DOCSLIB.ORG

Orthoses in Paediatrics: Supporting Development and Therapeutic Intervention in Babies, Children and Young People

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Orthoses in Paediatrics: Supporting Development and Therapeutic Intervention in Babies, Children and Young People Clinical specialties in orthotics and prosthetics Image Courtesy of Orthokids Orthoses in paediatrics: supporting development and therapeutic intervention in babies, children and young people What is an orthosis? Cranial orthoses for babies with An orthosis (pl. orthoses) is an externally applied device that is positional plagiocephaly and designed and fitted to the body. Orthoses (historically known as splints or braces) are described by the body part they brachycephaly encompass. An orthosis may be used to correct body alignment, What is positional plagiocephaly and support function, minimise discomfort or pain, protect a body part after injury or surgery, re-distribute pressure, correct deformity or brachycephaly? assist in rehabilitation. Positional (or deformational) plagiocephaly (pron. play-gee-o-kef- a-lee) and brachycephaly (pron. brak-ee-kef-a-lee) are types of Orthoses in paediatrics – who needs them? cranial deformity – meaning a misshapen head. Plagiocephaly Orthoses play an important role in supporting development occurs when there is flattening on one side of the head, causing and therapeutic intervention across a range of pathologies in asymmetry. Brachycephaly occurs when there is flattening of the the paediatric population – from hip orthoses to encourage hip back of the head. Plagiocephaly and brachycephaly are common development in newborn babies, to spinal orthoses to reduce cranio-facial conditions that occur most often when babies spend abnormal spinal curves in adolescents with scoliosis or kyphosis. prolonged periods lying with their head in the same position. How do cranial orthoses help? Hip orthoses for babies with Cranial orthoses are a developmental dysplasia of the hip (DDH) treatment option for babies What is DDH? with more severe deformity, where counter positioning Developmental dysplasia (or dislocation) of the hip (DDH) is an is not possible or has not abnormal development of the hip joint. The ball at the top of the improved head shape, and thighbone (the femoral head) is not stable within the socket (the who also have good head acetabulum). The ligaments which hold the joint together may also control. A cranial orthosis be stretched and loose. DDH can occur in one or both hip joints. is a custom-made helmet fabricated with a hard plastic How do hip orthoses help? shell and foam lining. An orthotist designs the helmet to Babies with DDH can be successfully treated with hip abduction Image Courtesy of Orthokids orthoses. There are different types of hip abduction orthoses – a redirect skull growth by fitting Cranial Remodelling Helmet pavlik harness, a ‘Denis Browne’ brace, a ‘Rhino’ brace. Though closely to the head but leaving varied in design, these hip orthoses all hold the hip joint in the room for growth in the flattened area. Refer to the Plagiocephaly most stable position – with the thigh ‘up and out’ - so that the and Brachycephaly Clinical Specialty Fact Sheet for further ligaments tighten and the hip joint develops normally. An orthotist information. works with a multidisciplinary team and the family to determine the hip abduction orthosis design that best meets the hip position Foot abduction orthoses for children requirements of the individual baby. with Congenital Talipes Equinovarus What is Congenital Talipes Equinovarus? Congenital Talipes Equinovarus (or CTEV or congenital clubfoot) is the most common congenital deformity affecting 1 in 1000 Denis Browne Brace live births. In CTEV, the foot is twisted, pointing inward and Image Courtesy of Orthokids downward. www.aopa.org.au 1 of 2 Orthotists – supporting the Australian community How do foot How do spinal orthoses abduction orthoses help? help? Spinal orthoses provide The foot abduction corrective forces on the spine orthosis is also known to promote symmetrical spinal as ‘boots and bar’. alignment in adolescents who It is part of the gold have moderate structural curves standard treatment for (scoliosis 25-45° or kyphosis 55- treating CTEV as part of Foot Abduction Orthosis 80°) and who are still growing. Spinal orthoses effectively the Ponseti method. This method begins with manipulation and prevent curve progression in AIS casting to stretch the foot into a corrected position, then often a Image Courtesy of Orthokids and reduce kyphotic curves in small operation is performed to lengthen the Achilles tendon (a Boston Brace people with Scheurmann’s disease. tenotomy), and finally, wearing of special boots, connected by a Orthotists combine knowledge of complex anatomy and bar (the foot abduction orthosis) to keep the feet in their corrected biomechanics to design and fabricate an orthosis (made out of position and avoid relapse. An orthotist works as part of a rigid plastic) that incorporates the necessary forces to correct multidisciplinary team in the selection and fitting of foot abduction spinal alignment. Refer to the Spinal Clinical Specialty Fact Sheet orthoses to support therapy and surgical interventions. for further detail. Ankle-foot orthoses for children with Who provides orthoses? cerebral palsy An orthotist (pron. or-tho-tist) is a tertiary qualified Allied Health What is cerebral palsy? Practitioner who is trained to assess and treat the physical and functional limitations of people, using orthoses. Orthotists are Cerebral palsy (or CP) is a neurological disorder caused by a responsible for paediatric orthotic management including DDH, non-progressive brain injury or malformation that occurs while plagiocephaly, CTEV, cerebral palsy, scoliosis and kyphosis. the child’s brain is still developing — before birth, during birth, Orthotists combine clinical and biomechanical expertise with or immediately after birth. Cerebral Palsy primarily affects body their knowledge of current evidence, materials and product movement and muscle coordination. Cerebral palsy is the most developments to support children with developmental and mobility common childhood physical disability in Australia. impairments to meet their personal goals. How do ankle-foot orthoses help? How do I access an orthotist? The most common type of orthosis If your child requires orthotic management for one of these – or used to help children with cerebral any other – condition, your GP or medical specialist will refer you palsy is the ankle-foot-orthosis (or to an orthotist. Certified Orthotist/Prosthetists ‘cOP-AOPA’ AFO). AFOs are custom-made can also be located using the ‘Find a practitioner’ search function and encompass the foot, ankle on the AOPA website (www.aopa.org.au). and lower leg. The design and purpose of the AFO is different according to each person’s unique Orthotic management in paediatrics: needs and goals, which often • Many babies, children and young people benefit from includes supporting or correcting orthotic intervention – including those with Developmental abnormal limb positioning, Dysplasia of the Hip (DDH), deformational plagiocephaly, preventing deformity, providing Congenital Talipes Equionovarus (CTEV or clubfoot), cerebral a stable base for sitting and Image Courtesy of Orthokids palsy, scoliosis and kyphosis Ankle Foot Orthoses standing, and facilitating a safer and • Orthoses help to reduce deformity, correct body alignment more efficient walking pattern. AFOs are also used by children and support functional goals such as sitting, standing and who have other conditions such as spina bifida, developmental walking delay or CTEV. Orthotists work with the client, family and members • Orthotists are Allied Health Professionals who support babies, of the multidisciplinary team to determine the most appropriate children and young people by providing comprehensive and AFO to help each child meet their personal goals. evidence based orthotic care and interventions Spinal orthoses for adolescents with scoliosis and kyphosis What is spinal deformity? Spinal deformity is an abnormal curvature of the vertebral column. Two common spinal deformities are Adolescent Idiopathic Scoliosis (AIS) - a sideway curvature of the spine with rotation resulting in a rib hump; and Scheurman’s kyphosis – an increased forward curve of the thoracic (upper) spine presenting as rounded shoulder. Disclaimer – This fact sheet does not replace clinical advice. If you require orthotic services AOPA recommend speaking to your practitioner. This fact sheet was developed based on interpretation of current evidence as of August 2016. References available on request. www.aopa.org.au 2 of 2.
Load more

Recommended publications
  • New Guidelines Review Evidence on PT, Helmets for Positional Plagiocephaly by Sandi K
    Neurologic Disorders, Neurological Surgery, News Articles New guidelines review evidence on PT, helmets for positional plagiocephaly by Sandi K. Lam M.D., M.B.A., FACS; Thomas G. Luerssen M.D., FACS, FAAP Positional plagiocephaly is a common condition encountered by pediatricians and referred to pediatric subspecialty physicians such as neurosurgeons and plastic surgeons. About one in four U.S. infants has some degree of positional plagiocephaly. The incidence has increased since the Academy initiated the Back to Sleep campaign in 1994 to prevent sudden infant death syndrome. Due to practice variation in diagnosis and treatment paradigms for this common condition, the Joint Section on Pediatric Neurosurgery of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons (CNS) sought to develop evidence-based management guidelines. A multidisciplinary task force conducted a systematic review of the literature from 1966 to October 2014 on pediatric plagiocephaly. Nearly 400 abstracts were reviewed yielding 110 articles for full review; 60 were deemed relevant. The task force made 10 recommendations pertaining to imaging diagnosis, repositioning, physical therapy and helmet orthoses. The guidelines are published in CNS' journal Neurosurgery and have been endorsed by the Academy. They are available at http://bit.ly/2d7NzS1. Definition of positional plagiocephaly In the guidelines, the term positional plagiocephaly encompasses both positional occipital plagiocephaly (unilateral flattening of parieto-occipital region, compensatory anterior shift of the ipsilateral ear, bulging of the ipsilateral forehead) and positional brachycephaly (symmetric flattening of the occiput, foreshortened anterior- posterior dimension of the skull, compensatory biparietal widening) and the combination of both of these deformities.
    [Show full text]
  • West Texas Craniofacial Center of Excellence
    TEAM MEMBERS Tammy Camp, M.D. PAID PERMIT #68 LUBBOCK, TX LUBBOCK, U.S. POSTAGE POSTAGE U.S. NONPROFIT ORG Pediatrician, Texas Tech Physicians Desiree Pendergrass, M.D. Pediatrician Dr. Camp Dr. Camp and Dr. Pendergrass will screen infants and children for cardiac, renal, feeding or airway problems often associated with syndromic craniofacial deformities. Alan Eisenbaum, M.D. Pediatric ophthalmologist, Dr. Pendergrass Texas Tech Physicians Curt Cockings, M.D. Pediatric ophthalmologist Dr. Eisenbaum and Dr. Cockings will screen infants and children with abnormal head shapes for any evidence of optic disc swelling of papilledema Dr. Eisenbaum suggestive of elevated intracranial pressure. They will also screen for any visual loss secondary to optic neuropathy, amblyopia or exposure keratopathy as a results of small orbital volume in syndromic synostoses. APPOINTMENTS Dr. Demke sees patients at the Texas Tech Physicians Medical Pavilion in the Surgery Clinic. His clinic days are Tuesday and Thursday, 8 a.m. – 5 p.m. Please call (806)743-2373 for a referral. SURGERY Dr. Nagy sees patients at Covenant Women’s and Children’s Hospital on Tuesdays and Wednesdays 9am – 5pm weekly. For this clinic location, Lubbock, 79430 Texas please call (806) 743-7700 for a referral. He also sees patients at Texas Department Surgery of Tech Physicians Medical Pavilion, 3rd floor, on Mondays from 9am – 5pm 8312 – MS Street 4th 3601 weekly. For this clinic location, please call (806) 743-7335 for a referral. If a patient needs to see both Dr. Demke and Dr. Nagy, arrangements SURGERY will be made to see the patient on the same day.
    [Show full text]
  • Occipital Plagiocephaly: a Critical Review of the Literature
    Occipital plagiocephaly: a critical review of the literature Harold L. Rekate, M.D. Pediatric Neurosurgery, Barrow Neurologic Institute, Phoenix, Arizona The objective of this review was to determine what information is available on the incidence, pathophysiology, late complications, and treatment paradigms for occipital plagiocephaly based on a critical review of the literature obtained from recognized databases in peer-reviewed scientific publications. The content of this article is based on a critical review of the literature, and when discussing treatment options, classification of those articles with respect to the strength of the recommendations they contain. Using standard computerized search techniques, databases containing medical literature were queried for key words related to occipital plagiocephaly beginning in 1966. Key words used for this search were: lambdoid, craniosynostosis, cranial sutures, facial asymmetry, torticollis, and plagiocephaly. Titles of all articles were scanned for relevance. Copies of all potentially relevant articles published in the English language were obtained and received at least a cursory review. Several articles not captured by these methods were found to be important when referenced in the articles obtained. Articles discussing treatment were divided into Class I, Class II, and Class III data for the purpose of deciding on their applicability to the development of a potential consensus for the treatment of this controversial condition. Using the aforementioned key words, there were 4308 articles identified with potential relevance: scanning by title excluded all but 89. Of the 89, those with on-line abstracts were scanned, the remainder were obtained via interlibrary loan when needed for scanning of the article itself. The actual incidence of occipital plagiocephaly is unknown and there are no population-based studies of its incidence or prevalence.
    [Show full text]
  • Occipital Plagiocephaly: a Critical Review of the Literature
    Occipital plagiocephaly: a critical review of the literature Harold L. Rekate, M.D. Pediatric Neurosurgery, Barrow Neurologic Institute, Phoenix, Arizona The objective of this review was to determine what information is available on the incidence, pathophysiology, late complications, and treatment paradigms for occipital plagiocephaly based on a critical review of the literature obtained from recognized databases in peer-reviewed scientific publications. The content of this article is based on a critical review of the literature, and when discussing treatment options, classification of those articles with respect to the strength of the recommendations they contain. Using standard computerized search techniques, databases containing medical literature were queried for key words related to occipital plagiocephaly beginning in 1966. Key words used for this search were: lambdoid, craniosynostosis, cranial sutures, facial asymmetry, torticollis, and plagiocephaly. Titles of all articles were scanned for relevance. Copies of all potentially relevant articles published in the English language were obtained and received at least a cursory review. Several articles not captured by these methods were found to be important when referenced in the articles obtained. Articles discussing treatment were divided into Class I, Class II, and Class III data for the purpose of deciding on their applicability to the development of a potential consensus for the treatment of this controversial condition. Using the aforementioned key words, there were 4308 articles identified with potential relevance: scanning by title excluded all but 89. Of the 89, those with on-line abstracts were scanned, the remainder were obtained via interlibrary loan when needed for scanning of the article itself. The actual incidence of occipital plagiocephaly is unknown and there are no population-based studies of its incidence or prevalence.
    [Show full text]
  • Identifying the Misshapen Head: Craniosynostosis and Related Disorders Mark S
    CLINICAL REPORT Guidance for the Clinician in Rendering Pediatric Care Identifying the Misshapen Head: Craniosynostosis and Related Disorders Mark S. Dias, MD, FAAP, FAANS,a Thomas Samson, MD, FAAP,b Elias B. Rizk, MD, FAAP, FAANS,a Lance S. Governale, MD, FAAP, FAANS,c Joan T. Richtsmeier, PhD,d SECTION ON NEUROLOGIC SURGERY, SECTION ON PLASTIC AND RECONSTRUCTIVE SURGERY Pediatric care providers, pediatricians, pediatric subspecialty physicians, and abstract other health care providers should be able to recognize children with abnormal head shapes that occur as a result of both synostotic and aSection of Pediatric Neurosurgery, Department of Neurosurgery and deformational processes. The purpose of this clinical report is to review the bDivision of Plastic Surgery, Department of Surgery, College of characteristic head shape changes, as well as secondary craniofacial Medicine and dDepartment of Anthropology, College of the Liberal Arts characteristics, that occur in the setting of the various primary and Huck Institutes of the Life Sciences, Pennsylvania State University, State College, Pennsylvania; and cLillian S. Wells Department of craniosynostoses and deformations. As an introduction, the physiology and Neurosurgery, College of Medicine, University of Florida, Gainesville, genetics of skull growth as well as the pathophysiology underlying Florida craniosynostosis are reviewed. This is followed by a description of each type of Clinical reports from the American Academy of Pediatrics benefit from primary craniosynostosis (metopic, unicoronal, bicoronal, sagittal, lambdoid, expertise and resources of liaisons and internal (AAP) and external reviewers. However, clinical reports from the American Academy of and frontosphenoidal) and their resultant head shape changes, with an Pediatrics may not reflect the views of the liaisons or the emphasis on differentiating conditions that require surgical correction from organizations or government agencies that they represent.
    [Show full text]
  • Congenital Scoliosis of the Pediatric Cervical Spine
    Congenital Scoliosis of the Pediatric Cervical Spine Brandon Toll, Amer Samdani, Joshua Pahys and Steven Hwang Shriners Hospitals for Children-Philadelphia ICEOS Portugal 2018 Introduction Literature on congenital scoliosis predominantly focuses on thoracic and thoracolumbar curves Papers to date include a handful of 1-2 patients and one series of 18 patients of cervicothoracic hemi vertebra (Chen et al, Spine 2018) Purpose: to better define surgical outcomes of patients having undergone spinal fusions for cervical scoliosis with osseous anomalies Methods Retrospective chart and radiographic review of 17 patients was conducted (2009-2016) from a single center (Shriners Hospitals for Children-Philadelphia) All patients treated surgically for cervical congenital scoliosis with adequate clinical and radiographic data available for analysis Analysis was performed with t-tests (paired and independent samples) and binary correlation Concurrent Findings Cohort Total Number (%) VACTERL Syndrome 2 (11.8) 9 boys/8 girls Tethered Cord 2 (11.8) The most prevalent presentations Sprengel’s Deformity 2 (11.8) were torticollis (29%), and Klippel- Torticollis 5 (29.4) Feil syndrome (17.6%) Klippel-Feil Syndrome 3 (17.6) Pierre Robin Syndrome 1 (5.9) Mean age at surgery was 7.07 ± Brown Syndrome 1 (5.9) 3.38 years Bruck Syndrome 1 (5.9) Average follow-up of 3.06 ± 1.78 Poland’s Syndrome 1 (5.9) years Goldenhar Syndrome 1 (5.9) Larsen Syndrome 2 (11.8) 4 cognitively delayed (23.5%) and 3 non-ambulatory (17.6%) Cognitively Delayed 4 (23.5) Non-ambulatory
    [Show full text]
  • Craniofacial Syndromes: Crouzon, Apert, Pfeiffer, Saethre-Chotzen, and Carpenter Syndromes, Pierre Robin Syndrome, Hemifacial Deformity 10/4/17, 406 PM
    Craniofacial Syndromes: Crouzon, Apert, Pfeiffer, Saethre-Chotzen, and Carpenter Syndromes, Pierre Robin Syndrome, Hemifacial Deformity 10/4/17, 406 PM Craniofacial Syndromes Updated: Feb 21, 2016 Author: Kongkrit Chaiyasate, MD, FACS; Chief Editor: Jorge I de la Torre, MD, FACS more... Crouzon, Apert, Pfeiffer, Saethre-Chotzen, and Carpenter Syndromes Crouzon Syndrome Crouzon syndrome was first described in 1912. Inheritance Inheritance is autosomal dominant with virtually complete penetrance. It is caused by multiple mutations of the fibroblast growth factor receptor 2 gene, FGFR2. [1, 2, 3] Features Features of the skull are variable. The skull may have associated brachycephaly, trigonocephaly, or oxycephaly. These occur with premature fusion of sagittal, metopic, or coronal sutures, with the coronal sutures being the most common. In addition, combinations of these deformities may be seen. [4] See the image below. http://emedicine.medscape.com/article/1280034-overview PaGe 1 of 61 Craniofacial Syndromes: Crouzon, Apert, Pfeiffer, Saethre-Chotzen, and Carpenter Syndromes, Pierre Robin Syndrome, Hemifacial Deformity 10/4/17, 406 PM Typical appearance of a patient with Crouzon syndrome, with maxillary retrusion, exorbitism, and pseudoprognathism. Anteroposterior view. View Media Gallery The orbits are shallow with resulting exorbitism, which is due to anterior positioning of the greater wing of the sphenoid. The middle cranial fossa is displaced anteriorly and inferiorly, which further shortens the orbit anteroposteriorly. The maxilla is foreshortened, causing reduction of the orbit anteroposteriorly. All these changes result in considerable reduction of orbital volume and resultant significant exorbitism. In severe cases, the lids may not close completely. The maxilla is hypoplastic in all dimensions and is retruded.
    [Show full text]
  • A Guide to Understanding Craniosynostosis
    a guide to understanding craniosynostosis a publication of children’s craniofacial association 1 a guide to understanding craniosynostosis his parent’s guide to craniosynostosis is designed to answer tquestions that are frequently asked by parents of a child with craniosynostosis. It is intended to provide a clearer understanding of the condition for patients, parents and others. how can children’s craniofacial association (cca) benefit my family? CA understands that when one family member has a ccraniofacial condition, each person in the family is affected. We provide programs and services designed to address these needs. A detailed list of CCA’s programs and services may be found on our website at www.ccakids.org or call us at 800.535.3643. The information provided here was written by a member of the Medical Advisory Board of the Children’s Craniofacial Association. This booklet is intended for information purposes only. It is not a recommendation for treatment. Decisions for treatment should be based on mutual agreement with the craniofacial team. Possible complications should be discussed with the physician prior to and throughout treatment. Design and Production by Robin Williamson, Williamson Creative Services, Inc., Carrollton, TX. ©2015 Children’s Craniofacial Association, Dallas, TX what is craniosynostosis? raniosynostosis is a medical term that literally means fused cbones of the skull. It is a condition that some children are born with or later develop. The skull is abnormally shaped because of the fusion of skull bones. To better understand craniosynostosis, it is helpful to know that our skulls are not made up of one single “bowl” of bone.
    [Show full text]
  • Craniosynostosis
    European Journal of Human Genetics (2011) 19, 369–376 & 2011 Macmillan Publishers Limited All rights reserved 1018-4813/11 www.nature.com/ejhg PRACTICAL GENETICS In association with Craniosynostosis Craniosynostosis, defined as the premature fusion of the cranial sutures, presents many challenges in classification and treatment. At least 20% of cases are caused by specific single gene mutations or chromosome abnormalities. This article maps out approaches to clinical assessment of a child presenting with an unusual head shape, and illustrates how genetic analysis can contribute to diagnosis and management. In brief Apart from the genetic implications, it is important to recog- nise cases with a genetic cause because they are more likely to Craniosynostosis is best managed in a multispecialty tertiary be associated with multiple suture synostosis and extracranial referral unit. complications. Single suture synostosis affects the sagittal suture most com- Genes most commonly mutated in craniosynostosis are monly, followed by the coronal, metopic and lambdoid sutures. FGFR2, FGFR3, TWIST1 and EFNB1. Both environmental factors (especially intrauterine fetal head As well as being associated with syndromes, some clinically constraint) and genes (single gene mutations, chromosome non-syndromic synostosis (usually affecting the coronal abnormalities and polygenic background) predispose to cra- suture) can be caused by single gene mutations, particularly niosynostosis. the Pro250Arg mutation in FGFR3. Most genetically determined craniosynostosis is characterised In severe cases, initial care should be directed towards main- by autosomal dominant inheritance, but around half of cases tenance of the airway, support of feeding, eye protection and are accounted for by new mutations. treatment of raised intracranial pressure.
    [Show full text]
  • Shprintzen-Goldberg Syndrome: Case Report Shprintzen-Goldberg Sendromu: Olgu Sunumu Sinem Yalçıntepe1, Özge Özalp Yüreğir1, Sevcan Tuğ Bozdoğan2, Hüseyin Aslan3
    Meandros Med Dent J Case Report / Olgu Sunumu Shprintzen-Goldberg Syndrome: Case Report Shprintzen-Goldberg Sendromu: Olgu Sunumu Sinem Yalçıntepe1, Özge Özalp Yüreğir1, Sevcan Tuğ Bozdoğan2, Hüseyin Aslan3 1Adana Numune Training and Research Hospital, Genetic Diagnosis Center, Adana, Turkey 2Mersin University Faculty of Medicine, Department of Medical Genetics, Mersin, Turkey 3Eskişehir Osmangazi University Faculty of Medicine, Department of Medical Genetics, Eskişehir, Turkey Abstract Shprintzen-Goldberg syndrome is a rare syndrome with craniosynostosis of coronal, sagittal or lambdoidal sutures, dolichocephaly, typical craniofacial features, skeletal abnormalities, scoliosis, joint hyperextensibility or contractures, neurological findings and brain malformations. Fifteen months old male patient with hydrocephalus and dysmorphic facial appearance was referred to our clinic for genetical evaluation. In his dysmorphic examination, the findings were dolichocephaly, prominent forehead and glabella, hypertelorism, prominent eyes, proptosis, depressed nasal root, anteverted nostrils, small nose, low-set and posteriorly rotated, dysplastic ears, microretrognathia, short philtrum, fish mouth of mouth, plump cheeks, high and narrow palate, secondary alveolar arch, pectus carinatum. Hands were small and he had arachnodactyly. Toes were thin. He had also hypotonia and umbilical hernia. With these findings, he was clinically diagnosed Keywords as Shprintzen-Goldberg syndrome. This is the first reported case of Shprintzen- Shprintzen-Goldberg syndrome, Goldberg syndrome from Turkey according to literature review. dolichocephaly, craniosynostosis Anah­tar­Ke­li­me­ler Shprintzen-Goldberg sendromu, dolikosefali, Öz Shprintzen-Goldberg sendromu koronal, sagital ya da lambdoid sütürlerin kraniosinostoz kraniyosinostozu, dolikosefali, tipik kraniofasiyal özellikler, iskelet anomalileri, skolyoz, eklem hiperekstansibilitesi veya kontraktürleri, nörolojik anomaliler Received/Geliş­Ta­rihi : 01.04.2015 ve beyin anomalileri ile karakterize nadir görülen bir sendromdur.
    [Show full text]
  • Paediatric Orthopedics : When Does Physiology Become Pathology?
    Paediatric Orthopedics : When does Physiology become Pathology? A/Prof Arjandas Mahadev Head and Senior Consultant Department of Orthopaedic Surgery KK Women’s and Children’s Hospital SINGAPORE SCOPE FLATFEET When to Worry? LOWER LIMB MALALIGNMENT INTOEING ACHES AND PAINS ABNORMAL GAIT/LIMPING CHILD FLATFEET FLATFEET Two diagnostic groups Physiological • Dynamic – Due to generalised ligamentous laxity – Due to tight TA • Fixed Flatfeet – Neuromuscular e.g. CP – Idiopathic – Tarsal coalition with/without peroneal spasm Pathological FLATFEET Dynamic FLATFEET Management Dynamic with no tight TA • Watch and Masterly Inactivity Dynamic with tight TA • Stretching and Medial Arch Support Fixed • Treat underlying problem - usually needs surgery. Good Shoeing • Heel in line with back of leg – Firm heel counter • Arch lifted off and not bearing weight – Built in soft arch supports • No pressure on weight bearing area – Good padding of the sole with good flexibility Arch Supports • Most effectively used when the heel is aligned in a good pair of shoes • DOES NOT create an arch- only supports it and arch will collapse again once removed • No need for custom made ones as child is still growing. Arch Supports Heel Cord Stretching FLATFEET When to Worry ? THE VALGUS FOOT Biomechanics FLATFEET TARSAL COALITION Calcaneo Navicular • Dynamic 9 to 12 years – Due to generalised ligamentous laxity oblique xray – Due to tight TA Talo - calcaneum • Fixed Flatfeet 12 to 15 years – Due to pathological ligament laxity. CT – Due to pathological tight muscles 50% bilateral /contracture – Talar anatomy Treat if < 30% involved- treat with soft tissue interposition • oblique talus - fat • Vertical talus - ext digitorum brevis – Tarsal coalition with/without peroneal spasm Spasmodic peroneal flatfoot.
    [Show full text]
  • Diagnosing and Treating Deformational Plagiocephaly
    Nonprofit Organization U.S. Postage PAID Twin Cities, MN Study of Nearly 10,000 Patients Who Have VOLUME 22, NUMBER 5 2013 200 University Ave. E. Permit No. 5388 St. Paul, MN 55101 Head Shape Conditions Yields Valuable 651-291-2848 www.gillettechildrens.org Insights ADDRESS SERVICE VOLUME 22, NUMBER 5 2013 REQUESTED Gillette’s craniofacial program launched nearly 15 years ago under the guidance of Robert Wood, M.D. Our program serves patients from the upper Midwest A Pediatric Perspective focuses on specialized topics in pediatrics, orthopedics, and across the nation who have complex congenital neurology, neurosurgery and rehabilitation medicine. conditions ranging from cleft lip and palate to cranio- Diagnosing and Treating KEY INSIGHTS synostosis. We also care for patients who have rare To subscribe to or unsubscribe from syndromes that affect facial features and head shapes, A Pediatric Perspective, please send an Deformational Plagiocephaly, email to [email protected]. including Apert, Pfieffer and Crouzon syndromes. ■ Craniosynostosis, a condition in which an infant’s cranial bones fuse Editor-in-Chief – Steven Koop, M.D. Torticollis and Craniosynostosis prematurely, should be repaired when Because we have one of the largest programs in the Editor – Ellen Shriner Designers – Becky Wright, Kim Goodness the child is 3 to 6 months old. country—treating nearly 10,000 patients in 15 years— Photographers – Anna Bittner, in Infants Paul DeMarchi we have the opportunity to gather extensive retro- ■ Both craniosynostosis and deform- By Robert Wood, M.D., F.A.C.S., F.A.A.P. spective data. The author presented these findings at Copyright 2013.
    [Show full text]