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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 - PowerPoint PPT Presentation
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Paediatric Orthopaedics
E.E.Fogarty
F.R.C.S.I, F.R.A.C.S
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Socrates
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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
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Limp
Normal gait
Causes of limp
Investigations
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Normal Gait
Bipedal
Rhythmic and effortless
Depends On a number of reflexes Intact locomotor system
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Gait Cycle
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Walking
Cruise before 1year
Walk at 14-18months
Develop a mature(adult) gait at 3years
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Limp
Is any disturbance of gait Is due to one or more of 3 general causes
Pain
Weakness
Structural abnormalities
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Types of Limp
Antalgic
Neuromuscular
Trendelenberg
Short leg gait
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Causes of Limp
Congenital Coxa vara, congenital short limb
Inflammatory Juvenile chronic arthritis,transient synovitis
Infectious Osteomyelitis,septic arthritis,discitis
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Causes of Limp
Developmental Scfe, Ddh, Perthes , acquired limb length
discrepancy Neoplastic
Benign Malignant Secondary tumours
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Causes of Limp
Traumatic Toddlers and stress fractures
Neuromuscular Metabolic Haematological Referred
Appendicitis
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Stress Fracture
Adolescent
Upper Tibia
Looks aggressive
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Stress Fracture
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Investigations
Plain x-rays
Scannogram plus wrist x-ray
MRI,CT scan, Bone scan
FBC,ESR
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Hip
Intoeing Transient synovitis Development dysplasia of the hip Perthes disease Slipped capital femoral epiphysis
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Intoeing
Common condition Large number of children May be simple or complex
Femur Tibia Foot
Familial tendency
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Line of progression
Foot progression angleQuickTime™ and a
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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.
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Ultrasound
Femur
Capsule
Normal Effusion
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Joint Pain
Trauma
No
Arthrotomy
Cloudy fluidPositive gram stain
Aspiration
Fever>38.5ESR>40CRP>20
Aspiration
Transient Synovitis
Fever< 38.5ESR<40CRP<20
Yes
UltrasoundJoint Effusion
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Joint Fluid Aspiration
Normal JRA SA
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%
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Developmental Dysplasia of the Hip
Incidence 0.1% 4 times commoner in girls Risk factors
1st. Born Breech Oligohydramnios
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Diagnosis
Ortolani Barlow Asymmetrical folds Galeazzi sign Limp X-ray U/S
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Ortolani Test
Ortolani manoeuvre to determine if the hip is dislocated
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Barlow’s Test
the Barlow is a provocative test for a dislocatable hip
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Asymmetrical Folds
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Galeazzi Sign
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Ultrasound
The angle, which is a measurement of the slope of the superior aspect of the bony acetabulum, and the angle, which evaluates the cartilaginous component of the acetabulum
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Ultrasound
Indications for ultrasonography are not universally established
Overdiagnosis above the expected incidence of DDH
Not Cost–effective
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Treatment
0-6 months Pavlik
6-18 months Traction and casting
More than 18 months Open reduction Osteotomy
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Thoracic band
Shoulder straps
Stirrups
Ant. Post. Straps
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Perthes
Ischaemic necrosis Collapse and repair Peak incidence 4-9 yrs Limp no pain Classification
Lat.Pillar
Containment
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Knee
Genu varum
Genu valgum
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Genu Varum
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Genu Valgum
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Foot
Flatfoot
Metatarsus varus
Talipes equino-varus
Pes cavus
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Flatfoot
Mobile Infantile Postural Temporary
Spastic Neuromuscular
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Physiological Pes Planus
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Metatarsus Varus
Partly genetic Normal hindfoot Adducted forefoot Usually resolves May need stretching
and casting
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Talipes Equino-varus
1.2/1000 live births Stiff Smaller calf Deformities
Equinus Inversion Adduction
Stretching,strapping Surgery
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Pes Cavus
Neurological Pma Dysraphism Friedrich’s ataxia
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