems

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