1 / 33

Pediatric Orthopedic Management Guidelines for Lower Limb Conditions

Learn about the assessment, management, and treatment of various lower limb conditions in children, including knock knees, leg length inequalities, and femoral deficiencies. Understand the importance of measuring Vitamin D levels and detecting infections early. Follow the guidelines for hip examinations and screening policies to ensure proper care from infancy to early childhood. Utilize Ponseti's method for clubfoot treatment and know when to refer for further evaluation. Stay informed on decision-making processes and outcomes to provide the best orthopedic care for pediatric patients.

emilyhenry
Télécharger la présentation

Pediatric Orthopedic Management Guidelines for Lower Limb Conditions

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Knock knees • Inter-malleolar distance • Mechanical axis • Measure both with tape measure • Consider rickets • Indications ? • Mechanical axis lateral to tibia • Anatomic axis > 15 degrees

  2. Knock knees

  3. Knock knees: management • Guided growth • V expensive plate • Cheaper screws

  4. Vitamin D Measure Vitamin D level in children with aches and pains before referral Low Vitamin D is a potent cause of musculo-skeletal pain 40% of attendees at paedorthop clinic either deficient or insufficient Normal > 50 nmol/L Insufficient < 50 nmol/L Deficient < 25 nmol/L

  5. Infection

  6. Septic arthritis v irritable hip • Decision trees common • History of fever > 38o • Non weight bearing • WCC > 12,000 • ESR > 40 Kocher et al. J Bone Joint Surg Am. 1999 Dec;81(12):1662-70.

  7. Decision analysis • One predictor 0.2% • Two predictors 40% • Three predictors 93% • Four predictors 99%

  8. Outcome Resolution

  9. Outcome Tom Smith Arthritis Life long disability

  10. DDH: Clinical detection

  11. What tests; Neonates • Ortolani reduction clunk (1936) • “segno del scotto” • Barlow test (1966) • Le Damany (1912) • “signe de ressaut”

  12. Ortolani

  13. Barlow

  14. Barlow: Examine each hip separately

  15. What you’re feeling

  16. When ? Old Guidelines • At birth (but many lax) • In first 2/52 • At 6 – 8 weeks (last chance for O/B+) • At 3 months ? • At 6 – 9 months (required by guidelines but ? useful) • 15 - 21 months

  17. Current UK Screening PolicyNIPE 2008

  18. Treatment requirement

  19. Examination at 3 months • Instability unlikely • Limited abduction important • Asymmetric skin creases caused by Nestle • LLD difficult to judge • If in doubt USS at hip instability

  20. Limited abduction

  21. Clubfoot

  22. Ponseti’s method

  23. Ponseti’s method

  24. Ponseti’s method

  25. Ponseti’s method : Splintage • Boots on bar External rotation splintage • 70 degrees ER • Full time 2 - 4 months • Night 2 - 4 years

  26. Ponseti’s method : Splintage

  27. Leg Length Inequality • Use Galleazzi sign for measurement in infants • No need to refer small children unless gross discrepancy or concern about hips

  28. Femoral deficiencies • Spectrum • Congenital short femur • PFFD • 1 in 50-200,000

  29. Examine the hips in children with knee pain

  30. What we’re doing • Central referral place “dummy clinic” • Website for advice and simple treatment • Leaflets • Videos • More advice and guidance • Send back referrals for normal variants

More Related