7.1 Congenital Deformities Flashcards
(22 cards)
Talipes eqinovarus
Ankle bone
Foot
Bent forward
Bent inward
Complex deformity of ankle and foot
4 type of deformities
CAVE
Cavus of mid foot
Adductus of forefoot
Varus of hind foot
Equinus of hind foot
2 type of club foot
Idiopathic (isolated): unknown cause, no other medical condition
Non-isolated (associated with neurogenic or syndromes)
Risk factor of club foot
genetic predisposition
Chromosomal syndrome
Improper intrauterine position
Multiple fetuses
Oligohydraminos
Amniotic band syndrome
Sign and symptoms of club foot
Small size foot
shortened tendon
atrophy muscles,
limb length discrepancy,
walk in lateral boarder of foot
Why medical management should start asap
Take advantage of elasticity of tissue forming ligament, joint capsules and tendon
Bones primarily cartilaginous at birth, begin to ossify shortly
2 treatment options of club foot
- Ponseti method
Correction:
1) Gentle manipulation
2) Casting (from toes to upper thigh, 5-9 casts, last cast wears for 3 weeks)
3) percutaneous Achilles tenotomy 挑腳筋 (release tight heel cord)
Maintain correction:
Bracing program (full time for 3 months, at night for 3-4 years)
- surgical intervention
Indication: Ponseti method fail, severe relapse
- posteromedial release procedure/
tibialis anterior tendon transfer TATT
- cast+brace
Nursing management of club foot
Check circulation and skin of foot
Expose top of toes
Keep cast clean and dry
Change diaper often to prevent cast soiling
Report if: red, sore, irritated skin
foul-smelling odor or drainage
Poor circulation in toes
Cast slipping off
DDH
Developmental dysplasia of hip
Unstable joint (socket or acetabulum & femoral head misaligned)
Type of DDH
Dysplasia
Subluxation
Dislocation
(Femoral head located inside/partially outside/outside acetabulum)
(Unstable joint capsules, shallow acetabulum)
Risk factor
- physiologic factor
- mechanical factor
- physiologic factor
Hormonal effect of estrogen increase laxative of hip joint
Female (with higher ligament laxative) - mechanical factor
Breech presentation 頭向上胎位
Swaddling practice 打直包b
Twin/first pregnancy, oligohydraminos
Clinical manifestations of DDH
- positive Ortolank’s sign (abd) clunk
- positive Barlow’s sign (add) click
Shortening of thigh
Asymmetry of thigh creases米芝蓮, gluteal and thigh skinfold
Positive Galeazzi sign 高低膝
Use USG or X-ray for diagnosis DDH?
USG for infant<6 month
X-ray for infant 4-6mont
(X-ray not show Cartilage )
Medical management
Newborn-6months
- Paclik harness
To maintain flexed and abducted position, full time for 6-12 weeks nighttime for 4-6 weeks
Change treatment if fail to reduce within 4 weeks
6-18 months
- Closed reduction and spica cast
Manual manipulation
> 18 months
- Open reduction and spica cast
Pelvic osteotomy to reshape socket
Complication of pavlik harness
Avascular necrosis
Nursing management of DDH
prevent immobility complication
Skin problem
spalik harness care
(Avoid anything holds legs together
Type of scoliosis
Idiopathic
(Mostly onset: adolescent >11)
Congenital
Neuromuscular
(Non ambulatory patient primary neuromuscular problems)
Signs and symptoms of scoliosis
Unequal shoulder height, waist angle, scapular prominences and height,
Ribs prominences & chest asymmetry
Back pain
Breathing difficulties
Diagnostic test for scoliosis
Adam’s forward bent test
Use scoliometer
X-ray
Use Cobb method >10 degree
Scoliosis curve magnitudes
Mild 10-20
Moderate 20-45
Severe >45
Scoliosis Medical management
Mild
- regular follow up
- muscle stretching + strengthen ex
Moderate
- brace treatment
1) CTLSO/ Milwaukee brace
2) TLSO/ Boston brace (common)
3) Charleston bending brace (night)
Severe
- spinal fusion
- vertebral body tethering
Pavlik harness care
- Soft padding can be added to cover straps to prevent harmful rubbing
- avoid anything holding legs tgt
- diaper worn beneath abduction straps
- wear knee length socks beneath lower leg straps and booties to prevent chafing
- do not pick baby up by feet
