Fibular hemimelia
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Fibular hemimelia is a congenital disorder characterized by partial or complete absence of the fibula. It ranges from mild fibular shortening to bilateral involvement with associated defects of the femur, tibia, ankle, and foot. Treatment options include ablative procedures like Syme's amputation, limb lengthening using the Ilizarov technique, and the super ankle procedure to reconstruct the ankle and correct foot deformities for a plantigrade foot. Dr. Dror Paley's experience with over 2000 cases strongly recommends limb reconstruction over amputation.
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PFFD [proximal femoral focal deficiency]
This document discusses longitudinal deficiency of the femoral partial (LDFP), which is a congenital absence of part or all of the femur associated with other lower limb abnormalities. It can be unilateral or bilateral. The etiology is unknown but may involve vascular or infection issues. Clinical presentation includes a shortened lower limb, thickened thigh, foot deformities, and abnormal limb positioning. Treatment options include surgical procedures like ankle disarticulation or femoral-pelvic fusion, or non-surgical approaches like prosthetics tailored to the specific classification and severity of the LDFP. Prosthetic fittings aim to address limb length discrepancy, joint instability, muscle inadequacy, and functional needs.
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2. The anatomy, components, and classification of clubfoot deformities.
3. Treatment methods including the Ponseti method of serial casting and bracing, which has a 95% success rate when compliant.
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Quadriceps contracture
Quadriceps contracture is caused by repeated intramuscular injections in the thigh during infancy, which leads to muscle ischemia, necrosis and fibrosis. This causes the quadriceps muscle to adhere to the bone and deep fascia, restricting knee flexion over time. Surgical release of the fibrosed muscles is usually needed to prevent late deformities and regain knee motion. Procedures aim to isolate and release the rectus femoris muscle from surrounding scar tissue using techniques like proximal release or quadricepsplasty. Postoperative physiotherapy is important for recovery.
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Patellar Instability
This document discusses patellar instability, including relevant anatomy, predisposing factors, clinical features, radiological evaluation, and management. It begins with an introduction classifying patellar instability as acute, recurrent, or habitual. Relevant anatomy includes the patella, trochlea, and static and dynamic stabilizers of the patellofemoral joint. Risk factors include ligamentous laxity, alignment issues, and anatomical factors like patella alta or trochlear dysplasia. Clinical exams and radiological tests are used to evaluate patients. Management involves conservative treatments like bracing and physical therapy or surgical options like lateral release, MPFL reconstruction, and realignment procedures depending on the individual case.
Habitual dislocation of patella
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Quadriceps contracture is caused by repeated intramuscular injections in the thigh during infancy, which leads to muscle ischemia, necrosis and fibrosis. This causes the quadriceps muscle to adhere to the bone and deep fascia, restricting knee flexion over time. Surgical release of the fibrosed muscles is usually needed to prevent late deformities and regain knee motion. Procedures aim to isolate and release the rectus femoris muscle from surrounding scar tissue using techniques like proximal release or quadricepsplasty. Postoperative physiotherapy is important for recovery.
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This case report describes a 21-year old female patient with a 10-year history of habitual left patellar dislocation. Examination found lateral subluxation of the patella in flexion and reduced range of motion. X-rays showed patella baja on the left side and lateral dislocation of the patella. The patient underwent a proximal and distal soft tissue realignment procedure involving lateral release, medial reinforcement, and partial medialization of the patellar tendon. Post-operatively, the patella was centrally located with improved range of motion and stability. Habitual patellar dislocation is rare in adults and can be treated with soft tissue realignment surgery to reinforce the medial structures and release tight
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1. The historical aspects and key figures in the development of clubfoot treatment methods.
2. The anatomy and biomechanics involved in clubfoot deformity.
3. The Ponseti method of non-surgical clubfoot correction, which involves weekly manipulation, casting, and often a percutaneous Achilles tenotomy.
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Perthes disease is a childhood condition that affects the hip. It results from a temporary loss of blood supply to the femoral head. The key points are:
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- The exact cause is unknown but theories involve vascular compromise to the femoral head.
- Presentation includes limping, groin or thigh pain that increases with activity. Imaging shows changes to the femoral head over different stages.
- Treatment depends on the stage and age of the child, ranging from non-operative bracing and casting to surgical procedures like osteotomies if containment is needed to prevent further deformity and damage.
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Proximal focal femoral deficiency (PFFD) is a rare congenital disorder characterized by a shortened femur with an apparent discontinuity between the femoral neck and shaft. The cause is unknown, though it is thought to result from factors affecting limb development between 4-6 weeks of gestation. Presentation includes limb length discrepancy, hip instability, and knee abnormalities. Treatment options depend on the severity and stability of the hip, and may include knee fusion/amputation with prosthesis, rotationplasty, or limb lengthening in milder cases. Classification systems aim to characterize the anatomical defects to guide management.
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Fibular hemimelia is a congenital absence or deficiency of the fibula that is associated with other lower limb abnormalities. It results from interference with limb bud development during fetal development. Clinically, it presents with a shortened limb and foot deformities like equinovalgus, as well as leg length discrepancy and foot/ankle instability. Treatment options range from conservative management with heel lifts for small discrepancies, to epiphysiodesis or amputation for larger discrepancies. Surgical treatment may involve osteotomies, tendon releases, or procedures like a Gruca or Syme's amputation.
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- It typically affects children between the ages of 4-10 years old and is more common in boys.
- The exact cause is unknown but theories involve vascular compromise to the femoral head.
- Presentation includes limping, groin or thigh pain that increases with activity. Imaging shows changes to the femoral head over different stages.
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Proximal focal femoral deficiency (PFFD) is a rare congenital disorder characterized by a shortened femur with an apparent discontinuity between the femoral neck and shaft. The cause is unknown, though it is thought to result from factors affecting limb development between 4-6 weeks of gestation. Presentation includes limb length discrepancy, hip instability, and knee abnormalities. Treatment options depend on the severity and stability of the hip, and may include knee fusion/amputation with prosthesis, rotationplasty, or limb lengthening in milder cases. Classification systems aim to characterize the anatomical defects to guide management.
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This document provides information about pes planus (flat foot), including its components, classification, examination, and treatment. Pes planus is characterized by a lowered or absent medial longitudinal arch. It can be flexible or rigid depending on joint mobility. Flexible flat foot is more common and usually asymptomatic, especially in children. Treatment focuses on orthotics, exercises, or surgery if conservative measures fail. Surgical options include tendon lengthening, arthrodesis, and osteotomies to realign the foot structure.
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This document summarizes information about congenital pseudoarthrosis of the tibia (CPT), including:
1. CPT is characterized by a spontaneous fracture that heals poorly, often associated with anterolateral bowing of the tibia. While the term is a misnomer, an alternative name has not been established.
2. Key aspects of CPT include nonunion of a tibial fracture that develops spontaneously or after minor trauma in a dysplastic bone segment. It usually develops in the first two years of life and commonly affects the tibia and fibula.
3. Treatment approaches aim to achieve union at the fracture site while preventing refracture, correcting limb length inequality and growth abnormalities, and preventing
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The document discusses ulnar nerve palsy and tendon transfers used to treat it. It begins by describing the anatomy of the ulnar nerve and its motor and sensory functions. It then discusses clinical findings associated with ulnar nerve injuries at different locations. Various tendon transfers are summarized that aim to restore small and ring finger flexion, key pinch, correct clawing, and improve grip strength for patients with ulnar nerve palsy. These include transferring forearm muscles like the ECRB to restore key pinch or correct clawing. The modified Stiles-Bunnell procedure is also summarized, which uses the middle finger superficialis tendon to dynamically correct clawing during finger flexion.
Osteotomies around the hip
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تقوس الساق الخلقي - Congenital tibial angulation البروفيسور فريح ابوحسان -...
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جراحة العظام / علاج العظام في الاردن / افضل دكتور عظام في الاردن / افضل اخصائي عظام في الاردن / استشاري عظام/افضل استشاري عظام في الاردن /جراحة عظام / /عمليات تطويل العظام في الاردن / اطباء العظام في الاردن / دكتور طب عظام في الاردن / الاطباء في الاردن / خلع ورك / عمليات اليزاروف في الاردن /علاج الكسور /خلع الولادة / تركيب المفصل / اوجاع العظام /افضل طبيب عظام اطفال في الاردن / استشاري اطفال عظام في الاردن / /علاج خلع الكتف / علاج التواء الكاحل / التواء الكاحل / علاج الام العظام / علاج هشاشة العظام / ارقام اطباء عظام في الاردن / مشاكل العظام والمفاصل /مستشار جراحة العظام والمفاصل والكسور/مستشار جراحة عظام الأطفال.Craniovertebral juction 1 by dr mohammad mushtaq
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Common childhood problems of the lower limb (cong. & dev.)
This document summarizes several congenital orthopedic conditions discussed in an orthopedics tutorial, including: developmental dysplasia of the hip, Perthes disease, recurrent dislocation of the patella, congenital talipes equinovarus (clubfoot), and syndactyly. For each condition, it describes the etiology, key features, diagnosis, and treatment approaches. Common causes of congenital orthopedic conditions include genetic disturbances, drugs, infections, trauma, anoxia, and compression in utero.
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The human foot has two basic functions: supporting body weight and propelling the body through locomotion. It is designed with elastic longitudinal and transverse arches that act as shock absorbers. The arches are maintained through bone shape, ligaments, tendons, and muscle slings which prevent sagging under weight. Common foot deformities include talipes (clubfoot), pes planus (flat foot), pes cavus (high arched foot), hallux valgus (bunion), and hammertoe.
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The document discusses the use of the Evans Bilobed Flap technique for managing radial club hand at the Red Cross Children's Hospital from 2010-2014. It provides a brief history of incision techniques used previously. The Evans Bilobed Flap technique provides excellent exposure of the radius and ulna as well as dorsal and volar exposure, allowing for one-stage correction. It had no major complications and provided good soft tissue coverage away from the area of potential pollicization with only a 20% minor complication rate of epidermolysis. Results on 7 patients who underwent the procedure are presented.
Pathophysiology+of+Osteoarthritis
Osteoarthritis is a degenerative joint disease characterized by the breakdown of articular cartilage. This leads to fibrillation, fissures, and eventually the loss of full thickness cartilage. Cytokines like TNF-α and IL-1 are believed to play a pivotal role in the initiation and progression of osteoarthritis by stimulating cartilage breakdown and synovial inflammation. A complex interaction between pro-inflammatory and anti-inflammatory cytokines contributes to the imbalance between cartilage matrix synthesis and degradation in osteoarthritis.
Fracture healing
This document discusses bone healing and repair. It begins with an introduction and overview of bone structure and function. There are several cell types involved in bone healing including osteoblasts, osteoclasts and fibroblasts. Bone healing can occur directly through primary healing or indirectly through secondary healing which involves callus formation. Several factors can affect bone healing such as nutrition, age, infection and vascularity. Complications of bone healing include nonunion, malunion and delayed union. Bone grafts undergo revascularization from the recipient site and healing of extraction sockets occurs in stages from coagulum to bone development.
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Levels of evidence, recommendations & phases of
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Congenital pseudoarthrosis
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2. It is classified into six types by Boyd based on location and characteristics of the defect.
3. Types 1-4 involve the tibia, while types 5-6 may also involve the fibula or other sites. Common features include anterolateral bowing of the tibia and pseudarthrosis formation.
Keinbock disease
1) Kienböck's disease is a painful wrist condition caused by osteonecrosis of the lunate bone.
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Levels of evidence, systematic review and guidelines
1) Evidence-based medicine requires integrating the best research evidence with clinical expertise and patient values and circumstances.
2) Levels of evidence are used to rank types of medical studies, with systematic reviews and randomized controlled trials ranked highest.
3) Systematic reviews use explicit and reproducible methods to identify, select, and critically appraise relevant research to answer a specific clinical question.
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تقوس الساق الخلقي - Congenital tibial angulation البروفيسور فريح ابوحسان -...
تقوس الساق الخلقي - Congenital tibial angulation البروفيسور فريح ابوحسان -...
Common childhood problems of the lower limb (cong. & dev.)
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Following References were used to prepare this powerpoint presentation which makes the slides accurate and relaible for studying purpose; Therapeutic Exrercise – Carolyn Kisner
Orthopaedic Physical Assessment – Magee
Orthopaedic Medicine – L. Ombregt
Campbell’s Operative Orthopaedics
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Fibular hemimelia
- 1. Fibular Hemimelia Dr. Ajay Alex CMC Ludhiana
- 2. Fibular hemimelia Its is a congenital disorder characterised by partial or complete absence of the fibula. It is the most common deficiency of long bones, and consists of a spectrum of anomalies ranging from mild fibular shortening with Limb length discrepancy to bilateral involvement with associated defects of the femur, tibia, ankle and foot.College of M
- 4. • Etiology- related to isolated mutation of the Limb bud. (sporadic) • Fibular hemimelia is usually not an inheritable condition. • 1:40,000
- 5. Fibular hemimelia Associated anomalies • Ankle instability– ball and socket joint • Valgus foot with the absence of one or more lateral rays • Tarsal coalition • Congenital short femur and Femur deficiency. • Diaphyseal angular deformity apex anteromedial. • Fibular deficiency • Hypoplasia of the lateral femoral condyle or patella • Knee instability – ACL insufficiency
- 6. Shortening, absence of lateral rays anterior bowing
- 7. Equinus Hind foot valgus
- 8. Agenesis of femur with FH Equino varus with FH
- 9. Fibular hemimelia • Achterman–Kalamchi classification Type IA Type IB Type II
- 10. • Type IA- the proximal fibular epiphysis is distal to the level of the tibial growth plate, whereas the distal fibular growth plate is proximal to the dome of the talus • Type IB- there is a partial absence of the fibula and proximally the fibula is absent for 30 to 50 percent of its length, whereas distally it is present but unable to support the ankle. • Type II- includes all limbs when there is a complete absence of the fibula or when only a distal, vestigial fragment is present
- 11. PALEYS Classificaton • Type 1- is a congenitally short tibia and fibula with a stable ankle joint. fibula is only slightly shorter at its upper end compared to the opposite side. • Type 2- short tibia and fibula with a foot that stands flat to the ground but often goes into a valgus position. Ball and socket ankle joint. • Type 3A- the fixed equinovalgus , due to a malorientation of the ankle joint. • Type 3B- the fixed equinovalgus deformity, due to a malunited subtalar coalition.
- 13. •Type 3C- it is due to a combination of maloriented ankle joint and a malunited subtalar coalition. •Type 3D- the subtalar joint is not fused and does not have the coalition but is maloriented. In fact in this condition, there is hypermobility of the subtalar joint. •Type 4- also known as the club foot type of fibular hemimelia has a subtalar coalition maloriented into varus (foot turned inwards) and appears more like a club foot deformity instead of the equinovalgus typical fibular hemimelia
- 14. Paleys Type-4
- 15. Goals of treatment • Plantigrade foot with stable ankle • Restore LLD • Correction of associated deformities of knee, tibia & ankle • Facilitate optimal prosthetic fitting if foot is ablated
- 16. Fibular hemimelia : Management options • Ablative - Syme’s or Boyd’s amputation. • Limb lengthening - Limb lengthening using Ilizarov technique & foot deformity correction
- 17. Knee Valgus
- 18. Stabilisation of ankle a) _ b) Gruca operation c) Bending osteotomy of exner d) Reconstruction of lateral malleolus e) Tibiotalar arthrodesis
- 19. Post Gruca’s
- 20. Foot & ankle deformity • Superankle procedure • Aim : to give fuctional plantigrade foot • 1st surgery • Youngest age 12 months without lengthening 18 month with lengthening
- 21. Super ankle procedure • Step 1: fibrous fibular anlage removal • Step 2: lengthen peroneal & Achilles tendon • Step 3: decompress peroneal & posterior tibial nerve • Step 4: reshaping dome of talus
- 22. • Step 5 : osteotomies depending upon type, 3A supra-malleolar, 3B subtalar, 3C combined, 3D special subtalar to correct mal-orientation • Step 6: pinning through heel pad • Step 7 : repair of lengthened Achilles & peroneal tendons • Step 8 : compartment release
- 23. Limb length discrepency • May be at tibia, femur & foot • Estimated LLD: Paley multiplier • 5 cm can be corrected in 4 years • 8 cm at 8year • 8 cm at 12 year • 5 cm by femoral epiphysoidesis of contralateral side • Total 25 cm LLD correctable
- 25. Dr. Dror Paley’s experience • After doing limb reconstruction in 2000 FH cases strongly recommended limb lengthening with super ankle procedure and suggested there is no role of amputation Only foot deformity no amputation Only LLD no amputation Why? In combination • Redifined foot deformity • Paley classification • Estimated LLD
- 26. THANK YOU
Editor's Notes
- In SA with lengthening bending of tibia will be corrected during lengthening, but if done alone bending should be corrected by removing wedge from tibia and fixation with internal pins & cast
- 1) To prevent valgus reccurence & helps in lengthening, 3) to prevent damage during deformity correction 4) increase arc of motion of ankle joint