CONGENITAL SKELETAL

DISORDERS
SREEDEVI .T.SURESH
II YEAR M.S.c NURSING
 Bones of the Human Body

The skeleton has 206 bones

 Two basic types of bone tissue

 Compact bone

 Homogeneous

Spongy bone

 Small needle-like pieces of bone

Many open spaces

Types of Bone Cells
Osteocytes

 Mature bone cells

Osteoblasts

Bone-forming cells

 Osteoclasts
 FRACTURE
COMPLETE FRACTURE

TRANSVERSE FRATURE

OBLIQUE FRACTURE

GREEN STICK FRACTURE

SPIRAL FRACTURE

OPEN FRACTURES

CLOSED FRACTURES
 CLINICAL FEATURES
PAIN
TENDERNESS
ERYTHYMA
WARMTH
DEFORMITY
LIMITED RANE OF MOTION
SWELLING
BLEEDING
 DIAGNOSIS
X- RAY

ELEVATED ESR

ELEVATED WBC COUNT

BLOOD CULTURE AND SENSITIVITY

 MANAGEMENT
CAST APPLICATION

IMMOBILIZE THE PART

PAIN MAGEMENT

ANTIBIOTIC THERAPY

SURGICAL CORRECTION

SUPPORTIVE MANAGEMENT
 TORTICOLLIS
It is caused by injury at birth or other cause to

sternocleidomastoid muscle one side of the neck. This

may occur specially in neonates having wide shoulder

 CAUSES
CONGENITAL

PRESENTATION IN BREECH AND TRANSVERSE

TRAUMATIC

INFECTIVE LESION OF CERVICAL SPINE

SPASMODIC
 FEATURES

SWELLING AT THE AFFECTED SIDE

HEAD TILTED TO AFFECTED AREA

CHIN DEVIATED TO THE OPPOSITE SIDE

ASYMMETRY OF THE FACE, EYES,EARS AND

SKULL
 MANAGEMENT
CONSERVATIVE
Passive stretching done in 1st year of life
Place the child in prone position
Hang the toys in the crib on the same affected side
Place he crib in the entrance of the room is on the side
of deformity
STERCHING EXRECISE
Tilting head away from he affected side, It done 10 sec
for 4-6 times a day
Cont…
Physiotherapist or nurse should demonstrate the
procedure
SURGICAL MANAGEMENT
Z- plasty done 1-4 years
 CLUB FOOT OR TALIPES
a congenital deformity in which the

foot is twisted out of shape or position

 TYPES
Dorsiflexion - t. calca´neus

 Plantar flexion - t. equi´nus

 Abducted and everted -t.val´gus or flatfoot

Abducted and inverted - t. va´rus

 Various combination
Club foot
TALIPES EQUINOVARUS
 CAUSES
Defective gene

Excessive pressure of amniotic fluid

Uterine compression

Arrested fetal development

Circulatory failure

Radiation
 FEATURES
deformity is readily apparent at birth

 can be detected antenatally during the routine check

up

development ultrasound scan around 20 weeks.

X-rays may be needed to confirm diagnosis

 MANAGEMENT
Treatment is most successful when started

early in infancy because delay causes

muscles and bones of legs to develop

abnormally,with shortening of tendons

NON SURGICAL
MANAGEMENT
Gentle, manipulation of foot with casting

done every few days for 1 to 2 weeks intervals

 Ponseti’s Method of treatment

BILATERAL CAST
DENNIS BROWN SPLINT
Ponseti’s Method Of Treatment
Involves serial manipulation and plaster casting of

the clubfoot.

 The ligaments and tendons of the foot are gently

stretched with weekly, gently manipulations.

 SURGICAL MANAGEMENT
Done if nonsurgical treatment not effective tight

ligaments released

 Tendons lengthened or transplanted

 Other surgical treatments

 Circumferential release
CONGENITAL HIP DISPLASIA
imperfect development of hip –can affect femoral

head, acetabulum, or both head of femur does not lie

deep enough with in the acetabulum and slips out on

movement

occurs in females 7 times more often than males

 CLASSIFICATION
Acetabular dysplasia
 mildest form
 femoral head remains in acetabulum
 subluxation
 most common form
 femoral head partially displaced
 dislocation
 femoral head not in contact with acetabulum
 displaced posteriorly and superiorly
 FEATURES
Limitation in abduction of leg on affected side

Asymmetry of gluteal, popliteal, and thighfolds

Waddling gait and lordosis when child begins to

walk
GALEAZZI SIGN
With child in a
supine position,
the right knee
on the side of
the subluxation
appears lower
than the left
because of
malposition of
the femur head.
 BARLOWS TEST
infant on a supine position. Doctor abducts the

hips by moving the bent hips and knees apart.

 If the hip feels like it can be pushed out the back

of the socket, this is considered abnormal.

 This is called a positive Barlow's Test and is a

sign of instability in the hip

 ORTOLANI TEST
As the hip is abducted further, the doctor might feel

the ball portion (the femoral head)slide forward as it

slips back into the socket or audible click when

abducting and externally rotating hip on affected side

 MANAGEMENT
Proper positioning: legs slightly flexed and

abducted
 Pavlik harness

 Frejka pillow: a pillow splint that maintains

abduction of legs
 Bryant’s traction

 Spica cast
PAVLIK HARNESS
FREJKA PILLOW
DOUBLE HIP SPICA CAST
SURGICAL MANAGEMENT
Pelvic osteotomy