Congenital talipes equino varus (CTEV), also known as clubfoot, is a congenital deformity of the foot where the foot is twisted inward and downward. The causes are mostly unknown but may be genetic, mechanical pressure in the womb, or issues with calf muscle development. Clinically, the foot appears smaller, turned inward and downward. Treatment depends on severity but may include manipulation, casting, soft tissue releases, tendon transfers and osteotomies. Splint
3. CTEV
Vague term used to define a number of
abnormalities in the foot.
4. CTEV-ETIOLOGY
The true etiology of congenital clubfoot is
unknown.
Idiopathic
Mechanical-intra uterine pressure
Ischeamia of calf muscles
genetic
Secondary
Paralyticdisorders
Arthrogryposis multiplex congenita.
5. CTEV-PATHO ANATOMY
Bones
Smaller
Talus faces downwards
Calcaneum small
Joints
Ankle-equinus
Subtalar-inversion
Mid tarsal-Forefoot adduction and cavus
Muscles and tendons
Posteriorly- tendo achilles.
Medially- TP, FDL, FHL
Capsules and ligaments
Capsules of ankle and sub talar joint,
Medially-Talo navicular ligament, spring ligament, deltoid
ligament
Plantar fascia and ligaments
6. CTEV-CLINICAL FEATURES
Detected at birth
Brought during early infancy
Brought during late infancy and early childhood
Brought during late childhood
Examination
Normally-foot dorsiflexed to touch the chin of tibia
Foot is smaller, in equinus, varus and adduction.
Heel is small
Deep skin creases on the back and medial side of foot
Bony prominences and callosities on the lateral side of
foot
Outer side of the foot is convex.
12. SPINA BIFIDA
A congenital disorder in which the two halves
of the posterior vertebral arch fail to fuse at
one or more levels.
13. SPINA BIFIDA-TYPES
Occulta
Mildest form
Midline defect near the lamina
Cystica
More severe form
Contents of the canal prolapse
Meningocele
Myelomeningocele-open, closed.
hydrocephalus
14. SPINA BIFIDA-CLINICAL FEATURES
Spina bifida occulta
Usually nothing
Midline dimple, tuft of hair, pigmented navus
Neurological symptoms-enuresis, incontinence,
weakness in the lower limbs
Spina bifida cystica
Saccular lesion in the lumbar region
Hydrocephalous
Equinovarus or calcaneo valgus of feet
Recurvatum of knee
Hip dislocation
LMN type paralysis
Loss of sphincter control
18. SPINA BIFIDA-TREATMENT
Wound care
Poper closure of defect
Hydrocephalous- ventriculo-peritoneal shunt,
if necessary for 5 to 6 years.
Physiotherapy and splinting
20. CDH
Spontaneous disloation of the hip occuring
before, during or shortly after birth.
21. CDH-AETIOLOGY
Not well understood
Hereditary predisposed to joint laxity
Hormone induced joint laxity
Breech presentation
Hereditary faulty development of
acetabulum.
22. CDH-PATHOLOGY
Femoral head is dislocated upwards- small
capital epiphysis
Femoral neck- anteverted
Acetabulum-shallow
Ligamentum teres-hypertrophied.
Fibrocartilaginous labrum- folded limbus.
Streched capsule
Muscles-shortened
23. CDH-CLINICAL FEATURES
At birth-from pediatrician
Early child hood-asymmetry of groin creases,
limitation of hip movements, click
Older children-peculiar gait.
25. CDH-DIAGNOSIS
Barlow’s test
Ortolani’s test
Galeazzi’s sign
Telescopy test
Trendelenburg’s test
Xray-shallow acetabulum, break in shenton’s
line, small head
Ultrasound
29. SPRENGEL’S SHOULDER
Failure of descent of the scapula, which is
developmentally a cervial appendage.
30. SPRENGEL’S SHOULDER-CLINICAL FEATURES
May be noticed at birth
Shoulder on the affected side is elevated
Smaller shoulder
Occasionally both sides are affected(klippel feil
syndrome)
Shorter neck-associated with kyphosis or
scoliosis
Abduction and elevation restricted
Xray-scapula may be elevated, associated
vertebral anomalies.
32. SPRENGEL’S SHOULDER-TREATMENT
Mild- left alone
Children younger than 6 years-scapula an be
repositioned by release of the muscles,
exision of the supraspinous portion of the
scapula.
34. MADELUNG DEFORMITY
Defective growth of the distal radial epiphysis
resulting in a deformity due to a comparative
overgrowth of the ulna.
Traumatic and congenital
35. MADELUNG DEFORMITY-CLINICAL FEATURES
Lower end of radius curves forwards and
ventrally
Wrist is dislocated
Lower end of ulna projects out
May be isolated or a part of generalised
dysplasia
Deformity increases until growth ceases
40. RADIO ULNAR SYNOSTOSIS-CLINICAL FEATURES
Postero lateral dislocation of radial head
Complete loss of supination and pronation
41. RADIO ULNAR SYNOSTOSIS-TREATMENT
Exision of the bony bridge- unsuccessful.
Change the resting position of the limb to
supination by tendon transfers.
43. PSEUDARTHROSIS OF TIBIA
A birth defect in the lower end of tibia in
children, where a fracture fails to unite.
44. PSEUDARTHROSIS OF TIBIA-PRESENTATION
Usually diagnosed in early infany
Child may be born with a fractured tibia or
attenuated later in life.
Leg is bowed anteriorly
Xray
Gap, marked thinning, sometimes fibula is also
afffected
48. PSEUDARTHROSIS OF TIBIA-TREATMENT
Simple immobilisation-fails
ORIF with bone grafting-succeeds
occasionally
Excision of the affected segment and slowly
closing the gap.
