Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Dr. Mohammed A Abbas Department of Orthopaedics & Trauma PDF created with pdfFactory Pro trial version www.pdffactory.com
May 19, 2015
Acquired Bone DeformitiesIntegrated - based Lecture
ByDr. Abdullah H A Juma
Dr. Mohammed A AbbasDepartment of
Orthopaedics & Trauma
PDF created with pdfFactory Pro trial version www.pdffactory.com
Definitions•• AcquiredAcquired : adjective; arising in response to the
action of the environment on the organism. It is opposite to congenital, familial, genetic & hereditary. It develops after birth.
•• BoneBone : noun; the hard part of the skeleton. Functions as supportive, locomotive & protective as well as manufacturing blood cells and homeostasis.See pictures of bones.
• Deformity : noun; deviation from normal form.
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
Types of Acquired Bone Deformities (1)
• Torsional deformity : The bone is twistedmedially (inwards, internally),
e.g. intoeing gait in lower limb.see pic.tip position in upper limb
or laterally (outwards, externally),e.g. outtoeing gait in LL
external rotational deformity in UL
PDF created with pdfFactory Pro trial version www.pdffactory.com
Pictures of internal ( inwards ) torsional deformities
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
Pictures of external ( outward ) torsional deformities
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
Types of Acquired Bone Deformities (2)
• Angular deformity : The bone is seen angulated in 2 planes,1. Sagittal plane ( Antero / posterior ).
e.g. anteriorly ; anterior bowing.posteriorly ; posterior bowing.see pic.
2. Coronal plane ( Medio / laterally ).e.g. medially ; varus deformity.
laterally ; valgus deformity.
PDF created with pdfFactory Pro trial version www.pdffactory.com
Pictures of angular deformity in the sagittal plane ( anterior / posterior )
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
Pictures of angular deformity in the coronal plane ( medial / lateral ), i.e. towards or
away from midline
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
Causes ofAcquired Bone Deformities
• Traumatic. • Inflammatory.• Degenerative.• Infectious.• Tumours.• Dietary.• Miscellaneous.
PDF created with pdfFactory Pro trial version www.pdffactory.com
RicketsA condition producing all types of deformities
• Softening of bone in childhood due to lack of mineralization.
• Due to vitamin D deficiency which leads to Calcium & Phosphorus deficiency.
• Types :1. Dietary deficiency.2. Secondary to liver ( biliary ), renal and intestinal diseases.3. Hereditary, sex-linked, vit - D resistant.
PDF created with pdfFactory Pro trial version www.pdffactory.com
Pictures of rickets with all types of deformities
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
Scoliosistorsional and angular deformities in the spine
See pictures
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
PDF created with pdfFactory Pro trial version www.pdffactory.com
Investigations
• Bone profile; calcium, phosphate, alkaline phosphatase.
• Serum level of vitamin D.• X-rays.• Urinary excretion of calcium and
phosphate.• Bone biopsy.• Bone densitometry.
PDF created with pdfFactory Pro trial version www.pdffactory.com
General Outline of Treatment
• Medically : treat the primary causes plus supplement of deficient factors.
• Surgically : to correct the deformities.• Supportive measures : orthoses and
prostheses to control deformities.• Physical therapy.• Occupational therapy.
PDF created with pdfFactory Pro trial version www.pdffactory.com
Case report
• A 5 years old boy who presents with bowing in both lower extremities. This has been progressive and he takes a poor diet. Family history is negative for a similar case and no history of trauma exists.
• Examination shows increased inte-rcondylar distance with varus deformity of both legs.
• How do you approach this case ?
PDF created with pdfFactory Pro trial version www.pdffactory.com
Answer• History : proper, detailed, precise and accurate.• Examination : General, Systemic & Local.
Tools of Examination: Look(Inspection)Feel(Palpation)Move
SOAP S = Subjective = HistoryO = Objective = ExaminationA = Assessment ( working/DD/definiteDx.)P = Plan ( investigations and treatment )
PDF created with pdfFactory Pro trial version www.pdffactory.com
Requirements & Expectations
• Sound knowledge.• Build up skills of communication with patients,
taking a proper history, conducting a proper examination, reading x-rays and other investigatory tests.
• Intellectuality and cognitive ability are required for best achievement.
• Attitudes and good behavior are mandatory.• Ending up with a safe and a competent medical
practitioner.
PDF created with pdfFactory Pro trial version www.pdffactory.com
The END
PDF created with pdfFactory Pro trial version www.pdffactory.com
• You can download this lecture from the website of : Dr. Abdullah H. A. Juma
www.slideshare.net/slideaj
PDF created with pdfFactory Pro trial version www.pdffactory.com