Skeletal System MalformationSkeletal System Malformation
Center for Joint Surgery
Southwest Hospital
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
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
Treatment-Non SurgicalTreatment-Non Surgical
Manual rectificationInfant < 1 year2 times / dayContinue for several weeksFixation in bandage
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
TreatmentTreatment
Non-surgical treatment: – Training of anterior and posterior tibial muscle– Orthopaedic shoes– Manual treatment– Plaster fixation
Sugical treatment: triple ankle joint union.
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