This document provides information on various types of splints used to treat developmental dysplasia of the hip (DDH), including:
- The Pavlik harness, which places hips in flexion and allows abduction, with indications for its use in neonates and infants up to 1 year old.
- The Ilfeld/Craig splint, which positions hips in abduction and external rotation.
- The Frejka pillow and triple diapers, which are no longer recommended due to risk of avascular necrosis.
- The von Rosen splint, which positions hips in 90 degrees flexion and 60-70 abduction with a reported 95% success rate and low risk of complications.
This document discusses shoulder instability, including definitions, anatomy, evaluation, and treatment. It defines instability as the inability to maintain the humeral head in the glenoid fossa, ranging from dislocation to laxity. Static stabilizers include the labrum and ligaments, while dynamic stabilizers are the rotator cuff and scapulothoracic muscles. Evaluation involves history, exam, and imaging to classify instability by direction, degree, and etiology. Treatment depends on classification but may include immobilization, rehabilitation, or surgical repair of labral tears or bone defects.
This document discusses radial club hand, which is a congenital musculoskeletal anomaly caused by failed development along the radial border of the upper extremity. It presents the embryology, classification systems, clinical features, treatment recommendations, and surgical techniques for radial club hand. Specifically, it describes the deficient muscles, skeletal abnormalities including absent radius, neurovascular anomalies, and treatment approaches such as splinting, casting, tendon transfers, centralization of the carpus, and bilobed flaps procedures.
The document discusses the history and development of elastic stable intramedullary nailing (ESIN) for fractures in children. It describes early techniques using rigid pins and wires, and the development of the modern ESIN method in the 1980s using pre-bent titanium nails inserted from opposite sides of the bone for axial, lateral, and rotational stability. Key aspects of ESIN technique are outlined, including nail sizing, insertion points, pre-bending, and final positioning to stabilize fractures while minimizing soft tissue injury and allowing callus formation. Risks and special considerations for different bone fractures are also mentioned.
This document discusses congenital vertical talus (CVT), a rare foot deformity. It begins by defining CVT and providing background information. It then describes the anatomy and pathoanatomy of CVT. Key points include that CVT results in an almost vertical talus bone and rigid flatfoot deformity. Treatment involves serial casting and manipulation to prepare for surgery, with the goal of restoring normal anatomical relationships in the foot. Surgical techniques described include open reduction and percutaneous fixation of the talonavicular joint with K-wires. Complications of surgery can include wound issues and stiffness.
This document provides an overview of arthrogryposis multiplex congenita (AMC), including:
1) A definition of AMC as a nonprogressive condition characterized by multiple joint contractures present at birth involving at least two body regions.
2) A discussion of classification systems and the etiology, which is usually absence of fetal movement leading to contractures.
3) Details on clinical features including common joint involvement in the upper and lower limbs, classification of distal arthrogryposis types, and other arthrogryposis conditions.
Over the past decade, technology and research have greatly expanded the functionality and aesthetics of prosthetic feet. Today, amputees have a wide array of feet from which to choose. Various models are designed for activities ranging from walking, dancing and running to cycling, golfing, swimming and even snow skiing.
This document provides an overview of hallux valgus, including its anatomy, causes, symptoms, diagnosis, and treatment options. Key points include:
- Hallux valgus is a lateral deviation of the great toe and medial deviation of the first metatarsal. It can cause pain over the bunion.
- Risk factors include heredity, footwear, ligament laxity, and pes planus. Diagnosis involves examining range of motion, deformity, and taking x-rays to measure angles.
- Treatment progresses from footwear modifications and stretching to various surgical procedures depending on severity, including distal soft tissue procedures, osteotomies, and joint fusion or replacement in severe cases.
This document provides an overview of hemiarthroplasty, which involves replacing the femoral head with a prosthesis while retaining the natural acetabulum. It discusses the history and types of prostheses used in hemiarthroplasty. The indications, surgical procedure, postoperative care, and possible complications of hemiarthroplasty are described. A case example of a 78-year-old female undergoing cemented bipolar hemiarthroplasty for a fractured neck of femur is presented.
This document discusses shoulder instability, including definitions, anatomy, evaluation, and treatment. It defines instability as the inability to maintain the humeral head in the glenoid fossa, ranging from dislocation to laxity. Static stabilizers include the labrum and ligaments, while dynamic stabilizers are the rotator cuff and scapulothoracic muscles. Evaluation involves history, exam, and imaging to classify instability by direction, degree, and etiology. Treatment depends on classification but may include immobilization, rehabilitation, or surgical repair of labral tears or bone defects.
This document discusses radial club hand, which is a congenital musculoskeletal anomaly caused by failed development along the radial border of the upper extremity. It presents the embryology, classification systems, clinical features, treatment recommendations, and surgical techniques for radial club hand. Specifically, it describes the deficient muscles, skeletal abnormalities including absent radius, neurovascular anomalies, and treatment approaches such as splinting, casting, tendon transfers, centralization of the carpus, and bilobed flaps procedures.
The document discusses the history and development of elastic stable intramedullary nailing (ESIN) for fractures in children. It describes early techniques using rigid pins and wires, and the development of the modern ESIN method in the 1980s using pre-bent titanium nails inserted from opposite sides of the bone for axial, lateral, and rotational stability. Key aspects of ESIN technique are outlined, including nail sizing, insertion points, pre-bending, and final positioning to stabilize fractures while minimizing soft tissue injury and allowing callus formation. Risks and special considerations for different bone fractures are also mentioned.
This document discusses congenital vertical talus (CVT), a rare foot deformity. It begins by defining CVT and providing background information. It then describes the anatomy and pathoanatomy of CVT. Key points include that CVT results in an almost vertical talus bone and rigid flatfoot deformity. Treatment involves serial casting and manipulation to prepare for surgery, with the goal of restoring normal anatomical relationships in the foot. Surgical techniques described include open reduction and percutaneous fixation of the talonavicular joint with K-wires. Complications of surgery can include wound issues and stiffness.
This document provides an overview of arthrogryposis multiplex congenita (AMC), including:
1) A definition of AMC as a nonprogressive condition characterized by multiple joint contractures present at birth involving at least two body regions.
2) A discussion of classification systems and the etiology, which is usually absence of fetal movement leading to contractures.
3) Details on clinical features including common joint involvement in the upper and lower limbs, classification of distal arthrogryposis types, and other arthrogryposis conditions.
Over the past decade, technology and research have greatly expanded the functionality and aesthetics of prosthetic feet. Today, amputees have a wide array of feet from which to choose. Various models are designed for activities ranging from walking, dancing and running to cycling, golfing, swimming and even snow skiing.
This document provides an overview of hallux valgus, including its anatomy, causes, symptoms, diagnosis, and treatment options. Key points include:
- Hallux valgus is a lateral deviation of the great toe and medial deviation of the first metatarsal. It can cause pain over the bunion.
- Risk factors include heredity, footwear, ligament laxity, and pes planus. Diagnosis involves examining range of motion, deformity, and taking x-rays to measure angles.
- Treatment progresses from footwear modifications and stretching to various surgical procedures depending on severity, including distal soft tissue procedures, osteotomies, and joint fusion or replacement in severe cases.
This document provides an overview of hemiarthroplasty, which involves replacing the femoral head with a prosthesis while retaining the natural acetabulum. It discusses the history and types of prostheses used in hemiarthroplasty. The indications, surgical procedure, postoperative care, and possible complications of hemiarthroplasty are described. A case example of a 78-year-old female undergoing cemented bipolar hemiarthroplasty for a fractured neck of femur is presented.
This document discusses the physiotherapy management of lower limb deformities resulting from polio. It covers strengthening weakened muscles, stretching shortened muscles, use of orthotics and splints, gait training, surgical correction of deformities if conservative treatment is not effective, and physiotherapy after surgeries like tendon transfers. Specific deformities around the hip, knee and ankle are described along with their causes and management approaches. Surgical options discussed include soft tissue releases, osteotomies, arthrodesis and tendon transfers. The overall goal of treatment is to improve strength, prevent deformities, achieve functional mobility and independence.
Jose Austine- Orthopaedic evaluation of cerebral palsyJose Austine
This document provides an overview of cerebral palsy (CP), including its history, definition, classification, etiology, assessment, and orthopedic evaluation. CP is caused by non-progressive brain lesions early in development that result in abnormal muscle tone and movement. It is important to correctly classify a patient's CP based on their motor function and movement disorder. A thorough orthopedic evaluation includes assessing medical history, physical exam of muscle tone and strength, contractures, deformities, and gait. Gait analysis through observation and in a lab helps document the patient's movement and plan for surgical interventions. The goal of evaluation and classification is to guide appropriate treatment and management of CP.
This document summarizes the management of scaphoid nonunion bone fractures. It discusses the causes, symptoms, diagnosis and various treatment options for scaphoid nonunion, including non-operative treatments like electrical stimulation and various surgical procedures like bone grafting, vascularized bone grafts, proximal row carpectomy, scaphoid excision and wrist fusion. Key surgical techniques for bone grafting like the Russe, Fernandez and Stark methods are outlined. The goal of treatment is to relieve pain, correct deformity, achieve bone union and prevent the progression to wrist arthritis.
- Total hip arthroplasty involves replacing the hip joint with prosthetic components. It is commonly performed for arthritis and other hip diseases.
- The procedure has evolved significantly since the early attempts in the 1900s using materials like gold foil and glass. Modern THA designs aim to reduce friction and stress on the implants.
- Key considerations in THA include restoring normal hip biomechanics, maximizing stability while allowing a full range of motion, and minimizing wear on the prosthetic components over many years. Proper positioning and design of the femoral stem and acetabular cup are important.
These slides contains information regarding fractures and dislocations of spine, various classifications of fracture spine, approach to fractures of spine, criteria for surgical or conservative management of patient, various named fractures involving cervical spine and brief description of spine fracture dislocation.
Osteotomies around the hip are surgical procedures used to correct biomechanical alignment and load transmission across the hip joint. They involve removing a portion of bone. The goals are to improve femoral head coverage, containment, motion, relieve pain, and correct leg length discrepancies. Different types of osteotomies target the proximal femur or pelvis. Proximal femoral osteotomies are classified based on anatomical location and degree of displacement. Pelvic osteotomies aim to redirect the acetabulum and include Salter, Sutherland, Steel/Tonnis, and Ganz/Bernese procedures. Key considerations for each procedure include indications, approach, osteotomy cuts made, advantages/disadv
The patellar tendon bearing prosthesis was invented in the 1950s as an improvement over the plug fit socket. It distributes pressure over specific areas of the residual limb that are better able to tolerate pressure, such as the patellar tendon, muscles, and bone. Areas with nerves, blood vessels, and less tissue are relieved of pressure. The prosthesis has a socket, foot assembly such as a SACH foot, shank to connect them, and a suspension like a strap to hold it in place. It provides control, weight bearing ability, and acceptance for amputees.
This document summarizes the epidemiology, anatomy, mechanisms of injury, classification, treatment approaches, and complications for radial head fractures. Some key points:
- Radial head fractures account for 4% of all fractures and 30% of elbow fractures. They are rare in children.
- The radial head provides stability to the elbow joint and transmits 50-60% of the load across the elbow.
- Fractures are typically classified using the Mason classification system based on displacement.
- Treatment depends on fracture type but may include non-operative management, open reduction and internal fixation, radial head replacement, or radial head excision.
- Complications can include nerve injuries, stiffness, hardware issues, and recurrent
The document discusses functional casting and bracing techniques used to treat fractures while allowing restricted movement. It describes the principles of functional casting which include maintaining stability and reduction while promoting blood flow and muscle contraction to encourage healing. Specific casts for treating fractures of the humerus, tibia, femur and hip are outlined, including the Sarmiento cast and hip spica cast. The timing, positioning and complications of different casts are summarized. Functional casting aims to continue function during fracture healing to accelerate rehabilitation.
The document discusses developmental dysplasia of the hip (DDH), including: definitions; clinical detection from birth to 6 months using tests like Ortolani's and Barlow's; treatment from birth to 6 months using a Pavlik harness or closed reduction and hip spica casting; and treatment from 6 to 18 months also using closed reduction and hip spica casting, with the goal of obtaining and maintaining reduction without damaging the femoral head. Obstacles to reduction like hypertrophic soft tissues are also mentioned.
This document provides an overview of the history and types of spinal orthoses. It begins with a brief history of spinal orthotic use dating back to ancient times. It then describes various types of cervical, cervicothoracic, and thoracolumbosacral orthoses, including their indications, biomechanics, design features, and how they control spinal motion. Examples of custom-fit and prefabricated options are discussed. The document concludes with descriptions of specific orthosis designs like the halo, SOMI, and TLSO and how they immobilize different spinal regions.
This document discusses different types of ankle fractures and dislocations, including isolated malleolar fractures, bimalleolar fractures, trimalleolar fractures, syndesmotic injuries, and dislocations. It provides details on incidence, classification systems like the Weber classification for lateral malleolar fractures, treatment approaches such as casting, open reduction and internal fixation (ORIF), and postoperative weight bearing status. Specific fractures like posterior malleolar fractures, Bosworth fracture dislocations, pilon/plafond fractures, and fractures in diabetics are also covered.
Pathology and management of recurrent shoulder dislocationAbdullahi Sanusi
This document discusses the pathology and management of recurrent shoulder dislocations. It begins with an introduction covering the epidemiology and risk factors for recurrence. It then covers the surgical anatomy of the shoulder joint and stabilizing structures. The main pathological findings associated with recurrence include Bankart lesions, Hill-Sachs lesions, and ligamentous laxity. Treatment involves both surgical and non-surgical options depending on the individual case. The most common surgical procedures are Bankart repair and Latarjet procedure. Post-operative rehabilitation is important for recovery. Recurrence rates can be reduced with proper identification and treatment of the underlying causes.
This document discusses the anatomy and physiology of the thoracolumbar spine and classifies different types of thoracolumbar spine injuries. It describes the anatomy of the spinal cord, blood supply, and biomechanics of the thoracic and lumbar regions. Various injury mechanisms are outlined including compression fractures, burst fractures, and chance fractures. Imaging techniques like x-rays, CT, and MRI are discussed. The Denis three-column theory and TLICS classification system are introduced to classify injuries as stable or unstable. Non-operative and surgical treatment options are provided based on the injury classification.
Perthes disease, also known as Legg-Calve-Perthes disease, is caused by impaired blood flow in the femoral head that leads to bone death in children aged 3-12 years old, causing deformity of the femoral head; it is more common in boys and whites and symptoms include limping and hip pain that varies depending on the stage of bone regeneration. Genetic factors and growth abnormalities play a role in its development.
This document discusses the clinical examination of the hip joint, including inspection, palpation, range of motion testing, special tests, and gait analysis. Key examination findings are described for various hip pathologies like developmental dysplasia of the hip, arthritis, fractures, and dislocations. Landmark bony anatomy, compensations, and fallacies of certain examination maneuvers are also outlined.
Collapse of medial longitudinal arch, with the entire sole of the foot coming into complete or near-complete contact with the ground.
Books Refered :
Text Book Of ANATOMY - Vishram Singh
Joint Structure And Function – Cynthia Norkin
Therapeutic Exrercise – Carolyn Kisner
Orthopaedic Physical Assessment – Magee
Orthopaedic Medicine – L. Ombregt
Campbell’s Operative Orthopaedics
The document discusses upper limb orthosis, devices used to modify the structural and functional characteristics of the upper limb. It covers the objectives of upper limb orthosis including protection, correction, and assistance. It also discusses the classification, biomechanics, principles, and assessment of upper limb orthosis and provides descriptions and examples of specific upper limb orthoses including shoulder orthoses, arm slings, arm abduction orthoses, elbow/forearm/wrist orthoses, and elbow or wrist mobilization orthoses.
This document provides information on congenital dislocation of the hip (CDH) and developmental dysplasia of the hip (DDH). It discusses the causes, signs, symptoms, examination findings, treatment options including orthotic interventions like the Pavlik harness and Frejka pillow. CDH occurs at or shortly after birth while DDH develops during the embryonic, fetal or infantile stage. Treatment aims to achieve and maintain reduction of the femoral head into the acetabulum through splinting or bracing until the hip joint stabilizes.
Developmental dysplasia of the hip (DDH) is a spectrum of hip disorders that can occur from conception to skeletal maturity. It most commonly affects females and risk factors include genetic predisposition, breech positioning, and hormonal influences. Clinical features include limb asymmetry and limited hip movement. Diagnosis involves clinical tests and imaging like ultrasound or X-rays. Management depends on age, with splinting often used for young infants and closed or open reduction with spica casting for older children. Complications can include limping, osteoarthritis, or avascular necrosis if left untreated.
This document discusses the physiotherapy management of lower limb deformities resulting from polio. It covers strengthening weakened muscles, stretching shortened muscles, use of orthotics and splints, gait training, surgical correction of deformities if conservative treatment is not effective, and physiotherapy after surgeries like tendon transfers. Specific deformities around the hip, knee and ankle are described along with their causes and management approaches. Surgical options discussed include soft tissue releases, osteotomies, arthrodesis and tendon transfers. The overall goal of treatment is to improve strength, prevent deformities, achieve functional mobility and independence.
Jose Austine- Orthopaedic evaluation of cerebral palsyJose Austine
This document provides an overview of cerebral palsy (CP), including its history, definition, classification, etiology, assessment, and orthopedic evaluation. CP is caused by non-progressive brain lesions early in development that result in abnormal muscle tone and movement. It is important to correctly classify a patient's CP based on their motor function and movement disorder. A thorough orthopedic evaluation includes assessing medical history, physical exam of muscle tone and strength, contractures, deformities, and gait. Gait analysis through observation and in a lab helps document the patient's movement and plan for surgical interventions. The goal of evaluation and classification is to guide appropriate treatment and management of CP.
This document summarizes the management of scaphoid nonunion bone fractures. It discusses the causes, symptoms, diagnosis and various treatment options for scaphoid nonunion, including non-operative treatments like electrical stimulation and various surgical procedures like bone grafting, vascularized bone grafts, proximal row carpectomy, scaphoid excision and wrist fusion. Key surgical techniques for bone grafting like the Russe, Fernandez and Stark methods are outlined. The goal of treatment is to relieve pain, correct deformity, achieve bone union and prevent the progression to wrist arthritis.
- Total hip arthroplasty involves replacing the hip joint with prosthetic components. It is commonly performed for arthritis and other hip diseases.
- The procedure has evolved significantly since the early attempts in the 1900s using materials like gold foil and glass. Modern THA designs aim to reduce friction and stress on the implants.
- Key considerations in THA include restoring normal hip biomechanics, maximizing stability while allowing a full range of motion, and minimizing wear on the prosthetic components over many years. Proper positioning and design of the femoral stem and acetabular cup are important.
These slides contains information regarding fractures and dislocations of spine, various classifications of fracture spine, approach to fractures of spine, criteria for surgical or conservative management of patient, various named fractures involving cervical spine and brief description of spine fracture dislocation.
Osteotomies around the hip are surgical procedures used to correct biomechanical alignment and load transmission across the hip joint. They involve removing a portion of bone. The goals are to improve femoral head coverage, containment, motion, relieve pain, and correct leg length discrepancies. Different types of osteotomies target the proximal femur or pelvis. Proximal femoral osteotomies are classified based on anatomical location and degree of displacement. Pelvic osteotomies aim to redirect the acetabulum and include Salter, Sutherland, Steel/Tonnis, and Ganz/Bernese procedures. Key considerations for each procedure include indications, approach, osteotomy cuts made, advantages/disadv
The patellar tendon bearing prosthesis was invented in the 1950s as an improvement over the plug fit socket. It distributes pressure over specific areas of the residual limb that are better able to tolerate pressure, such as the patellar tendon, muscles, and bone. Areas with nerves, blood vessels, and less tissue are relieved of pressure. The prosthesis has a socket, foot assembly such as a SACH foot, shank to connect them, and a suspension like a strap to hold it in place. It provides control, weight bearing ability, and acceptance for amputees.
This document summarizes the epidemiology, anatomy, mechanisms of injury, classification, treatment approaches, and complications for radial head fractures. Some key points:
- Radial head fractures account for 4% of all fractures and 30% of elbow fractures. They are rare in children.
- The radial head provides stability to the elbow joint and transmits 50-60% of the load across the elbow.
- Fractures are typically classified using the Mason classification system based on displacement.
- Treatment depends on fracture type but may include non-operative management, open reduction and internal fixation, radial head replacement, or radial head excision.
- Complications can include nerve injuries, stiffness, hardware issues, and recurrent
The document discusses functional casting and bracing techniques used to treat fractures while allowing restricted movement. It describes the principles of functional casting which include maintaining stability and reduction while promoting blood flow and muscle contraction to encourage healing. Specific casts for treating fractures of the humerus, tibia, femur and hip are outlined, including the Sarmiento cast and hip spica cast. The timing, positioning and complications of different casts are summarized. Functional casting aims to continue function during fracture healing to accelerate rehabilitation.
The document discusses developmental dysplasia of the hip (DDH), including: definitions; clinical detection from birth to 6 months using tests like Ortolani's and Barlow's; treatment from birth to 6 months using a Pavlik harness or closed reduction and hip spica casting; and treatment from 6 to 18 months also using closed reduction and hip spica casting, with the goal of obtaining and maintaining reduction without damaging the femoral head. Obstacles to reduction like hypertrophic soft tissues are also mentioned.
This document provides an overview of the history and types of spinal orthoses. It begins with a brief history of spinal orthotic use dating back to ancient times. It then describes various types of cervical, cervicothoracic, and thoracolumbosacral orthoses, including their indications, biomechanics, design features, and how they control spinal motion. Examples of custom-fit and prefabricated options are discussed. The document concludes with descriptions of specific orthosis designs like the halo, SOMI, and TLSO and how they immobilize different spinal regions.
This document discusses different types of ankle fractures and dislocations, including isolated malleolar fractures, bimalleolar fractures, trimalleolar fractures, syndesmotic injuries, and dislocations. It provides details on incidence, classification systems like the Weber classification for lateral malleolar fractures, treatment approaches such as casting, open reduction and internal fixation (ORIF), and postoperative weight bearing status. Specific fractures like posterior malleolar fractures, Bosworth fracture dislocations, pilon/plafond fractures, and fractures in diabetics are also covered.
Pathology and management of recurrent shoulder dislocationAbdullahi Sanusi
This document discusses the pathology and management of recurrent shoulder dislocations. It begins with an introduction covering the epidemiology and risk factors for recurrence. It then covers the surgical anatomy of the shoulder joint and stabilizing structures. The main pathological findings associated with recurrence include Bankart lesions, Hill-Sachs lesions, and ligamentous laxity. Treatment involves both surgical and non-surgical options depending on the individual case. The most common surgical procedures are Bankart repair and Latarjet procedure. Post-operative rehabilitation is important for recovery. Recurrence rates can be reduced with proper identification and treatment of the underlying causes.
This document discusses the anatomy and physiology of the thoracolumbar spine and classifies different types of thoracolumbar spine injuries. It describes the anatomy of the spinal cord, blood supply, and biomechanics of the thoracic and lumbar regions. Various injury mechanisms are outlined including compression fractures, burst fractures, and chance fractures. Imaging techniques like x-rays, CT, and MRI are discussed. The Denis three-column theory and TLICS classification system are introduced to classify injuries as stable or unstable. Non-operative and surgical treatment options are provided based on the injury classification.
Perthes disease, also known as Legg-Calve-Perthes disease, is caused by impaired blood flow in the femoral head that leads to bone death in children aged 3-12 years old, causing deformity of the femoral head; it is more common in boys and whites and symptoms include limping and hip pain that varies depending on the stage of bone regeneration. Genetic factors and growth abnormalities play a role in its development.
This document discusses the clinical examination of the hip joint, including inspection, palpation, range of motion testing, special tests, and gait analysis. Key examination findings are described for various hip pathologies like developmental dysplasia of the hip, arthritis, fractures, and dislocations. Landmark bony anatomy, compensations, and fallacies of certain examination maneuvers are also outlined.
Collapse of medial longitudinal arch, with the entire sole of the foot coming into complete or near-complete contact with the ground.
Books Refered :
Text Book Of ANATOMY - Vishram Singh
Joint Structure And Function – Cynthia Norkin
Therapeutic Exrercise – Carolyn Kisner
Orthopaedic Physical Assessment – Magee
Orthopaedic Medicine – L. Ombregt
Campbell’s Operative Orthopaedics
The document discusses upper limb orthosis, devices used to modify the structural and functional characteristics of the upper limb. It covers the objectives of upper limb orthosis including protection, correction, and assistance. It also discusses the classification, biomechanics, principles, and assessment of upper limb orthosis and provides descriptions and examples of specific upper limb orthoses including shoulder orthoses, arm slings, arm abduction orthoses, elbow/forearm/wrist orthoses, and elbow or wrist mobilization orthoses.
This document provides information on congenital dislocation of the hip (CDH) and developmental dysplasia of the hip (DDH). It discusses the causes, signs, symptoms, examination findings, treatment options including orthotic interventions like the Pavlik harness and Frejka pillow. CDH occurs at or shortly after birth while DDH develops during the embryonic, fetal or infantile stage. Treatment aims to achieve and maintain reduction of the femoral head into the acetabulum through splinting or bracing until the hip joint stabilizes.
Developmental dysplasia of the hip (DDH) is a spectrum of hip disorders that can occur from conception to skeletal maturity. It most commonly affects females and risk factors include genetic predisposition, breech positioning, and hormonal influences. Clinical features include limb asymmetry and limited hip movement. Diagnosis involves clinical tests and imaging like ultrasound or X-rays. Management depends on age, with splinting often used for young infants and closed or open reduction with spica casting for older children. Complications can include limping, osteoarthritis, or avascular necrosis if left untreated.
This document discusses developmental dysplasia of the hip (DDH), including its causes, types, diagnosis, and treatment approaches. DDH encompasses a spectrum of hip abnormalities from instability to dislocation. It can be syndromic, associated with other conditions, or non-syndromic. Diagnosis involves physical exams and ultrasound to assess hip stability and anatomy. Treatment depends on age and severity, ranging from harnessing like Pavlik to manage instability, to closed or open reduction surgery for older children with dislocation. The goal is stable, concentric reduction and correction of any acetabular dysplasia.
This document discusses developmental dysplasia of the hip (DDH), formerly known as congenital dislocation of the hip. DDH is a spectrum of pathology in the development of the immature hip joint, ranging from mild dysplasia to frank dislocation. Risk factors include increased joint laxity, female sex, breech presentation, tight intrauterine space, and family history. Diagnosis involves physical examination maneuvers in infants and imaging like ultrasound and x-rays in older children. Treatment depends on age, with harnesses and casting for young infants and open reduction and casting for older children. Complications can include avascular necrosis, redislocation, and residual deformities.
Developmental dysplasia of the hip (DDH) is a spectrum of abnormalities in hip development ranging from mild acetabular dysplasia to dislocated hips. Girls are affected six times more often than boys, and in one third of cases both hips are affected. Abnormalities may not be noticed until the child begins to walk and presents with a limp or waddling gait. Diagnosis involves clinical examination and ultrasound or X-ray imaging to assess hip stability and anatomy. Treatment depends on age and severity, ranging from splinting in flexion and abduction for mild cases to closed or open reduction and hip immobilization in a spica cast for more severe or persistent dislocations.
This document discusses developmental dysplasia of the hip (DDH). It describes the signs and symptoms, risk factors, diagnosis, and treatment approaches for different age groups. For newborns under 6 months, treatment focuses on stabilization or reduction of the hip using the Pavlik harness. For infants 6-18 months, closed or open reduction is often needed if the hip is dislocated due to soft tissue contractures. Preliminary traction may help reduce risks of osteonecrosis during reduction in this age group.
This document provides information on developmental dysplasia of the hip (DDH). It discusses the definition, causes, incidence, clinical findings, pathology, diagnosis through imaging like ultrasound and X-rays, and treatment approaches for different age groups from newborns to older children. Key tests like Barlow, Ortolani and imaging classifications including Graf are outlined. The main treatment mentioned is use of Pavlik harness for young infants, while older infants may require traction and closed reduction or open reduction if closed fails.
This document summarizes a seminar on traction in orthopaedics. It discusses different types of traction including fixed traction using Thomas splints or halo-pelvic traction, as well as sliding traction. Skin traction is described using various methods like Buck's traction or Bryant's traction. Complications of halo-pelvic traction include cranial screw issues, pelvic rod problems, or neurological complications. The purpose of traction is to regain bone length and alignment, reduce fractures, relieve muscle spasms and pressure on nerves to aid in healing.
Physiotherapy in Developmental Dysplasia of HipSreeraj S R
This document provides information on developmental dysplasia of the hip (DDH), including definition, risk factors, incidence, etiology, physical examination findings, conservative treatment options like the Pavlik harness, and complications. DDH is a partial or complete displacement of the femoral head from the acetabular cavity present since birth. Risk factors include breech presentation and family history. Treatment for infants under 6 months often involves applying a Pavlik harness to maintain the hip in flexion and abduction to facilitate reduction of the femoral head into the acetabulum. Complications of harness treatment can include femoral nerve palsy, skin breakdown, and bone necrosis.
Club foot, also known as talipes, is a deformity present at birth where the foot is turned inward at the ankle and points down. It occurs in about 1 in 1000 births and can involve the varus, valgus, calcaneus, or equinus positions. Treatment initially uses plaster or fiberglass casts to stretch the foot into proper position, with serial casting over months. Surgery may be needed if casting fails or the foot is rigid. Developmental dysplasia of the hip is a hip joint malformation present at birth or shortly after, allowing the femoral head to ride upward out of the socket. It affects more females and is diagnosed using tests like Ortolani or Barlow along with x-rays
This document discusses developmental dysplasia of the hip (DDH), also known as congenital hip dysplasia. DDH ranges from shallow acetabulum to complete hip dislocation. Risk factors include breech presentation and family history. Diagnosis involves clinical tests like Barlow and Ortolani in newborns and ultrasound or x-ray in older infants. Treatment depends on age and includes Pavlik harness in newborns, closed or open reduction and casting in infants, and osteotomies if needed in older children. Complications can include avascular necrosis. Proper screening and treatment can prevent long term issues from untreated DDH.
Kyphosis is an excessive outward curvature of the spine that results in an abnormal rounding of the upper back. There are several types of kyphosis, with the most common being postural kyphosis caused by poor posture and weak back muscles. Symptoms may include back pain and muscle spasms. Treatment options include exercises to improve posture and strengthen back muscles, bracing, and in severe cases, surgery to correct the spinal curvature. Physiotherapy focuses on stretching tight muscles and strengthening weak back muscles to improve posture and reduce pain.
This document discusses development dysplasia of the hip (DDH), including its presentation, risk factors, diagnosis, natural history, and treatment. DDH includes a spectrum of disorders like subluxation, dislocation, and acetabular dysplasia. Risk factors include breech presentation, female sex, and family history. Clinical examination involves assessing range of motion and stability tests. Radiographs and ultrasound are used for diagnosis. Without treatment, DDH can progress to osteoarthritis, but early detection and treatment can help prevent long-term issues.
Developmental dysplasia of the hip (DDH) is a condition where the femoral head has an abnormal relationship with the acetabulum. It includes hip dysplasia or dislocation that develops after birth. Risk factors include breech presentation and family history. Screening involves clinical examination of neonates and ultrasound if risk factors present. Treatment depends on age and ranges from Pavlik harness or casting for neonates to closed or open reduction and femoral shortening or acetabular reorientation procedures for older children. Management of adult DDH involves restoration of the hip center and correction of bony deformities during total hip replacement.
Clubfoot, congenital hip dislocation, and torticollis are congenital deformities that affect bones, muscles, tendons, and other tissues. Congenital hip dislocation occurs when the femoral head spontaneously dislocates from the acetabulum before, during, or after birth. It is diagnosed through tests like Barlow's test and Ortolani's test. Treatment aims to reduce the femoral head into the acetabulum through closed or open manipulation and maintain the reduction with casting or splinting. The treatment approach depends on the age at presentation and whether it is unilateral or bilateral.
Developmental dysplasia of the hip is a condition where the femoral head does not properly fit into the acetabulum. It can present as hip dislocation or dysplasia. Risk factors include family history and breech presentation. Examination involves tests like Ortolani and Barlow. Treatment depends on age and severity, and may include casting, bracing, or surgery. Other congenital anomalies of the lower limbs discussed include congenital dislocation of the knee, clubfoot, and proximal femoral focal deficiency.
club-foot in children pediatric nursing.pptxaasthasubedi3
- Clubfoot is a congenital deformity where the foot is twisted out of shape. It occurs in 1-2 per 1000 live births.
- The most common type is talipes equinovarus, where the foot is pointed downward and inward.
- Treatment involves serial casting in the first few months of life to gradually correct the deformity, followed by bracing to maintain the correction. Surgery may be needed in more severe cases that do not respond to casting.
- The goal of treatment is to achieve a painless and stable foot.
The document discusses common congenital musculoskeletal disorders in children including clubfoot, hip displacement, and juvenile rheumatoid arthritis. It defines the conditions, describes causes and clinical manifestations, and outlines diagnostic evaluations and management approaches including casting, bracing, and surgery. Nursing diagnoses for musculoskeletal disorders are also reviewed such as impaired physical mobility, ineffective tissue perfusion, and risk for skin breakdown.
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2. What is a Splint? Harness?
• A splint is defined as “a rigid or flexible device
that maintains in position a displaced or
movable part; also used to keep in place and
protect an injured part” or as “a rigid or
flexible material used to protect, immobilize,
or restrict motion in a part.
4. History Of Splits
• Evidence suggests that splint usage dates back to
1500 B.C.
• Leaves, reeds, bamboo, and bark padded with
linen… [and] copper."
• In 1517, after the evolution of the armor trade,
injuries were being treated by metal braces
secured by screws.
• In1592, the first written piece on splints by
surgeon Hieronymus Fabricius, shows various
drawings of armor-like splints for the entire body.
5. History Of Splits
• In the mid-1700, doctors and mechanics worked
with each other to create splints for certain
injuries(PoP)
• In the 1800s it was beginning to be recognized
that rehabilitation after an injury was important.
Orthopedics began to become a separate field
from general surgery. A famous British Surgeon,
Hugh Owen Thomas, created specialty splints
that were cheap and best for injuries that were
being rehabilitated.
6. Uses
• Splints are most commonly used to immobilize
broken bones or dislocated joints.
• When a broken bone has been properly set.
• Immobilize unset fractures .
• Other injuries ;
• soft tissue sprains, tendon injuries.
7. Indications of Splinting In DDH
• 1.A hip that is dislocated and that can be
reduced by the examiner (Ortolani sign) at
the time the diagnosis is made.
• 2. Hips that are located but that can be
subluxated by the examiner (Barlow sign).
8. Indications of Splinting In DDH
• Some of these hips will spontaneously stabilize,
and some clinicians prefer to wait a few weeks
and reexamine the child before initiating
treatment.
• When observation is chosen, steps should be
taken to ensure follow-up because some of these
hips will subsequently dislocate if they are left
alone.
• 3. Less certain are the indications for the
treatment of hips that are normal on clinical
examination but abnormal on ultrasonography.
9. Rules IN Splinting : DDH
• 1. Hips must be properly reduced before
splinting or in a position that reduction
occures spontaneously .
• 2. Extreme positions must be avoided.
• 3. Hips should be able to move .(wide
abduction and forced internal rotation lead to
AVN).
11. Pavlic Harness/Neonates
• The Pavlik harness is applied by first placing
the chest strap just below the nipple line
• The child’s feet are placed in the stirrups, the
hips are placed in 120 degrees of flexion, and
the straps are secured.
• The posterior straps are fastened loosely to
allow for the abduction of the hips to occur by
gravity alone.
12. Harness/NeonatesPavlic
• Weekly visit for bathing or change to a larger
size(3-4weeks).
• Hyperflexion leads to FNP and less than 90
deg. is inadequate for reduction.
• Compliant parents needed.
• On the 3rd wk U/S : if unstable hip switch to
abduction orthosis(93% s.rate and no AVN).
• On the 6th wk week: examination and U/S .
13. Harness/NeonatesPavlic
• If both are toward stability start weaning.(gradual
weaning is preferable by some authors).
• At 3-4 months of age :radiograph.
• At 1 year of age a standing radiograph.
• If normal the follow up in once-twice /year till
skeletal maturity (significant incidiense of
asymmetric closure of the femoral head epiphysis
leading to valgus and inadequate coverage of the
head ).
14. Harness/NeonatesPavlic
• If the hip remains dislocated after 3 to 4
weeks of harness wear, the use of the harness
should be discontinued,and the hip should be
examined while the child is under anesthesia.
An arthrogram may show the cause of the
instability, and the hip should be managed
with either closed or open reduction.
15. Harness/NeonatesPavlic
• If the hip is reduced at 3 weeks but dislocates
during examination, the harness should be
worn for 3 to 6 more weeks until the hip
stabilizes.
• An abduction orthosis may be used for hips
that have not stabilized after 3 or more weeks
of treatment in the harness.
16. Months6-1HarnessPavlic
• To be effective, the harness must hold the hips
in more than 90 degrees of flexion, with the
position of the upper femoral metaphysis
pointed toward the triradiate cartilage.
• Higher dislocation have a higher faliure rate.
• Weekly examination.
• Follow up by U/S.
17. Months6-1HarnessPavlic
• If reduction is not obtained by3-4 wks /other
treatment plan.
• If reduction is obtained continue for 6 wks
after stability has achieved .
• When harness treatment is completed, some
clinicians elect to place the child in an
abduction splint for several more months.
18. Months6-1HarnessPavlic
• It is recommended for older children to have it
for a longer time to encourage acetabular
development.
• Precise guidelines of stoppage ???
• As the harness is discontinued, another AP
radiograph is obtained to assess hip reduction
and acetabular development.
19. A notch above the
acetabulum often
appears after the hip is
reduced, and this finding
is usually followed by
improved acetabular
development
Acetabular development
may be enhanced by
abduction splinting.
20. Months6-1HarnessPavlic
• Overall, the reported rate of AVN when the
Pavlik harness is used ranges from 0% to15%.
• Factors that are associated with the failure of
Pavlik harness treatment include
• 1.Patient age of more than 7 weeks .
• 2.Bilateral hip dislocation.
• 3.Absent Ortolani sign.
21. Backs-DrawHarnessPavlic
• 1. AVN (INPROPER APP VS dynamic process of dis).
• 2.Failure to reduce the hip.
• 3.Femoral nerve palsy.
• 4.The so-called Pavlik harness disease was reported by
Jones and associates, who found that prolonged positioning
of the dislocated hip in flexion and abduction potentiated
dysplasia and resulted in a hip that was likely to require an
open reduction.
• They noted a flattening of the posterolateral acetabulum in
these hips and recommended discontinuing the harness if
reduction had not occurred after 3 or 4 weeks.
• 5. Long-term follow-up is recommended for treated hips.
22. A, Anteroposterior (AP) radiograph obtained at
presentationwhen patient was 5 months old shows a
dislocated left hip.
B, AP radiograph of patient in the harness with
inadequate flexion.
23. C, AP radiograph obtained 2 weeks later shows adequate
flexion of the hip, although the hip is still dislocated.
D, AP radiograph obtained
1 month later shows that the hip has been reduced.
24. E, AP radiograph obtained when patient was 5
years old shows good acetabular
development.
25. Ilfeld Splint(CRAIG SPLINT)
• Since October 1951 a splint
• (FREDERIC W. ILFELD, M.D an American
orthopedic surgeon) .with two thigh cuffs
connected to an adjustable bar has been used
in about 250 cases of congenital hip disease
with good results.
27. SplintIlfeld
• With this splint the thighs are gradually and
without force directed into abduction and
external rotation, the "frog position."
• The surgeon adjusts the splint into further
abduction at weekly intervals until the desired
position is obtained.
• The splint is removed several times a day by
the mother for rotation-abduction exercise.
28. SplintIlfeld
• This exercise as well as the kicking and natural
movement of the hips in the splint tend to
improve local circulation, increase abduction,
and apply gentle pressure of the femoral head
against the acetabulum.
29. SplintIlfeld
• In the frog position the thigh muscles exert a
force along the femoral shaft "pulling" the
head into the acetabulum. In this way the
dislocation of the femoral head is reduced.
• In dysplasia of the hip with delay in the
development of the femoral head and
acetabulum, the pressure of the femoral head
in the abducted position is thought to
stimulate bony growth.
30. SplintIlfeld
• In dysplasia the splint is usually worn only at
night.
• In dislocation the splint is worn continuously
for several months being removed daily for
bathing and exercise.
• The splint is then worn only at night until hip
development is complete.
31. SplintIlfeld
• In older children it may be used after closed
or open reduction, even without preliminary
plaster fixation.
• In some cases the splint may replace the cast
after 4-6 weeks thus eliminating many months
of plaster immobilization.
32. AdvantagesSplintIlfeld
• 1. Reduce a dislocation of the hip without
anesthesia, hospitalization, or plaster cast
• 2. Dynamic, permitting crawling, walking, and
running.
• 3. Adjustable for growth, cool and comfortable,
light and handy.
• 4. Prevents stiffness of the hips and knees,
stimulates acetabular and femoral growth.
• 5. Convenient.
• 6. Allows mobility of the child.
33. Frejka pillow & Tripple diappers
• Proff.Dr. Bedrich Frejka (1890-1972) a Czech
Orthopedic Sx,
• has a poor outcome :
• 1. Forcefully abduct the hips.
• 2. High rate of AVN (pressure over epiphyseal vsl)
• The use of triple diapers should also be
abandoned because they do not effectively
position the hips, and their use may falsely
suggest to parents that something positive is
being accomplished.
35. Avascular necrosis after the use of the Frejka pillow.
Anteroposterior radiograph obtained when patient was 16 years
old shows a shortened femoral neck with trochanteric
overgrowth.
The valgus tilt of the femoral head indicates a lateral physeal
injury from avascular necrosis
36. Von Rosen Splint
• Designed by Professor Sophus Von Rosen of
Sweden in 1956.
• With reported 95% success rate and less than
1% risk of AVN.
• Hips are held in 90 deg. flexion and 60-70 deg.
abduction
38. Follow UpVon Rosen Splint
• 1.The child should be seen once weekly for:
• A. check for position and a possible change to
a larger size(7).
• B. to have a bath.
• C. check for skin problems.
• D. general advices for the parents.
39. Follow UpVon Rosen Splint
• 2. U/S every 4-6 weeks
• 3. Treatment continues for 6-12 weeks.
Depending on the degree of displacement and
the U/S finding in 6 wks.
40. Advices for ParentsVon Rosen Splint
• 1.Never remove the splint at home.
• 2.The child should lie on his back not on his
tummy.
• 3.Bathing: use unperfumed soap and carefully
wipe the skin and dry with a towel .then use an
unperfumed powder for skin.
• 4.Diappers changing frequently.
• 5.Contact the clinic for any concern.
• 6.To lay your child on their side, support them
with a rolled-up towel or blanket.
42. Tubingen Splint
• (By a German Professor Dr.Bernau for more
than 25 yrs )in a trial to match the treated hip
in a best position of being treated and safely
development
• “seated squat position”
• The same as the child assumes in whomb
before birth.
• A flexion of an excess of 90 deg. of hips and
spreads them slightly.
43. Tubingen Splint
• Advantages:
• 1.Freely movements of the child.
• 2.Natural body posture.
• 3.Easy handling.
• 4.Fast conditioning, suitable for everyday use.
• 5.Safe.