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