Paediatric Clinical Cases -A brief review , must know .

Klippel-Feil Syndrome

Clinical Examination

Short webbed neck , no neck appearance  , head on top of shoulder with restricted ROM

Spinal Examination

 Sprenge'ls deforomity

 Torticollis ,

 Scoliosis , kyphosis

 Congenital heart disease

( Risk of atlantoaxial instability )

Not to forget Neurological examination

Sprengel's deformity

 Trapezius , Rhomboids, Levator Scapulae may be absent


Pseudoarthrosis of Clavicle

Inspection

          swelling on shoulder

          mobile end , painless

          shoulder motion


       X-ray - sclerosed ends

     managent - conservative



Gunsotck Deformity

Scars

lumps of HMEs

Abduction , thumb up - clearly seen

 Measure carrying angle

 ROM

Able to reach his face or not

Instability


Treatment

Painless

 mass present posteriorly around lateral epicondyle

 Attitude - pronated

ROM - both restricted supination and loss of  full extension





Radial Head Dislocation

Posterior - always congenital

                  radius head thin , elongated , and posterior ulnar border round.

                 restriction -- extension , forearm rotation


Congenital  anterior dislocation - often associated with other congenital conditions

          Radial head rounded , deficient  capetullm and a long radius
             
            restriction - flexion and supination

Lateral Dislocation- Cubitus Valgus



Association - Ehler-Danlos syndrome

                      Arthrogryposis



Manasgement

 Conservative

 Surgery - shortening of radius

                 excision of radius head






Radioulnar Synostosis

Attitude

loss of supination and pronation




Madelung's deformity


female

b/l prominent ulnar styloid and restricted supination , DF , Radial deviation

 Wrist deviation - ulnar and volar ward

Aetiology

 Post trauma

 HME, Achondroplasia

 Chromosomal - Turner's syndrome

 Idiopathic or primary

Surgery

 age and growth remaining

 severity - deformity

severity of symptoms

 operations

        Osteotomy , Epiphysiodesis

        Improve ROM  - Sauve Kapandji

                                    Darrach

        Both wrist fusion and Ostoetomy




Trigger Thumb 

Interphalangeal joint of thumb flexed , b/l

No other anomalies

Extension limited

At base , node mobile with flexion / extension of the joint

Treatment

 Surgical release of A1 pulley

Infants - - stretching

Congenital Absence of limbs or Part of limb

 1. failure of formation

  2. failure of differentiation

  3. failure of duplication

4. overgrowth

 5. Constriction band syndrome

 6.Miscellaneous

 7.Generalized skeletal abnormailities


Failure of Formation

 Transverse

 Longitdinal
       

      Preaxial - Hypoplasia of thumb/ radius

       central - cleft of hand

     Post - axial - ulnar hypoplasia

         intercalated arrest - phocomelia


LLD

 Depends on predicted LLD at skeletal maturity

 Current LLD

   Clinical

   Radiological

       orthoroentgenoraphy

       parallel beam scanogram

       CT scanogram

     Predicted LLD at maturity

      Menalus rule of thumb

     Moseley straight line method

     Eastwood and cole method

     Paley's multiplier method

Patient perception


   how tall is child ?

  how tall are family members ?


PFFD

   Gait - Squat

   Short Femur

        Scars

        shoe raise

Knee - ACL / PCL


Leg

   Shaft of Fibula

Foot

    Size, toes , functional or not

Ankle - Lateal and medial malleolus






























































               































































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