Thousands of Pediatric Orthopedic Conditions
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Genu Varum and Genu Valgum Genu Varum and Genu Valgum
Common Pediatric Lower Limb Disorders Dr.Kholoud Al-Zain Assistant Professor Consultant, Pediatric Orthopedic Surgeon Nov- 2018 Acknowledgement: Dr.Abdalmonem Alsiddiky Dr.Khalid Bakarman Prof. M. Zamzam Topics to Cover 1. In-toeing 2. Genu (varus & valgus), & proximal tibia vara 3. Club foot 4. L.L deformities in C.P patients 5. Limping & leg length inequality 6. Leg aches 1) Intoeing Intoeing- Evaluation • Detailed history – Onset, who noticed it, progression – Fall a lot – How sits on the ground • Screening examination (head to toe) • Pathology at the level of: – Femoral anteversion – Tibial torsion – Forefoot adduction – Wandering big toe Intoeing- Asses rotational profile Pathology Level Special Test • Femoral anteversion • Hips rotational profile: – Supine – Prone • Tibial torsion • Inter-malleolus axis: – Supine – Prone • Foot thigh axis • Forefoot adduction • Heel bisector line • Wandering big toe Intoeing- Special Test Foot Propagation Angle → normal is (-10°) to (+15°) Intoeing- Femoral Anteversion Hips rotational profile, supine → IR/ER normal = 40-45/45-50° Intoeing- Tibial Torsion Inter-malleolus axis Supine position Sitting position Intoeing- Tibial Torsion Foot Thigh Axis → normal (0°) to (-10°) Intoeing- Forefoot Adduction Heel bisector line → normal along 2 toe Intoeing- Adducted Big Toe Intoeing- Treatment • Establish correct diagnosis • Parents education • Annual clinic F/U → asses degree of deformity • Femoral anti-version → sit cross legged • Tibial torsion → spontaneous improvement • Forefoot adduction → anti-version -
Multiple Hereditary Exostoses Abstract Book, 2005
CONFERENCE ON Multiple Hereditary Exostoses InsightsInsights IntoInto PathogenesisPathogenesis November 3-5, 2005 Shriners Hospital of Houston 6977 Main Street Houston, Texas and the Houston Marriott Medical Center 6580 Fannin Street Houston, Texas Organizers: Dan Wells, Ph.D., Jacqueline Hecht, Ph.D., Sarah Ziegler Sponsored By: The Shriners Hospital The National Institutes of Health American Association of Enchondroma Diseases March of Dimes Birth Defects Foundation The Orthopaedic Research Society The MHE Coalition Gene Dx, DNA Diagnostic Services The Mizutani Foundation for Glycoscience HME: Insights into Pathogenesis. Schedule of Events Thursday November 3, 2005 8:30-9:00 Arrive at Shriners (Coffee and Pastries) 9:00-9:10 Dan Wells, Ph.D. Welcome to conference 9:10-9:30 Jacqueline Hecht, Ph.D. Introduction to genetics and natural history MHE ORTHOPAEDICS AND CLINICAL GENETICS (Christine Alvarez) 9:30-10:10 Christine Alvarez, M.D. Introduction of orthopaedics and defining severity of Hereditary Multiple Exostosis 10:10-10:40 Luca Sangiorgi, M.D., Ph.D. Mutational analysis and clinical expression of disease in patients with HME. 10:40-11:00 BREAK 11:00-11:30 Wim Wuyts, Ph.D. Mutation detection strategies for molecular screening in patients with HME. 11:30-12:00 George Thompson, M.D. Clinical treatments and surgical procedures. 12:00-1:15 LUNCH BONE DEVELOPMENT (Dan Wells) 1:15-1:45 John R. Hassell, Ph.D. FGF binding to percelan isolated from the growth plate. 1:45-2:15 David Ornitz, M.D., Ph.D. FGF that regulate growth plate development. 2:15-2:45 Maurizio Pacifici, M.D., Ph.D. -
Bone and Soft Tissue Tumors Have Been Treated Separately
EPIDEMIOLOGY z Sarcomas are rare tumors compared to other BONE AND SOFT malignancies: 8,700 new sarcomas in 2001, with TISSUE TUMORS 4,400 deaths. z The incidence of sarcomas is around 3-4/100,000. z Slight male predominance (with some subtypes more common in women). z Majority of soft tissue tumors affect older adults, but important sub-groups occur predominantly or exclusively in children. z Incidence of benign soft tissue tumors not known, but Fabrizio Remotti MD probably outnumber malignant tumors 100:1. BONE AND SOFT TISSUE SOFT TISSUE TUMORS TUMORS z Traditionally bone and soft tissue tumors have been treated separately. z This separation will be maintained in the following presentation. z Soft tissue sarcomas will be treated first and the sarcomas of bone will follow. Nowhere in the picture….. DEFINITION Histological z Soft tissue pathology deals with tumors of the classification connective tissues. of soft tissue z The concept of soft tissue is understood broadly to tumors include non-osseous tumors of extremities, trunk wall, retroperitoneum and mediastinum, and head & neck. z Excluded (with a few exceptions) are organ specific tumors. 1 Histological ETIOLOGY classification of soft tissue tumors tumors z Oncogenic viruses introduce new genomic material in the cell, which encode for oncogenic proteins that disrupt the regulation of cellular proliferation. z Two DNA viruses have been linked to soft tissue sarcomas: – Human herpes virus 8 (HHV8) linked to Kaposi’s sarcoma – Epstein-Barr virus (EBV) linked to subtypes of leiomyosarcoma z In both instances the connection between viral infection and sarcoma is more common in immunosuppressed hosts. -
ICD-10 Diagnoses on Router
L ARTHRITIS R L HAND R L ANKLE R L FRACTURES R OSTEOARTHRITIS: PRIMARY, 2°, POST TRAUMA, POST _____ CONTUSION ACHILLES TEN DYSFUNCTION/TENDINITIS/RUPTURE FLXR TEN CLAVICLE: STERNAL END, SHAFT, ACROMIAL END CRYSTALLINE ARTHRITIS: GOUT: IDIOPATHIC, LEAD, CRUSH INJURY AMPUTATION TRAUMATIC LEVEL SCAPULA: ACROMION, BODY, CORACOID, GLENOID DRUG, RENAL, OTHER DUPUYTREN’S CONTUSION PROXIMAL HUMERUS: SURGICAL NECK 2 PART 3 PART 4 PART CRYSTALLINE ARTHRITIS: PSEUDOGOUT: HYDROXY LACERATION: DESCRIBE STRUCTURE CRUSH INJURY PROXIMAL HUMERUS: GREATER TUBEROSITY, LESSER TUBEROSITY DEP DIS, CHONDROCALCINOSIS LIGAMENT DISORDERS EFFUSION HUMERAL SHAFT INFLAMMATORY: RA: SEROPOSITIVE, SERONEGATIVE, JUVENILE OSTEOARTHRITIS PRIMARY/SECONDARY TYPE _____ LOOSE BODY HUMERUS DISTAL: SUPRACONDYLAR INTERCONDYLAR REACTIVE: SECONDARY TO: INFECTION ELSEWHERE, EXTENSION OR NONE INTESTINAL BYPASS, POST DYSENTERIC, POST IMMUNIZATION PAIN OCD TALUS HUMERUS DISTAL: TRANSCONDYLAR NEUROPATHIC CHARCOT SPRAIN HAND: JOINT? OSTEOARTHRITIS PRIMARY/SECONDARY TYPE _____ HUMERUS DISTAL: EPICONDYLE LATERAL OR MEDIAL AVULSION INFECT: PYOGENIC: STAPH, STREP, PNEUMO, OTHER BACT TENDON RUPTURES: EXTENSOR OR FLEXOR PAIN HUMERUS DISTAL: CONDYLE MEDIAL OR LATERAL INFECTIOUS: NONPYOGENIC: LYME, GONOCOCCAL, TB TENOSYNOVITIS SPRAIN, ANKLE, CALCANEOFIBULAR ELBOW: RADIUS: HEAD NECK OSTEONECROSIS: IDIOPATHIC, DRUG INDUCED, SPRAIN, ANKLE, DELTOID POST TRAUMATIC, OTHER CAUSE SPRAIN, ANKLE, TIB-FIB LIGAMENT (HIGH ANKLE) ELBOW: OLECRANON WITH OR WITHOUT INTRA ARTICULAR EXTENSION SUBLUXATION OF ANKLE, -
ICD-9CM Coding Achilles Bursitis Or Tendinitis 726.71 Adhesive
ICD-9CM CODING OF COMMON CHIROPRACTIC CONDITIONS CONDITION ICD-9CM coding Achilles bursitis or tendinitis 726.71 Adhesive capsulitis of shoulder 726 Anklyosing Spondylitis (spine only) 720 Anterior cruciate ligament (old disruption) 717.83 Bicipital tenosynovitis 726.12 Boutonniere deformity 736.21 Brachial neuritis or radiculitis 723.4 Bunion 727.1 Bursitis of knee 726.6 Calcaneal spur 726.73 Carpal tunnel syndrome 354 Cervical radiculitis 723.4 Cervical spondylosis with myelopathy 721.1 Cervical spondylosis without myelopathy 721 Cervicalgia 723.1 Chondromalacia of patella 717.7 Claw hand (acquired) 736.06 Claw toe (acquired) 735.5 Coccygodynia 724.79 Coxa plana 732.1 Coxa valga (acquired) 736.31 Coxa vara (acquired) 736.32 de Quervain's disease 727.04 Degeneration of cervical intervertebral disc 722.4 Degeneration of thoracic or lumbar intervertebral disc 722.5 Disc Degeneration (Cervical with myelopathy) 722.71 Disc Degeneration (Lumbar with myelopathy) 722.73 Disc Degeneration (Thoracic) 722.51 Disc Degeneration (Cervical) 722.4 Disc Degeneration (Lumbar) 722.52 Disc Degeneration (Thoracic with myelopathy) 722.72 Disc displacement without myelopathy (Thoracic) 722.11 Disc displacement of without myelopathy (Cervical ) 722 Disc displacement without myelopathy (Lumbar) 722.1 Dupuytren's contracture 728.6 Entrapment syndromes 354.0-355.9 Epicondylitis (Lateral) 726.32 Epicondylitis (Medial) 726.31 Flat foot-Pes planus (acquired) 734 Fracture (Lumbar) 805.4 Ganglion of tendon sheath 727.42 Genu recurvatum (acquired) 736.5 Genu valgum -
Treatment of Aneurysmal Bone Cysts with Titanium Elastic Nails in Children
Treatment of Aneurysmal Bone Cysts with Titanium Elastic Nails in Children Yi-chen Wang Children's Hospital of Shanghai Xing Jia Children's Hospital of Shanghai Yang Shen Children's Hospital of Shanghai Sun Wang Children's Hospital of Shanghai Liang-chao Dong Children's Hospital of Shanghai Jing Ren Children's Hospital of Shanghai Li-hua Zhao ( [email protected] ) Research Keywords: Primary aneurysmal bone cyst, Titanium Elastic Nails, recurrence, ecacy Posted Date: July 6th, 2020 DOI: https://doi.org/10.21203/rs.3.rs-38776/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/16 Abstract Background: The main treatment method of the primary aneurysmal bone cyst (ABC) is to curettage and bone grafts with high-speed burring, radiotherapy, sclerotherapy, arterial embolism and hormone therapy can be used for the lesions whose location cannot be easily exposed by the surgery. Regardless of the method, high recurrence rates are a common problem. The purpose of this study was to evaluate retrospectively the use of titanium elastic nails as a internal xation in the treatment of aneurysmal bone cysts in children. Methods: Children with histological primary aneurysmal bone cyst were evaluated between 2010 to 2017. The patients were divided into 2 groups according to the treatment plan. Patients in the study group operated with curettage and bone grafts with high-speed burring + internal xation of titanium elastic nails (TEN), and patients in the control group operated with curettage and bone grafts with high-speed burring. The curative effect of the children in the 2 groups were analyzed statistically according to the imaging results (Neer grading) and MSTS functional evaluation. -
Case Report Chondroblastoma of The
CASE REPORT CHONDROBLASTOMA OF THE PATELLA ASSOCIATED WITH AN ANEURYSMAL BONE CYST R. TREBŠE1, A. ROTTER2,V. PIŠOT1 Chondroblastoma is a rare, benign tumor of bone, cartilage germ cells, and they redefined the tumor accounting for about 1% of all bone tumor cases. It as “benign chondroblastoma”. tends to affect the epiphyseal ends of long bones, Chondroblastoma is rare, representing about 1% most often in males during the first and second of all primary bone tumors (1, 5, 9). It is typically decades of life. It has well-characterized radio- centered in an epiphysis. Although it occurs most graphic and histologic features but despite its histo- often in the end of a long tubular bone, it can logically benign appearance a few cases of metastases appear in any secondary center of ossification. It is have been reported. Local recurrences after curet- tage and bone grafting occur in 11% to 25% of cases. most probably a tumor of cartilaginous origin and The features of a patellar chondroblastoma are the is more common in males by a ratio of about 2-to- same as for other locations. In reviewing the litera- 1 (1, 5, 9). Seventy percent of chondroblastomas ture we found an unusually high male-to-female occur during active epiphyseal plate growth, and ratio. It is interesting that the usual treatment of the about two-thirds of the patients are in the second patellar chondroblastoma has been patellectomy, decade of life (5). whereas curettage and bone grafting has predomi- Local pain of several months’ duration and nated in the other locations. -
A Case Report on Charcot-Marie-Tooth Disease with a Novel Periaxin Gene Mutation
Open Access Case Report DOI: 10.7759/cureus.5111 A Case Report on Charcot-Marie-Tooth Disease with a Novel Periaxin Gene Mutation Sorabh Datta 1 , Saurabh Kataria 1 , Raghav Govindarajan 1 1. Neurology, University of Missouri, Columbia, USA Corresponding author: Sorabh Datta, [email protected] Abstract Charcot-Marie-Tooth (CMT) disease is one of the most common primary hereditary neuropathies causing peripheral neuropathies. More than 60 different gene mutations are causing this disease. The PRX gene codes for Periaxin proteins that are expressed by Schwann cells and are necessary for the formation and maintenance of myelination of peripheral nerves. Dejerine-Sottas neuropathy and Charcot-Marie-Tooth type 4F (CMT4F) are the two different clinical phenotypes observed in association with PRX gene mutation. This article describes a case of an elderly male with a novel mutation involving the PRX gene. Categories: Genetics, Internal Medicine, Neurology Keywords: neurology, sensorimotor neuropathy, congenital, gene expression, genetic mutation, protein, pes cavus, demyelinating diseases, charcot-marie-tooth, autosomal recessive disorder Introduction As per the Dyck classification in the year 1970, primary hereditary neuropathies are divided into hereditary motor sensory neuropathy (HMSN) and hereditary sensory autonomic neuropathy (HSAN) [1]. Charcot- Marie-Tooth (CMT) disease is a type of HMSN with an estimated prevalence of 1 in 2,500 [2]. CMT can follow autosomal recessive (ARCMT), X-linked recessive, and also an autosomal dominant pattern. CMT type 4 is a rapidly increasing ARCMT disease form in HMSN, although CMT type 1 and 2 still account for the most substantial proportion of the patient population [3]. CMT4F is a severe, demyelinating subtype of CMT type 4 and is characterized by childhood onset of slowly progressing weakness in the distal muscles associated with atrophy. -
Immunopathologic Studies in Relapsing Polychondritis
Immunopathologic Studies in Relapsing Polychondritis Jerome H. Herman, Marie V. Dennis J Clin Invest. 1973;52(3):549-558. https://doi.org/10.1172/JCI107215. Research Article Serial studies have been performed on three patients with relapsing polychondritis in an attempt to define a potential immunopathologic role for degradation constituents of cartilage in the causation and/or perpetuation of the inflammation observed. Crude proteoglycan preparations derived by disruptive and differential centrifugation techniques from human costal cartilage, intact chondrocytes grown as monolayers, their homogenates and products of synthesis provided antigenic material for investigation. Circulating antibody to such antigens could not be detected by immunodiffusion, hemagglutination, immunofluorescence or complement mediated chondrocyte cytotoxicity as assessed by 51Cr release. Similarly, radiolabeled incorporation studies attempting to detect de novo synthesis of such antibody by circulating peripheral blood lymphocytes as assessed by radioimmunodiffusion, immune absorption to neuraminidase treated and untreated chondrocytes and immune coprecipitation were negative. Delayed hypersensitivity to cartilage constituents was studied by peripheral lymphocyte transformation employing [3H]thymidine incorporation and the release of macrophage aggregation factor. Positive results were obtained which correlated with periods of overt disease activity. Similar results were observed in patients with classical rheumatoid arthritis manifesting destructive articular changes. This study suggests that cartilage antigenic components may facilitate perpetuation of cartilage inflammation by cellular immune mechanisms. Find the latest version: https://jci.me/107215/pdf Immunopathologic Studies in Relapsing Polychondritis JERoME H. HERmAN and MARIE V. DENNIS From the Division of Immunology, Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio 45229 A B S T R A C T Serial studies have been performed on as hematologic and serologic disturbances. -
Peds Ortho: What Is Normal, What Is Not, and When to Refer
Peds Ortho: What is normal, what is not, and when to refer Future of Pedatrics June 10, 2015 Matthew E. Oetgen Benjamin D. Martin Division of Orthopaedic Surgery AGENDA • Definitions • Lower Extremity Deformity • Spinal Alignment • Back Pain LOWER EXTREMITY ALIGNMENT DEFINITIONS coxa = hip genu = knee cubitus = elbow pes = foot varus valgus “bow-legged” “knock-knee” apex away from midline apex toward midline normal varus hip (coxa vara) varus humerus valgus ankle valgus hip (coxa valga) Genu varum (bow-legged) Genu valgum (knock knee) bow legs and in toeing often together Normal Limb alignment NORMAL < 2 yo physiologic = reassurance, reevaluate @ 2 yo Bow legged 7° knock knee normal Knock knee physiologic = reassurance, reevaluate in future 4 yo abnormal 10 13 yo abnormal + pain 11 Follow-up is essential! 12 Intoeing 1. Femoral anteversion 2. Tibial torsion 3. Metatarsus adductus MOST LIKELY PHYSIOLOGIC AND WILL RESOLVE! BRACES ARE HISTORY! Femoral Anteversion “W” sitters Internal rotation >> External rotation knee caps point in MOST LIKELY PHYSIOLOGIC AND MAY RESOLVE! Internal Tibial Torsion Thigh foot angle MOST LIKELY PHYSIOLOGIC AND WILL RESOLVE BY SCHOOL AGE Foot is rotated inward Internal Tibial Torsion (Fuchs 1996) Metatarsus Adductus • Flexible = correctible • Observe vs. casting CURVED LATERAL BORDER toes point in NOT TO BE CONFUSED WITH… Clubfoot talipes equinovarus adductus internal varus rotation equinus CAN’T DORSIFLEX cavus Clubfoot START19 CASTING JUST AFTER BIRTH Calcaneovalgus Foot • Intrauterine positioning • Resolve -
Mackenzie's Mission Gene & Condition List
Mackenzie’s Mission Gene & Condition List What conditions are being screened for in Mackenzie’s Mission? Genetic carrier screening offered through this research study has been carefully developed. It is focused on providing people with information about their chance of having children with a severe genetic condition occurring in childhood. The screening is designed to provide genetic information that is relevant and useful, and to minimise uncertain and unclear information. How the conditions and genes are selected The Mackenzie’s Mission reproductive genetic carrier screen currently includes approximately 1300 genes which are associated with about 750 conditions. The reason there are fewer conditions than genes is that some genetic conditions can be caused by changes in more than one gene. The gene list is reviewed regularly. To select the conditions and genes to be screened, a committee comprised of experts in genetics and screening was established including: clinical geneticists, genetic scientists, a genetic pathologist, genetic counsellors, an ethicist and a parent of a child with a genetic condition. The following criteria were developed and are used to select the genes to be included: • Screening the gene is technically possible using currently available technology • The gene is known to cause a genetic condition • The condition affects people in childhood • The condition has a serious impact on a person’s quality of life and/or is life-limiting o For many of the conditions there is no treatment or the treatment is very burdensome for the child and their family. For some conditions very early diagnosis and treatment can make a difference for the child. -
First Metatarsophalangeal Joint Replacement with Total Arthroplasty in the Surgical Treatment of the Hallux Rigidus R
Acta Biomed 2014; Vol. 85, Supplement 2: 113-117 © Mattioli 1885 Original article First metatarsophalangeal joint replacement with total arthroplasty in the surgical treatment of the hallux rigidus R. Valentini, G. De Fabrizio, G. Piovan Clinica Ortopedica e Traumatologica, Università degli Studi di Trieste, Azienda Ospedaliero-Universitaria “Ospedali Riuniti” di Trieste Abstract. The hallux rigidus, especially in advanced stage, has always been a challenge as regards the surgical treatment. Over the years there have been various surgical techniques proposed with the aim of relieving pain, correcting deformity and maintain a certain degree of movement. For some years we have addressed the prob- lem with the replacement metatarsophalangeal joint arthroplasty with Reflexion system. As far as our experi- ence we have operated and monitored 25 patients (18 females and 7 males) of mean age 58.1 years, operated with this technique from June 2008 to June 2011. It reached an average ROM of 72° (extension and flexion 45° and 27°) with a good functional recovery in 8 patients, and this articulation was good (50° - 40°) in 12 patients and moderate in 5 with a articular range from 40°- 30°. The clinical results, according to our experience, appear to be favorable, as even patient satisfaction is complete. (www.actabiomedica.it) Key words: hallux rigidus, metatarsophalangeal, arthroprosthesis Introduction The pathology of stiff big toe has ranked about Regnauld classification (5) in three stages, so that the Degenerative disease of the first metatarsal- I stage is characterized by wear of the joint with mini- phalangeal articulation, the so-called “Hallux rigi- mal osteophytes reaction, the II stage is reached when dus”, especially in advanced phase, has always been the joint line is further reduced, the articular surfaces a sort of challenge as a surgical treatment.