D ilemmas BOTA 2015 Robin W Paton FRCSOrthopaedic PhD Visiting Professor UCLAN Honorary Senior Lecturer University of Manchester Congenital Talipes Equinovarus CTEV CTEV 1 to 2 per 1000 births ID: 776612
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Childhood Orthopaedic conditions:Dilemmas BOTA 2015
Robin W Paton FRCS(Orthopaedic) PhD
Visiting Professor, UCLAN
Honorary Senior Lecturer, University of Manchester
Slide2Congenital Talipes Equinovarus (CTEV)
CTEV
1 to 2 per 1000 birthsMore common in malesUnilateral > bilateralExclude spinal & syndromic causesC: cavusA: adductusV: VarusE: equinus
Bilateral CTEV
Slide3Congenital talipes Calcaneo-valgus (CTCV)
CTCV
Rarer than CTEVAssociations: pathological DDH fibular hemi-melia spinal disorders vertical talus
Deformity: foot towards shin
Slide4Pes cavus (including plantaris deformity)
Secondary causes
brain: CP/ Friedrich ataxia spine: cord tether diastematomylia polio spina bifida Peripheral: HSMN muscular dystrophiesTrauma: compartment syndrome burnsOther: CTEV (iatrogenic) Duchenne’s MD
Pes cavus: deformity
Slide5Pes cavus
HMSN (Charcot Marie Tooth)
Pathology: autosomal dominant & recessive inheritanceautosomal dominant form - Chr-17myelination protein 22 abnormalIncidence: 1:2500HSMN I : presents earlierHSMN 2: axonal formProblem: progressive deformity PB/ TA/ weak Intrinsic ms. Hands/feet wasted
Slide6Pes Planus
Secondary Types
Flexible types: Hyper laxity Marfans syndrome Ehlos Danlos syndromeRigid types: tarsal coalition vertical talus JCA osteochondrosis
Tarsal coalition: Calcaneo-navicular bar
Slide7Cerebral palsy
Non progressive, brain origin, impaired motor function, presenting < 2 years of age.Incidence: 1:400Pre-natal: maternal infection alcohol/ drugs congenital malformation brainPerinatal: birth trauma/ asphyxia (10%) Low birth weight/ <36 gestation Neonatal jaundicePostnatal: cerebral haemorrhage NAI meningitis
Classification
Anatomical:
hemiplegia
diplegia
four limb involvement
total body involvement
Physiological:
spastic (UMN) 60%
athetoid
(basal ganglia) 20%
ataxic (cerebellar)
Slide8Cerebral Palsy
Walking prognosis:If can sit independently by 2 years100% hemiplegia66% spastic four limb involvement0% TBI
Slide9Slipped Upper Femoral Epiphysis (SUFE/SCFE)
Epidemiology1:50,000, > male, black > white11 to 15 years of ageVulnerable epiphysis: hormonal: hypothyroidism (<25 percentile) growth hormone renal radiationMechanical: trauma obesity (> 80th. Percentile)
Slide10Slipped Upper Femoral Epiphysis (SUFE)
Clinical presentation:Symptoms:LimpOften no hip painPain radiating to kneeSigns:Limited internal rotation of the hipLimited abduction / flexion of the hipFoot in external rotationUnable to weight bear (Loder positive)
Slide11Case 1
18 month old female
Slide12Case 1
Age 6 years
Slide13Case 28 year old female
Slide14Case 2
Slide15Case 2:20 months post operatively
Slide16Case 3
13 year old male
Slide17Case 5
1.5 year old female
Slide18Case 5
Post operative 3.5 year old
Slide19Thank you
Slide20Case 1
15 year old malePrevious surgery aged 18 months right hip