Skeletal System MalformationSkeletal System Malformation

Center for Joint Surgery

Southwest Hospital

Congenital TorticollisCongenital Torticollis

Osteal torticollisMuscular torticollis: common

EtiologyEtiology

Contraction and degeneration of one side of sternocleidomastoid musle

Cause of degeneration? unknownCongenital disease? unknown

DiagnosisDiagnosis

Node found at the lower part of sternocleidomastoid muscle within 1 week after delivery.

Physical signWithout red skin, rising of temp.,

tendernessNode change into fibrous bundle, later.

Differentiation diagnosisDifferentiation diagnosis

Congenital cervical malformationInfectious diseasesTorticollis caused by poor-sighted. Torticollis caused by poor-hearing.Benign paraxysmal torticollis

TreatmentTreatment

Physical therapy: heat, massage, manual, orthopaedic splint, etc.

TractionSurgical therapy:

– Infant 1-4 years– Amputation of sternocleidomastoid muscle – Plaster fixation after surgery.

Congenital dislocation of hip, CDHCongenital dislocation of hip, CDH

Female: male = 6:1Etiology

– 20% cases have inheritance character– Delivery station: breech delivery （臀位生产） – Local custom

PathologyPathology

Malformation of bone and soft tissue structures around hip joint.– Leaning of pelvis– False acetabular– Malformation of original cup– Compensative scoliolosis

（脊柱侧弯）

DiagnosisDiagnosis-Physical Examination-Physical Examination

Pre-standing phase– Allis sign or Galeazzi sign– Barlow test– Ortolani sign– Abduction sign

DiagnosisDiagnosis-Physical Examination-Physical Examination

Dislocation phase– Physical sign– Limping– Nelaton line– Trendelenburg test

Fluorenscopy examinationFluorenscopy examination(X ray) (X ray)

Perkin quadrantAcetabular indexCE angle (center edge angle)Shenton lineSharp angle

TreatmentTreatment

Infant phase (0-6 months)Pavlik splint

TreatmentTreatment

Child phase (1-3 years)Manual reduction, splint, plaster

TreatmentTreatment

Child phase (>3 years)Surgical reduction

– Salter Pelvic Osteotomy, <6 years– Pemberton Acetabular Osteotomy

>6 years Acetabular index > 46°

– Chiari Osteotomy: Older patients Acetabular index > 46°

Congenital Talipes Congenital Talipes EquinovarusEquinovarus

Morbidity: 1%Male : female: 2:1Etiology: unknown

PathologyPathology

Adduction of intertarsal joint （跗骨间关节）

Dorsal flexion of ankle jointVarus of footTibial inversion or contracture of posterior

tibial muscle

X ray examinationX ray examination

X ray examinationX ray examination

Treatment-Non SurgicalTreatment-Non Surgical

Manual rectificationInfant < 1 year2 times / dayContinue for several weeksFixation in bandage

Treatment-Non SurgicalTreatment-Non Surgical

SplintsPlaster fixation

> 10 years old

Soft tissue surgery

Triple ankle joint union

Treatment-SurgicalTreatment-Surgical

ScoliosisScoliosis

Non-structural scoliosisIdiopathic scoliosis

– Infant type ( <4 years)– Juvenile type ( 4 –10 years)– Adolescent type ( >10 years)

PathologyPathology

Change of vetebraea, lamina, spinal processRibsIntervetebrea disk, muscle, ligamentVisceral leision （内脏病变）

DiagnosisDiagnosis

Physical signsHeart and lung diseasesX ray examination

– A-P, lateral– Traction – Stagnara– Contrast examination

FlatfootFlatfoot

Loss of foot archEtiology: Congenital: vaguls of calcaneous, vertical

talus, great navacular tubercle, paranavacular bone, soft tissue diseases.

Secondary

DiagnosisDiagnosis

Flat foot Pain during long time walkingX ray :lateral shot

TreatmentTreatment

Non-surgical treatment: – Training of anterior and posterior tibial muscle– Orthopaedic shoes– Manual treatment– Plaster fixation

Sugical treatment: triple ankle joint union.

Hallux ValgusHallux Valgus

Valgus malformation of first phalanx （趾骨）Pain of the head of the first phalanxTreatment: Physical therapySurgical therapy:

– soft tissue, bone, combination

MC bride, Keller, etc.