Top Banner
Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma
55

Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.

Dec 20, 2015

Download

Documents

Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Page 1: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.

Acquired Bone DeformitiesIntegrated - based Lecture

By

Dr. Abdullah H A Juma

Department of

Orthopaedics & Trauma

Page 2: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.

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.

Page 3: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 4: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 5: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 6: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 7: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 8: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 9: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 10: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.

Types of Acquired Bone Deformities (1)

• Torsional deformity : The bone is twisted medially (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

Page 11: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.

Pictures of internal ( inwards ) torsional deformities

Page 12: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 13: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 14: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 15: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 16: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.

Pictures of external ( outward ) torsional deformities

Page 17: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 18: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.

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.

Page 19: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.

Pictures of angular deformity in the sagittal plane ( anterior / posterior )

Page 20: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 21: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 22: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 23: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.

Pictures of angular deformity in the coronal plane ( medial / lateral ), i.e. towards or

away from midline

Page 24: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 25: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 26: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 27: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 28: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 29: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 30: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 31: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 32: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.

Causes of Acquired Bone Deformities

• Traumatic.

• Inflammatory.

• Degenerative.

• Infectious.

• Tumours.

• Dietary.

• Miscellaneous.

Page 33: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.

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.

Page 34: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.

Pictures of rickets with all types of deformities

Page 35: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 36: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 37: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 38: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 39: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 40: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 41: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 42: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 43: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 44: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 45: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.

Scoliosistorsional and angular deformities in the spine

See pictures

Page 46: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 47: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 48: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.
Page 49: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.

Investigations

• Bone profile; calcium, phosphate, alkaline phosphatase.

• Serum level of vitamin D.

• X-rays.

• Urinary excretion of calcium and phosphate.

• Bone biopsy.

• Bone densitometry.

Page 50: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.

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.

Page 51: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.

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 ?

Page 52: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.

Answer• History : proper, detailed, precise and accurate.• Examination : General, Systemic & Local.

Tools of Examination: Look(Inspection)

Feel(Palpation)

Move

SOAP

S = Subjective = History

O = Objective = Examination

A = Assessment ( working/DD/definiteDx.)

P = Plan ( investigations and treatment )

Page 53: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.

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.

Page 54: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.

The END

Page 55: Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma.

• You can download this lecture from the website of : Dr. Abdullah H. A. Juma

www.slideshare.net/slideaj