Transcript Childhood Hip problems in the adult

Childhood Orthopaedic conditions:
Dilemmas
BOTA 2015
Robin W Paton FRCS(Orthopaedic) PhD
Visiting Professor, UCLAN
Honorary Senior Lecturer, University of Manchester
Congenital Talipes Equinovarus
(CTEV)
CTEV
Bilateral CTEV
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1 to 2 per 1000 births
More common in males
Unilateral > bilateral
Exclude spinal & syndromic causes
C: cavus
A: adductus
V: Varus
E: equinus
Congenital talipes Calcaneo-valgus (CTCV)
CTCV
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Deformity: foot towards shin
Rarer than CTEV
Associations:
pathological DDH
fibular hemi-melia
spinal disorders
vertical talus
Pes cavus (including plantaris deformity)
Secondary causes
Pes cavus: deformity
brain:
CP/ Friedrich ataxia
spine:
cord tether
diastematomylia
polio
spina bifida
Peripheral:
HSMN
muscular dystrophies
Trauma:
compartment
syndrome
burns
Other:
CTEV (iatrogenic)
Duchenne’s MD
Pes cavus
HMSN (Charcot Marie Tooth)
Pathology: autosomal dominant & recessive
inheritance
autosomal dominant form - Chr-17
myelination protein 22 abnormal
Incidence: 1:2500
HSMN I :
HSMN 2:
presents earlier
axonal form
Problem:
progressive deformity
PB/ TA/ weak
Intrinsic ms. Hands/feet wasted
Pes Planus
Tarsal coalition: Calcaneo-navicular bar
Secondary Types
Flexible types:
Hyper laxity
Marfans syndrome
Ehlos Danlos syndrome
Rigid types:
tarsal coalition
vertical talus
JCA
osteochondrosis
Cerebral palsy
Non progressive, brain origin, impaired motor
function, presenting < 2 years of age.
Incidence: 1:400
Classification
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Anatomical:
hemiplegia
diplegia
four limb involvement
total body involvement
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Physiological:
spastic (UMN) 60%
athetoid (basal ganglia) 20%
ataxic (cerebellar)
Pre-natal: maternal infection
alcohol/ drugs
congenital malformation brain
Perinatal: birth trauma/ asphyxia (10%)
Low birth weight/ <36 gestation
Neonatal jaundice
Postnatal: cerebral haemorrhage
NAI
meningitis
Cerebral Palsy
Walking prognosis:
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If can sit independently by 2 years
100% hemiplegia
66% spastic four limb involvement
0% TBI
Slipped Upper Femoral Epiphysis (SUFE/SCFE)
Epidemiology
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1:50,000, > male, black > white
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11 to 15 years of age
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Vulnerable epiphysis:
hormonal: hypothyroidism
(<25 percentile)
growth hormone
renal
radiation
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Mechanical:
trauma
obesity (> 80th. Percentile)
Slipped Upper Femoral Epiphysis (SUFE)
Clinical presentation:
Symptoms:
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Limp
Often no hip pain
Pain radiating to knee
Signs:
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Limited internal rotation of the hip
Limited abduction / flexion of the hip
Foot in external rotation
Unable to weight bear (Loder positive)
Case 1
18 month old female
Case 1
Age 6 years
Case 2
8 year old female
Case 2
Case 2:
20 months post operatively
Case 3
13 year old male
Case 5
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1.5 year old female
Case 5
Post operative 3.5 year old
Thank you
Case 1
15 year old male
Previous surgery aged 18 months right hip