Transcript Document
Orthopedics At A Glance Jeffrey Gershel, MD Jacobi Medical Center Intoeing • Angle of gait (FPA) – Normal 10-300 • Age-dependent Common Causes of Intoeing • Normal (usually) – Metatarsus Adductus – Internal Tibial Torsion – Femoral Anteversion • Pathologic – Club foot Metatarsus Adductus b Metatarsus Adductus (Varus) Metatarsus Adductus (Varus) • 1-3/1000 • Intrauterine crowding • Usually no RX needed – – – – Exercises Shoes Casting Bracing Varus vs. Valgus Varus Valgus Assessing Metatarsus Adductus • Heel bisector – 2nd-3rd toes • Lateral border – Convex • Widened space between first two toes • Flexibility • Dorsiflexion Metatarsus Adductus Club Foot • Talipes equinovarus – Equinus: plantar flexion • Walk on toes • Cannot dorsiflex – Varus: hindfoot inverted – Metatarsus adductus (and suppinated) – Cavus: high arch Club Foot Club Foot • Epidemiology – – – – 1/1000 M>F R>L Familial incidence • Associated findings • ?Neuromuscular disorder Club Foot Calcaneovalgus • Foot against anterolateral tibia – Dorsiflexion – Eversion • Can have “windswept feet” Calcaneovalgus • • • • Foot points up and out Joint laxity Stretching Later onset: neuromuscular disease Internal Tibial Torsion • 2nd year of life • Lateral malleolus anteriorly placed • Increased by prone sleeping Internal Tibial Torsion Denis Browne Bar Femoral Anteversion W Position Femoral Anteversion • F>M • Decreases with age – – – – 1 year old: 39o 2 years old: 31o 10 years old: 24o 16 years old: 16o Femoral Anteversion Femoral Anteversion Genu Varum (Bowlegs) • 1-3 years old • Medial knee capsule contracture • Increased distance between the knees • Differential diagnosis – Blounts – Rickets Blount’s Disease Rickets Developmental Hip Dysplasia (DDH) • • • • • 1-2/1000 Females >> males Familial Breech Oligohydramnios DDH Examination Barlow Ortolani DDH Examination Asymmetric skin creases Galeazzi sign Nursemaid’s Elbow Reduction of Nursemaid’s Elbow • • • • Axial traction Flex elbow Supinate forearm “Click” Osgood Schlatter • • • • Early teens Repetitive stress Pain with activity Prominent tibial tuberosity Osgood-Schlatter Osgood-Schlatter Congenital Torticollis (Wryneck) • 20% have DDH • Ischemia of SCM • SCM mass Torticollis • Head tilts to affected side • Face rotates to opposite side • “Catching a football” • Treatment: stretching Pes Planus Position of Comfort • Hip effusion – Abduction – External rotation – Flexion • Maximizes volume of the joint Erb’s Palsy • 1/1000 – Breech • • • • Associated fractures Upper brachial plexus Waiter’s tip position No DTR’s