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CEREBRAL PALSY
DDH
SUFE
Perthes’ Disease
Polidactily
Syndactily
Constrictions band syndrome
Osteogenesis Imperfecta
AMC
SURGICAL
When no further correction
by manipulation
Soft tissue procedure
Bone procedure
Non surgical treatment :
a. Ponsetti method
b. Kite’s and Lovell
c. French method
Complication Surgery :
1. Recurrence
2. Over correction
3. Stiffness
4. Pain
Result Not Completely Normal
Goal of Treatment
Plantigrade foot
Pain free
Stable over time
Near anatomically normal
Normal shoes
No satisfactory standardized evaluation
Radiology no correlation with the function
Percutaneous Tenotomy ( LA )
2 MONTH 1 YEARS
Use of the foot abduction orthosis following Ponseti casts
7 Year
Bilateral hip
dysplasia
DDH : Group of disorders of the
neonatal hip in which the head of the
femur is unstable or incongruous in
relation to the acetabulum.
Early detection and treatment of the
condition generally results in normal
development, whereas late diagnosis
has poor success
PATHOLOGY OF DDH
Pulvinar
PATHOGENESIS OF DDH
The disorder is not always present at
birth (congenital) and an infant may
have a normal neonatal hip screening
examination
And subsequently develop a dysplastic
or dislocated hip
EPIDEMIOLOGY
Incidence 1 in 1000 live birth
Left > right
Bilateral > right
Females : males = 5:1
White > black
Typical categories
Dislocated hip
Dislocatable hip
Subluxable hip
Dysplastic hip
Risk factors
Breech Presentation
First born Female
Family history - 10%
Associated musculoskeletal pathology
Diagnosis
New born : Dislocated hip can be reduced
In older children : Remains dislocated
Diagnosis in newborn (6 months)
Ortolani & Barlow
Ultrasound
Beware of Developmental dysplasia
Ortolani
Barlow
ULTRASOUND
Diagnosis: 6 to 18 months
Decreased abduction - Adductor contracture
Asymmetrical skin fold
Galeazzi sign : Apparent shortening
Limited Hip Abduction
Unequal
Skin
Crease
5/F R DDH
Trendelenburg (+)
Polyethylene
Abduction
Splint
Failure of Pavlik harness
6-8 weeks not stabilised
Traction
Closed reduction & arthrography
Open reduction if necessary
Treatment : 6 to 18 months
Management
6 to 18 months ,success Pavlik harness ↓
closed manipulation / open reduction.
standard regimen,treatment :
adequate preoperative traction,
adductor tenotomy,
closed reduction “Safe zone”
arthrogram
open reduction failed closed
avascular necrosis
hospital
Home
safe zone
Adductor tenotomy
Adductor tenotomy
Open reduction
Femoral shortening and derotation
Salter procedure