Common Orthopaedic Deformities PDF

COMMON ORTHOPAEDIC DEFORMITIES Prof. Dr. Nabil Ghaly Professor of Orthopaedic Surgery Ain Shams University  COMMON ORTHOPAEDIC DEFORMITIES A deformity is the deviation from the normal appearance of a part of the body. Common orthopaedic deformities are either congenit...

COMMON ORTHOPAEDIC DEFORMITIES Prof. Dr. Nabil Ghaly Professor of Orthopaedic Surgery Ain Shams University  COMMON ORTHOPAEDIC DEFORMITIES A deformity is the deviation from the normal appearance of a part of the body. Common orthopaedic deformities are either congenital or acquired. Most deformities may require surgical intervention. THE KNEE  Genu Varum Bow legs (or genu varum) is when the legs curve outward at the knees while the feet and ankles touch. Infants and toddlers often have bow legs. Genu Varum In genu varum, the anatomic tibiofemoral angle (aTFA) is greater than 173–175°. The mechanical axis that runs from the centre of the femoral head to the centre of the ankle lays more than 4 ± 2 mm medial to the centre of the knee joint.  THE KNEE Genu Varum (Bow leg): In infants: Most common cause is developmental and physiologic. The deformity gradually corrects with growth over months, almost correcting completely by the age of 4 years. No treatment is necessary.  THE KNEE Genu Varum (Bow leg): In children (aged 1.5- 2 years): Rickets is the commonest cause Is associated with its systemic signs, symptoms and laboratory findings. Treatment is directed to correcting the cause; usually vitamin D deficiency In some advanced cases osteocalsis or osteotomy is required. THE KNEE THE KNEE  THE KNEE Genu Varum (Bow leg): In adults: Osteoarthritis Mal-united fracture Ligamentous injury Paget's disease are the main causes Treatment is also directed at surgical correction of the deformity. Genu valgum Genu valgum, also known as 'knock knees,' is a condition in which the knees angle inward and touch each other when a person stands with their feet and legs together. The inner edges of the feet may also spread outward.  Genu valgum In the normal situation, when standing, the hips, knees and ankles all fall on a straight line. In other words, when you draw a line from the hip to the ankle, that line passes directly through the center of the knee. If that line passes to the outside of the knee (externally), this is called knock knees (valgus deformity). If that line passes to the inside of the knee (internally), this is called bowlegs (varus deformity).  THE KNEE Genu Valgum (knock knees): Valgus knee up to the age of 4 years: Usually developmental or physiological Almost always corrects itself by 6-8 years. If the condition is still progressive at that age, a supracondylar osteotomy of the femur is required. THE KNEE  THE HIP The normal neck-shaft angle of the proximal femur is 160° at birth Decreasing to 125 ° at adulthood. THE HIP ◼An angle less than 110 ° is called coxa vara ◼a deformity of the hip, whereby the angle between the head and the shaft of the femur is reduced to less than 120 degrees. ◼ This results in the leg being shortened and the development of a limp. It may be congenital and is commonly caused by injury, such as a fracture. THE HIP coxa valga. An angle more than 130 ° is called Coxa valga is a deformity due to an increase in the angle between the head and neck of the femur and its shaft (normally 135 degrees).  THE HIP They both lead to gait disability and secondary spinal pain and deformity. Treatment is by corrective subtrochanteric osteotomy.  THE ELBOW The carrying angle of the elbow is defined as the angle between the long axis of the extended forearm as it lies lateral to the long axis of the arm The normal carrying angle is 10- 15 degrees of valgus, which allows a clearing distance for objects to be carried by hand along side the trunk while walking. THE ELBOW A varus deformity is an excessive inward angulation (medial angulation, that is, towards the body's midline) of the distal segment of a bone or joint. The opposite of varus is called valgus. Varus deformity. Cubitus varus and cubitus valgus.  THE ELBOW ◼An angle above that will cause cubitus valgus, and below it cubitus varus. THE ELBOW These deformities are corrected surgically through a wedge osteotomy at the lower humerus. BONE SOFTENING DISEASES BONE SOFTENING DISEASES The bone is a type of connective tissue formed of cells and matrix Bone cells are mainly 2 types : Bone forming cells (osteoblasts). Bone resorbing cells (osteoclasts). The bone matrix is called osteoid and is formed of a type of collagen in which calcium salts are deposited. BONE SOFTENING DISEASES Bone softening disease may be caused by 1-Defective formation of osteoid e.g. osteogenesis imperfecta. 2-Defective mineralisation of osteoid e.g. Rickets. 3-Increased resorption of bone by osteoclasts e.g. hyperparathyroidism. 4-Decreased formation of bone by osteoblasts e.g. osteoporosis.  OSTEOGENESIS IMPERFECTA It is a generalized mesenchymal disorder characterized by : 1) Defective osteoid production causing failure of formation of mature bone. The bone formed is fragile resulting in multiple & repeated fractures. 2) Defective collagen production resulting in ligamentous hyperlaxity of joints and blue sclera. OSTEOGENESIS IMPERFECTA There are several types of the disease with variable degrees of affection:. 1) congenital Type: Still-born or born with multiple fractures. 2)Infantile type: They develop manifestations early in infancy by multiple easy fractures. 3)Tarda type: some cases develop manifestations in late child hood.  OSTEOGENESIS IMPERFECTA There is no specific treatment of the condition. Orthopedic management is directed to: Preventing fractures & deformities using plastic supporting devices Treating current fractures Correcting deformities which may need surgery. RICKETS It is a disease of growing bone due to inadequate calcification of bone matrix. Causes : Infantile Rickets: Due to deficient intake of vitamin D & lack of exposure to sunlight, which is necessary for formation of vitamin D by the skin. The disease manifests between 6 months & 3 years of age. The other types of rickets are manifested in an older age. RICKETS Coeliac Rickets : Due to deficient absorption of fat & vitamin D caused by hereditary intolerance to gluten. Renal rickets : Due to disturbed calcium phosphorous metabolism caused by renal dysfunction.  RICKETS Clinical Picture : The most important bony manifestations are bony deformities causing bow legs (genu varum) or knock knees (genu valgum). RICKETS Characteristic signs of infantile rickets are: Boxy-bossy skull Rickety rosary Pigeon chest Harrison Sulcus Broad metaphysis Marfan sign  RICKETS X-ray : shows bone rarefaction (diminished density in x-ray). The metaphyses become broadened & cupped & show brush border. With healing the frayed brush border of the metaphysis becomes replaced by a line of calcified bone. RICKETS Treatment : Infantile rickets : Good diet rich in Ca, P & Vitamin D and exposure to sunlight as well as administration of vitamin D & calcium. Renal rickets: Needs administration of high doses of vitamin D in the form of active vitamin D (one alpha) and calcium. Severe deformities not improving with medical treatment may need surgical correction (osteotomies). HYPERPARATHYROIDISM Primary hyperparathyroidism results from increased secretion of parathyroid hormone by parathyroid hyperplasia or tumour. HYPERPARATHYROIDISM This causes increased bone resorption by osteoclasts leading to: 1) Hypercalcemia. 2) Recurrent renal calculi. 3) Bone resorption causes cystic changes in bones, bone deformities and pathological fractures. Surgical treatment is by excision of parathyroid adenoma. OSTEOPOROSIS It is diminished bone mass due to diminished bone formation by osteoblasts with aging and after menopause.  Common sites affected are: Vertebral column : weakening of the vertebrae. causes vertebral collapse which causes back pain, kyphosis and gives a radiographic appearance of collapsed wedged or biconcave vertebra. Proximal femur Proximal humerus Distal radius causing fracture after minor trauma. Diagnosis is now possible using bone densitometry (DEXA) OSTEOPOROSIS Treatment : 1) Adequate diet with good supply of calcium, vitamin D & proteins 2) Daily exercises & exposure to sunlight. 3) Medications including - Calcium, vitamin D - Calcitonin which increases osteoblastic activity. - Bisphosphonates: Oral medications, which inhibit osteoclastic activity. - Hormonal Replacement therapy (HRT) used in some cases. THANK YOU