CONGENITAL DEFORMITIES

Presenters: Dr.A.Prakash, Dr. C. Arun Prasath.

Institution: Annamalai University. Date:12.2.2013.
CONGENITAL TALIPES EQUINO VARUS
(CTEV)
CTEV

 Vague term used to define a number of

abnormalities in the foot.
CTEV-ETIOLOGY
 The true etiology of congenital clubfoot is
unknown.
 Idiopathic
 Mechanical-intra uterine pressure
 Ischeamia of calf muscles
 genetic

 Secondary
 Paralyticdisorders
 Arthrogryposis multiplex congenita.
CTEV-PATHO ANATOMY
 Bones
 Smaller
 Talus faces downwards
 Calcaneum small
 Joints
 Ankle-equinus
 Subtalar-inversion
 Mid tarsal-Forefoot adduction and cavus
 Muscles and tendons
 Posteriorly- tendo achilles.
 Medially- TP, FDL, FHL
 Capsules and ligaments
 Capsules of ankle and sub talar joint,
 Medially-Talo navicular ligament, spring ligament, deltoid
ligament
 Plantar fascia and ligaments
CTEV-CLINICAL FEATURES
 Detected at birth
 Brought during early infancy
 Brought during late infancy and early childhood
 Brought during late childhood
 Examination
 Normally-foot dorsiflexed to touch the chin of tibia
 Foot is smaller, in equinus, varus and adduction.
 Heel is small
 Deep skin creases on the back and medial side of foot
 Bony prominences and callosities on the lateral side of
foot
 Outer side of the foot is convex.
CTEV-CLINICAL FEATURES
CTEV-DIAGNOSIS

 Xrays- reduced talo calcaneal angle.

 Normal-more than 35 degrees.
CTEV-TREATMENT
 Non-operative
 Manipulation
 Manipulation and corrective plaster

 Operative
 Postero-medial soft tissue release(TURCO’S)-<3
years
 Limited soft tissue release
 Tendon transfers
 Dwyer’s osteotomy
 Dilwyn-Ewan’s procedure- 4 to 8 years
 Wedge tarsectomy- 8 to 11 years
 Triple arthrodesis- >11 years
 Illizarov’s technique- recurrent.
CTEV-MAINTANANCE

 Ctev splints
 Denis-Brown splint

 CTEV shoes
SPINA BIFIDA
SPINA BIFIDA

 A congenital disorder in which the two halves

of the posterior vertebral arch fail to fuse at
one or more levels.
SPINA BIFIDA-TYPES
 Occulta
 Mildest form
 Midline defect near the lamina

 Cystica
 More severe form
 Contents of the canal prolapse
 Meningocele

 Myelomeningocele-open, closed.
 hydrocephalus
SPINA BIFIDA-CLINICAL FEATURES
 Spina bifida occulta
 Usually nothing
 Midline dimple, tuft of hair, pigmented navus
 Neurological symptoms-enuresis, incontinence,
weakness in the lower limbs
 Spina bifida cystica
 Saccular lesion in the lumbar region
 Hydrocephalous
 Equinovarus or calcaneo valgus of feet
 Recurvatum of knee
 Hip dislocation
 LMN type paralysis
 Loss of sphincter control
SPINA BIFIDA-CLINICAL FEATURES
SPINA BIFIDA-CLINICAL FEATURES
SPINA BIFIDA- DIAGNOSIS

 Xray
 CT

 MRI
SPINA BIFIDA-TREATMENT

 Wound care
 Poper closure of defect

 Hydrocephalous- ventriculo-peritoneal shunt,

if necessary for 5 to 6 years.
 Physiotherapy and splinting
CONGENITAL DISLOCATION OF HIP (CDH)
CDH

 Spontaneous disloation of the hip occuring

before, during or shortly after birth.
CDH-AETIOLOGY

 Not well understood

 Hereditary predisposed to joint laxity

 Hormone induced joint laxity

 Breech presentation

 Hereditary faulty development of

acetabulum.
CDH-PATHOLOGY
 Femoral head is dislocated upwards- small
capital epiphysis
 Femoral neck- anteverted
 Acetabulum-shallow
 Ligamentum teres-hypertrophied.
 Fibrocartilaginous labrum- folded limbus.
 Streched capsule
 Muscles-shortened
CDH-CLINICAL FEATURES

 At birth-from pediatrician
 Early child hood-asymmetry of groin creases,
limitation of hip movements, click
 Older children-peculiar gait.
CDH-CLINICAL FEATURES
CDH-DIAGNOSIS
 Barlow’s test
 Ortolani’s test
 Galeazzi’s sign
 Telescopy test
 Trendelenburg’s test
 Xray-shallow acetabulum, break in shenton’s
line, small head
 Ultrasound
CDH-DIAGNOSIS
CDH-TREATMENT
 Aim-reduce by closed means.
 Methods of reduction
 Closed manipulation
 Traction followed by closed manipulation
 Open reduction

 Maintenance of reduction
 Plaster cast
 Splints-Von Rosen’s splint
 Acetabular procedures
 Salter’s osteotomy
 Chiari’s pelvic displacement osteotomy
 Pemberton’s pericapsular osteotomy
 SPRENGEL’S SHOULDER
CONGENITAL ELEVATION OF SCAPULA
SPRENGEL’S SHOULDER

 Failure of descent of the scapula, which is

developmentally a cervial appendage.
SPRENGEL’S SHOULDER-CLINICAL FEATURES

 May be noticed at birth

 Shoulder on the affected side is elevated
 Smaller shoulder
 Occasionally both sides are affected(klippel feil
syndrome)
 Shorter neck-associated with kyphosis or
scoliosis
 Abduction and elevation restricted
 Xray-scapula may be elevated, associated
vertebral anomalies.
SPRENGEL’S SHOULDER-CLINICAL FEATURES
SPRENGEL’S SHOULDER-TREATMENT

 Mild- left alone

 Children younger than 6 years-scapula an be
repositioned by release of the muscles,
exision of the supraspinous portion of the
scapula.
MADELUNG DEFORMITY
RADIAL CLUB HAND
MADELUNG DEFORMITY

 Defective growth of the distal radial epiphysis

resulting in a deformity due to a comparative
overgrowth of the ulna.
 Traumatic and congenital
MADELUNG DEFORMITY-CLINICAL FEATURES

 Lower end of radius curves forwards and

ventrally
 Wrist is dislocated

 Lower end of ulna projects out

 May be isolated or a part of generalised

dysplasia
 Deformity increases until growth ceases
MADELUNG DEFORMITY-CLINICAL FEATURES
MADELUNG DEFORMITY-TREATMENT

 Exision of the lower end of ulna

 Exision of the damaged physis
RADIO ULNAR SYNOSTOSIS
RADIO ULNAR SYNOSTOSIS

 Synostosis-abnormal fusion of bones

RADIO ULNAR SYNOSTOSIS-CLINICAL FEATURES

 Postero lateral dislocation of radial head

 Complete loss of supination and pronation
RADIO ULNAR SYNOSTOSIS-TREATMENT

 Exision of the bony bridge- unsuccessful.

 Change the resting position of the limb to
supination by tendon transfers.
CONGENITAL PSEUDARTHROSIS OF TIBIA
PSEUDARTHROSIS OF TIBIA

 A birth defect in the lower end of tibia in

children, where a fracture fails to unite.
PSEUDARTHROSIS OF TIBIA-PRESENTATION

 Usually diagnosed in early infany

 Child may be born with a fractured tibia or
attenuated later in life.
 Leg is bowed anteriorly

 Xray
 Gap, marked thinning, sometimes fibula is also
afffected
PSEUDARTHROSIS OF TIBIA-PRESENTATION
PSEUDARTHROSIS OF TIBIA-PRESENTATION
PSEUDARTHROSIS OF TIBIA-PRESENTATION
PSEUDARTHROSIS OF TIBIA-TREATMENT

 Simple immobilisation-fails
 ORIF with bone grafting-succeeds
occasionally
 Excision of the affected segment and slowly
closing the gap.