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
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
Comments
Post a Comment