Some Problems in Pediatric Orthopedics Jochymek J. Dpt. of Pediatric Surgery, Orthopedics and Traumatology Masaryk University and Faculty Hospital in Brno Legg - Calvé - Perthes disease • Idiopathic juvenile avascular necrosis of the femoral head • most commonly in boys between ages 4 and 8 years • 10% of cases are bilateral • antalgic limp, pain LCP disease • Physical examination loss of motion, push and pull test Imaging Studies - X ray - bone scan - MRI LCP disease Classification • 1. by the extent of head involvement Caterall – 25, 50, 75, 100 % • 2. by the stage of the disease Waldenström – synovitis, necrosis or collapse, fragmentation, reconstitution LCP disease Treatment Containment is management technique which relies on the acetabulum to maintain the sphericity of the femoral head • Conservative t.- Atlanta brace • Surgery t.- varus osteotomy - redirectional ot.- Salter, Steel - combination Slipped Capital Femoral Epiphysis • ..is a failure of the upper femoral epiphysis allowing displacement of the femoral head on the neck • Most commonly in boys between ages 7 and 15 years • Etiology is complex SCFE Diagnosis • Knee pain, loss of medial hip rotation, Drehman sign • Radiography • Bone scans • CT scans SCFE Treatment • Only surgery treatment • Mild 0 - 30 degrees oper. sec. Arriese- Diase • Moderate 30 – 60 degrees Osteotomy by Imhäuser- Weber, Southwick • Severe 60+ degrees Osteotomy in femoral neck Developmental Dysplasia of Hip • DDH is a generic term describing a spectrum of anatomic abnormalities of the hip that may be congenital or develop during infancy or childhood • Girls 6 : boys 1 • Incidence Czech Rep. 5% • Etiology is multifactorial: genetic factor, intrauterine position, neonatal positioning, joint laxity, hormonal effects DDH Diagnosis • Clinical examination 3x – 2 days, 6 weeks, 3-4 months • Barlow´s sign, Ortolani´s sign, instability, limitation of abduction, shortening • Ultrasound Hip Screening – Graf • Radiography DDH Treatment • Frejka pillow • Pavlik harness • Vertical traction, Over head traction DDH • Contrast arthrography – reduction, spica cast • Obstructing limbus • Lig. transversum • Lig. teres - open reduction • Pulvinar • Tend. M. iliopsoas DDH Surgery treatment • A : Capsular arthroplasty – Chiari • B : Redirectional Osteotomy – Salter, Steel • C : Periarticular Osteotomy - Pemberton DDH • Missed cases, residual dysplasia Clubfoot • syn. Talipes equinovarus • CF is a complex congenital deformity which includes components of equinus, varus, adductus and medial rotation • 1 : 1000 , bilateral in half • Polygenic disorder • The tarsals are hypoplastic, the talus is most deformed Clubfoot Treatment • Ponseti concept – cast treatment, percutaneous achilotomy, splint • Operative treatment- complete subtalar release sec McKay Vertical Talus Genu Varum - Valgum • Genua vara • Genua valga Toe deformities • Polydactyly Leg Length Inequality • Femoral lengthening • Ilizarov lengthening Torticollis muscularis cong. Arthroscopy in childhood Arthroscopy in childhood Arthroscopy in childhood Orthotics