Childhood Orthopaedic conditions:Dilemmas BOTA 2015

Robin W Paton FRCS(Orthopaedic) PhDVisiting Professor, UCLAN

Honorary Senior Lecturer, University of Manchester

Congenital Talipes Equinovarus (CTEV)

CTEV

• 1 to 2 per 1000 births• More common in males• Unilateral > bilateral• Exclude spinal & syndromic causes

C: cavusA: adductusV: VarusE: equinus

Bilateral CTEV

Congenital talipes Calcaneo-valgus (CTCV)

CTCV

• Rarer than CTEV• Associations:

pathological DDHfibular hemi-meliaspinal disordersvertical talus

Deformity: foot towards shin

Pes cavus (including plantaris deformity)

Secondary causes

brain: CP/ Friedrich ataxia

spine: cord tetherdiastematomyliapoliospina bifida

Peripheral: HSMNmuscular dystrophies

Trauma: compartment syndrome

burns

Other: CTEV (iatrogenic)Duchenne’s MD

Pes cavus: deformity

Pes cavus

HMSN (Charcot Marie Tooth)

Pathology: autosomal dominant & recessive inheritanceautosomal dominant form - Chr-17myelination protein 22 abnormal

Incidence: 1:2500

HSMN I : presents earlierHSMN 2: axonal form

Problem: progressive deformityPB/ TA/ weakIntrinsic ms. Hands/feet wasted

Pes Planus

Secondary Types

Flexible types:

Hyper laxity Marfans syndromeEhlos Danlos syndrome

Rigid types:tarsal coalitionvertical talusJCAosteochondrosis

Tarsal coalition: Calcaneo-navicular bar

Cerebral palsy

Non progressive, brain origin, impaired motor function, presenting < 2 years of age.

Incidence: 1:400

Pre-natal: maternal infectionalcohol/ drugscongenital malformation brain

Perinatal: birth trauma/ asphyxia (10%)Low birth weight/ <36 gestationNeonatal jaundice

Postnatal: cerebral haemorrhageNAImeningitis

Classification

• Anatomical:hemiplegiadiplegiafour limb involvementtotal body involvement

• Physiological:spastic (UMN) 60%athetoid (basal ganglia) 20%ataxic (cerebellar)

Cerebral Palsy

Walking prognosis:

• If can sit independently by 2 years• 100% hemiplegia• 66% spastic four limb involvement• 0% TBI

Slipped Upper Femoral Epiphysis (SUFE/SCFE)

Epidemiology

• 1:50,000, > male, black > white

• 11 to 15 years of age

• Vulnerable epiphysis:hormonal: hypothyroidism

(<25 percentile) growth hormone

renalradiation

• Mechanical:traumaobesity (> 80th. Percentile)

Slipped Upper Femoral Epiphysis (SUFE)

Clinical presentation:Symptoms:

• Limp• Often no hip pain• Pain radiating to knee

Signs:

• Limited internal rotation of the hip• Limited abduction / flexion of the hip• Foot in external rotation• Unable to weight bear (Loder positive)

Case 1

18 month old female

Case 1

Age 6 years

Case 28 year old female

Case 2

Case 2:

20 months post operatively

Case 3

13 year old male

Case 5

• 1.5 year old female

Case 5

Post operative 3.5 year old

Thank you

Case 1

15 year old male

Previous surgery aged 18 months right hip