Butler's procedure overriding 5th toe - البروفيسور فريح عوده ابوحسان
Pediatric orthopaedic diseases البروفيسور فريح ابوحسان - امراض عظام...
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Transcript of Pediatric orthopaedic diseases البروفيسور فريح ابوحسان - امراض عظام...
Freih Odeh AbuHassanFreih Odeh AbuHassan,F.R.C.S.(Eng.), F.R.C.S.(Tr.& Orth.)( g ), ( )
Professor of OrthopedicsUniversity of Jordan
1/19/2011 1Professor Freih Abuhassan -University of Jordan
Cervical SpineCervical Spine
Torticollis1/19/2011 2Professor Freih Abuhassan -
University of Jordan
ShoulderShoulder
Sprengle’s deformity
1/19/2011 3Professor Freih Abuhassan -University of Jordan
Spinep
1/19/2011 4Professor Freih Abuhassan -University of Jordan
L t d i ti t f th= Lat. deviation or curvature of the spinep
= G > Boys= Uknown cause
St t l St t l= Structural or non Structural
1/19/2011 5Professor Freih Abuhassan -University of Jordan
• Non Str ct ral• Non Structural– Poor posturePoor posture– LLD– Disc
• Structural• Structural– CONGENITALCONGENITAL– IDIOPATHIC – N.M
1/19/2011 6Professor Freih Abuhassan -University of Jordan
1/19/2011 7Professor Freih Abuhassan -University of Jordan
1/19/2011 8Professor Freih Abuhassan -University of Jordan
1/19/2011 9Professor Freih Abuhassan -University of Jordan
=Observe ---10 -20 degree=Observe ---10 -20 degree
= Brace= BraceMILWAUKEE TLSOMILWAUKEE , TLSO ,CHARLESTONCHARLESTON30 40 degree30 - 40 degree
1/19/2011 10Professor Freih Abuhassan -University of Jordan
1/19/2011 11Professor Freih Abuhassan -University of Jordan
=SurgeryPost spinal fusionp40 - 45 degree40 45 degree
1/19/2011 12Professor Freih Abuhassan -University of Jordan
1/19/2011 13Professor Freih Abuhassan -University of Jordan
Congenital Scoliosis
1/19/2011 14Professor Freih Abuhassan -University of Jordan
1/19/2011 15Professor Freih Abuhassan -University of Jordan
Congenital KyphosisCongenital Kyphosis
1/19/2011 16Professor Freih Abuhassan -University of Jordan
Brachial plexus injuryac a p e us ju y
1/19/2011 17Professor Freih Abuhassan -University of Jordan
* 2 per 1000 Live birth* 2 per 1000 Live birth* 80 - 90 % Spontanous improvep p* Increasing > birth wt.*S*Surgeryif biceps not recovered by 3 mif biceps not recovered by 3 m
1/19/2011 18Professor Freih Abuhassan -University of Jordan
1/19/2011 19Professor Freih Abuhassan -University of Jordan
Congenital Hand Deformity
1/19/2011 20Professor Freih Abuhassan -University of Jordan
1/19/2011 21Professor Freih Abuhassan -University of Jordan
1/19/2011 22Professor Freih Abuhassan -University of Jordan
1/19/2011 23Professor Freih Abuhassan -University of Jordan
1/19/2011 24Professor Freih Abuhassan -University of Jordan
Causes of DDHCauses of DDHCauses of DDHCauses of DDH
* Li t l it H* Li t l it H* Ligaments laxity : Horm.* Ligaments laxity : Horm.* Mal position : Extended Br* Mal position : Extended Br* Mal position : Extended Br.* Mal position : Extended Br.* Genetic.* Genetic. Genetic. Genetic.* Post natal.* Post natal.
1/19/2011 25Professor Freih Abuhassan -University of Jordan
Risk factors for DDHRisk factors for DDHRisk factors for DDHRisk factors for DDH
11. . FFemale emale
22. . FFamily historyamily history
FF33. . FFirst born irst born breech.breech.
44.. FFeet def. : C.Valgus.eet def. : C.Valgus.44. . FFeet def. : C.Valgus.eet def. : C.Valgus.
55. . FFull term or Premature.ull term or Premature.
66. . FFaulty habitsaulty habits
1/19/2011 26Professor Freih Abuhassan -University of Jordan
Pathology of DDH
1/19/2011 27Professor Freih Abuhassan -University of Jordan
CDHCDHCDHCDH
* Chromosomal disease : * Chromosomal disease : 4545x.x.* Malformation : Sacral agenesis* Malformation : Sacral agenesis* Malformation : Sacral agenesis.* Malformation : Sacral agenesis.* Syndromes : * Syndromes : yy
1/19/2011 28Professor Freih Abuhassan -University of Jordan
Diagnosis of DDHDiagnosis of DDHDiagnosis of DDHDiagnosis of DDH
*< *< 33m.m.-- Clunk sign of Ortolani.Clunk sign of Ortolani.
** 33 1212 monthsmonths 3 3 --1212 months.months.-- Limited abduction. Limited abduction.
S iS i -- Shortening.Shortening.* * After After 1212 months.months.
-- Limping. Limping. -- Shortening.Shortening.
1/19/2011 29Professor Freih Abuhassan -University of Jordan
Galliazzi
Professor Freih Abuhassan -University of Jordan
1/19/2011 30
1/19/2011 31Professor Freih Abuhassan -University of Jordan
1/19/2011 32Professor Freih Abuhassan -University of Jordan
Investigation for DDHInvestigation for DDHInvestigation for DDHInvestigation for DDH
# Ult d ft# Ult d ft 99 kk# Ultrasound after # Ultrasound after 99 weeks.weeks.
# X# X--ray after ray after 33--4 4 months months ## ay a teay a te 33 o t so t s-- Abduction Abduction 30 30 degree.degree.-- IR IR 15 15 degree.degree.
1/19/2011 33Professor Freih Abuhassan -University of Jordan
1/19/2011 34Professor Freih Abuhassan -University of Jordan
1/19/2011 35Professor Freih Abuhassan -University of Jordan
1/19/2011 36Professor Freih Abuhassan -University of Jordan
Poor orthosis
1/19/2011 37Professor Freih Abuhassan -University of Jordan
Flexition
1/19/2011 38Professor Freih Abuhassan -University of Jordan
1/19/2011 39Professor Freih Abuhassan -University of Jordan
LEGGLEGG CALVE’CALVE’ PERTHE’SPERTHE’SLEGG LEGG -- CALVE’ CALVE’ -- PERTHE’S PERTHE’S
AVN h d f th f= AVN head of the femur= Children bet 2 13 Y= Children bet. 2-13 Y= Presentation= PresentationPain in the groin thigh kneePain in the groin, thigh, knee
1/19/2011 40Professor Freih Abuhassan -University of Jordan
1/19/2011 41Professor Freih Abuhassan -University of Jordan
1/19/2011 42Professor Freih Abuhassan -University of Jordan
Poor orthosisPoor orthosis
Old method of treatementOld method of treatement
1/19/2011 43Professor Freih Abuhassan -University of Jordan
S C F EPIPHYSISS C F EPIPHYSIS
=Displaced med. & post=Femoral H is held by lig.
1/19/2011 44Professor Freih Abuhassan -University of Jordan
1/19/2011 45Professor Freih Abuhassan -University of Jordan
P t tiP t tiPresentation Presentation Painful hip Painful hip ------Painful knee Painful knee
Affects adolescentsAffects adolescents–– Boys are affected twice as girlsBoys are affected twice as girls–– Boys are affected twice as girlsBoys are affected twice as girls–– Bilateral in Bilateral in 3030%%–– AetiologyAetiology
Hormonal imbalanceHormonal imbalance•• Hormonal imbalanceHormonal imbalance•• TraumaTrauma
1/19/2011 46Professor Freih Abuhassan -University of Jordan
1/19/2011 47Professor Freih Abuhassan -University of Jordan
1/19/2011 48Professor Freih Abuhassan -University of Jordan
Angular deformitiesAngular deformities1/19/2011 49Professor Freih Abuhassan -
University of Jordan
Bowlegs Knock kneesBowlegs Knock knees
1/19/2011 50Professor Freih Abuhassan -University of Jordan
N l t 3 Y ldNormal up to 3 Y old
1/19/2011 51Professor Freih Abuhassan -University of Jordan
Common 3 - 6 YRESOLVE by 7 - 10 Yy
1/19/2011 52Professor Freih Abuhassan -University of Jordan
Genu
1/19/2011 53Professor Freih Abuhassan -University of Jordan
1/19/2011 54Professor Freih Abuhassan -University of Jordan
Poor orthosis
1/19/2011 55Professor Freih Abuhassan -University of Jordan
No relation between bowlegs & O.ANo relation between bowlegs & O.A1/19/2011 56Professor Freih Abuhassan -
University of Jordan
S U il tSevere Unilat.
Family ShortstatureHistory stature
1/19/2011 57Professor Freih Abuhassan -University of Jordan
1/19/2011 58Professor Freih Abuhassan -University of Jordan
Intoe gaitIntoe gait
1/19/2011 59Professor Freih Abuhassan -University of Jordan
Metatarsus Metatarsus adductusadductus1/19/2011 60Professor Freih Abuhassan -
University of Jordan
1/19/2011 61Professor Freih Abuhassan -University of Jordan
1/19/2011 62Professor Freih Abuhassan -University of Jordan
1/19/2011 63Professor Freih Abuhassan -University of Jordan
CTEVCTEV
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•• Incidence: Incidence: 11 in in 10001000M l t f l tiM l t f l ti 22 11•• Male to female ratio Male to female ratio 22::11Bil t l iBil t l i 11//33 ff•• Bilateral in Bilateral in 11//3 3 of casesof cases
1/19/2011 65Professor Freih Abuhassan -University of Jordan
1/19/2011 66Professor Freih Abuhassan -University of Jordan
Flat FeetFlat Feet
No Longitudinal arch of the footNo Longitudinal arch of the footgg1/19/2011 67Professor Freih Abuhassan -
University of Jordan
1/19/2011 68Professor Freih Abuhassan -University of Jordan
Historical treatmentHistorical treatment
1/19/2011 69Professor Freih Abuhassan -University of Jordan
1/19/2011 70Professor Freih Abuhassan -
University of Jordan
ProspectiveProspective controlled Professor Freih Abuhassan -
University of Jordan
study 1/19/2011 71
1/19/2011 72Professor Freih Abuhassan -University of Jordan
Normal child needsnormal shoes
1/19/2011 73Professor Freih Abuhassan -University of Jordan
Special shoes or inserts fonly for abnormal
hild N M dichildren e.g N.M. dis.
1/19/2011 74Professor Freih Abuhassan -University of Jordan
1/19/2011 75Professor Freih Abuhassan -University of Jordan