Early Detection of Early Detection of Pediatric Pediatric

Orthopedic Orthopedic DisordersDisorders

dr. Sugeng Yuwana, Sp.OTDepartment of Orthopaedic &

TraumatologyFaculty of Medicine, Gadjah Mada

UniversityDr. Sardjito Hospital

Yogyakarta

Osteogenesis Imperfecta Osteogenesis Imperfecta (OI)(OI)

Genetically and phenotypically

diverse group of inherited connective

tisssue disorders

Pathogenesis:

Defect in the formation of type 1 collagen

(principle protein found in dentin, sclera

and ligament)

Manifestation of the Manifestation of the Syndrome:Syndrome:

Generalized osteoporosis Dentinogenesis imperfecta Blue sclerae Hearing loss Short stature Easy bruising Excessive sweating Generalized laxity Cardiopulmonary abnormalities

OIOI

Early detection:Early detection:

Fracture at birth

OIOI

Child AbuseChild Abuse

The term child maltreatment include: Abuse

Neglected

The pattern of multiple fracture at

various stage of healing is indicative

of child abuse, provide there is no

underlying bone disease

The most common The most common fracture sites:fracture sites:

Humerus

Femur

Tibia

With tranverse fracture pattern

Child AbuseChild Abuse

Physical signs:Physical signs: Multiple bruises especially over the

perineum or back

Soft tissue injuries may outnumber fractures

Ever major joints should be checked for effusion and stiffness

Child AbuseChild Abuse

An. A, Boy, 2 months y.o.

Close fracture of middle third of the right and left humerusUnion fracture of distal third of the right radius ulna

Union fracture of distal third of the left femurUnion fracture of proximal third of the left tibia

Guidelines for detecting Guidelines for detecting suspected child abuse: …suspected child abuse: …

A history should be obtained regarding all

injuries

The possibility of child abuse should be

considered in the differential diagnoses of

many injuries in children

The whole child must be examined

Other possibilities for injury should also be

considered

……Guidelines for detecting Guidelines for detecting suspected child abuse:suspected child abuse:

The examining physician should communicate personally with the social worker

Evaluation and treatment should be conducted with non-judgemental attitude

The examining physician should consult with other physicians for assistance in evaluating the child

Findings should be documented in the medical record and copies should be saved in personally held record

Developmental dysplasia of Developmental dysplasia of the Hip (DDH)the Hip (DDH)

The most common disorder affecting the hip in children

Dynamic disorders: Include some conditions that clearly

diagnosed at birth Others that become apparent during the

first year of life Or clinically silent during childhood but

become symptomatic during adolescence or early adulthood

Etiology:…Etiology:…

Physiologic factor: Ligamentous laxity

Mechanical factor: Prenatal:

Birth presentation 5%OligohydramnionPrimi gravidaCongenital knee recurvatum or

dislocationCongenital muscular torticollis

…

DDDDHH

……Etiology:Etiology: Postnatal:

SwaddlingStrapping

Genetic factor: 10%

DDH

Early detection:…Early detection:…

Newborn: Appearance at rest: affected site is more

adducted Asymmetric passive abduction Barlow test Ortholani test

DDH

Asymmetry of the thigh fold, popliteal and gluteal creases

Shortening of the extremity

Limited abduction of the Limited abduction of the right righ hipright righ hip

Ortolani testOrtolani test

Barlow`s testBarlow`s test

……Early detection:Early detection: Older children:

The signs change progressively Asymmetric range of passive abduction Galeazzi test Length leg discrepancy Trendelenburg gait (sailor’s/ waddling

gait) Palpable femoral head posterior to the

acetabulum

DDH

Galeazzi`s signGaleazzi`s sign

Ducklike wadle or sailor gait, Ducklike wadle or sailor gait, TrendelenburgTrendelenburg

TreatmentTreatment

The Pavlik harness

Girl, 6 y.o Girl, 6 y.o

girl, 4 yoDevelopmental displasia of the left hip

CTEV = congenital clubfootCTEV = congenital clubfoot(Congenital Talipes (Congenital Talipes

Equinovarus)Equinovarus) Definition:

Heel: inverted heel Forefoot and Midfoot: inverted and

adducted (varus) Ankle: equinus

Normal foot

Anterior and posterior view Anterior and posterior view clubfootclubfoot

Classification:Classification:

Intra uterine positioning (not CTEV)

Responds to simple stretching and

casting

Congenital clubfoot

Teratologic type: clubfoot syndrome

associated with athrogryposis multiplex

congenita, myelomeningocele, spina bifida

Early detection: Early detection: Dorsoflexion of the foot soon after birth

CaseCaseCTEV Cases