Congenital Malformations Of The Hip, Legs And Feet

Orthopedic hip, leg and Fußfehlbildungen are sometimes not apparent at birth. Causes are the posture in utero, ligaments weakness and skeletal abnormalities. Some abnormalities regress without intervention, others require treatment.

Orthopedic hip, leg and Fußfehlbildungen are sometimes not apparent at birth. Causes are the posture in utero, ligaments weakness and skeletal abnormalities. Some abnormalities regress without intervention, others require treatment. Entwicklungsdysplasie the hips (congenital dislocation of the hip -ehemals DDH) The hip dysplasia (DDH) is an aberration of the hip joint and leads to a dislocation or subluxation. Among the high-risk factors include breech presence of other strains (eg. As torticollis, congenital deformity) Positive family history (especially for girls) DDH seems the result of a ligament weakness or posture in utero to be. An asymmetrical fold of skin on the thigh and in the groin are common, but can also occur without hip dysplasia. If the dysplasia is not discovered or treated shortens the affected leg and the hip is painful. The abduction of the hip is often compromised due to an adductor. All children are examined during routine physical examination then. Since the accuracy of the physical examination is limited, infants are at high risk (and those in which in the physical examination abnormalities were detected) were examined usually with imaging methods. Two screening methods are available (n. D. Talk .: The most important test is the ultrasound examination in the sixth week of life). The Ortolani test detects a sliding back of the hip in the acetabulum, and the Barlow test detects sliding of the hip from the acetabulum. Both hips are examined separately. Both tests begin with the infant in the supine position, the hip and knee flexed to 90 ° (the feet are outside the sun). For the Ortolani test the hip is moved back to the starting position. Then the tested hip is abducted. Here, the knee of the center line is moved away in the direction of the treatment table, so that there is a frog leg position. Now the hip is gently pulled forward. The palpable, sometimes audible snapping of the femoral head, which slips over the back edge of the acetabulum and then is back in the bowl, is an indication of the instability. For the Barlow test the hip is returned to the initial position. The physician then draws on the hip, the knee is pulled over the body, while the thigh is pushed backwards. A Grab gives a hint here, if the femoral head from the acetabulum slips. A difference in the knee when the child is with flexed hips and knees, and feet on the table stand (Galeazzi Galeazzi drawing characters.) Leads to the conclusion primarily on a unilateral dysplasia. Later, about 3 or 4 months, the inability the thigh at diffracted hip and knee indicated to completely abduct, a subluxation or dislocation of the hip down. The abduction is hindered by the adductor spasm, which is often present when the hip is not deployed at the time of the investigation. Smaller clicks can be heard more often. Although these clicks usually disappear after 1-2 months, they should be checked regularly. Since a bilateral hip dysplasia is difficult to detect at birth, the children should be regularly checked during the first year. An ultrasound examination of the hips is recommended at 6-week-old infants at high risk, including those with a breech-birth or with other malformations (z. B. torticollis, congenital deformity), and in girls with a family history of hip dysplasia. For all other infants this is necessary for abnormalities during screening. The hip ultrasound can make the diagnosis early on. Radiographs of the hips can help in the diagnosis after the ossification of the bone has begun, usually 4 months. Early treatment is important. Any delay results in a significant reduction in the chances of a correction without surgical intervention. The hip can usually be brought into position immediately after birth. With the growth can then form an almost normal acetabulum. For treating multiple aids are used. The most common are abduction, which also help the sole wide winding is not effective. Frejka pillow and other rails can help. Padded diapers and double or triple diapers are not effective and should not be used to correct hip dysplasia. Galeazzi sign. The child is positioned as shown. The knee is due to the shift of the developing dysplastic hip backwards on the affected side lower (arrow). Femurtorsion (twisting), the femoral head can be twisted. The twist may be either inwards (anteversion of the femur, the knee facing each other with the toes inwards) or outwardly (retroversion of the femur, the knee point in the opposite direction) to go. It occurs frequently in newborns. At birth, the rotation can be inward almost 40 ° and is still considered normal. An external torsion can manifest at birth and still be normal. A twist is recognized that the child is placed in a prone position on the examination table. The hips are rotated outwardly and inwardly. Limiting the internal rotating shows an anteversion of the femur while a limitation of external rotation is a retroversion of the femur. Children with a twist inward typically sit in a W position (d. E. The knees together and feet are stretched apart) or sleep on your stomach with your legs stretched or flexed and rotated inward. The children take this position probably because it is more convenient for them. Previously it was thought the W position would worsen the twist while sitting. But there is no evidence that the children should avoid this position. In adolescents the inner torsion without intervention reduced gradually to 15 °. (Be in broken bones, turned into normal alignment and splinted) an orthopedic referral and treatment, which includes the de-rotating osteotomy children is reserved who have a neurological disorder such as spina bifida or in children, in which the twist ambulation with special needs. To twist outward can occur when forces cause the uterus to an abduction or rotation of the extremities to the outside. When a torsion is present at birth to the outside, the child should be carefully examined for hip dislocation (X-ray or ultrasound). A twist outward corrected spontaneously start especially if the children to stand and walk. There is a marked twist even after 8 years, the child should be referred to a children’s orthopedic surgeons. In addition to protecting the respiratory tract, the treatment consists of derotationellen osteotomy. Genu varum and genu valgum The 2 main types of misalignment of the knee or the femorotibial angle are the genu varum (bow legs), and the genu valgum (knock-kneed). If left untreated, both of which cause in adulthood a osteoarthritis. The Genu Varum is common in infants and disappear spontaneously at the age of 18 months. If it persists or exacerbated, should be thought of Blount’s disease (tibia vara). Also rickets and other metabolic bone diseases should be excluded (hypophosphatemic rickets). The Blount’s disease is due to a disturbance of growth of the medial aspect of the proximal growth plate of the tibia; Genu Varum and torsion of the tibia may occur. The Blount’s disease may occur in early childhood or in adolescence (when associated with obesity). Early diagnosis of Blount’s disease is difficult because X-rays may appear normal. The classic radiographic findings is the angulation (protrusion) of the medial metaphyseal. The early use of splints or braces may be effective, but surgery with or without an external fixation is often required. Genu varum (bow legs) DR P. MARAZZI / SCIENCE PHOTO LIBRARY var model = {thumbnailUrl ‘/-/media/manual/professional/images/m3500175-genu-varum-bowleg-science-photo-library-high_de.jpg ? lang = en & thn = 0 & mw = 350 ‘, imageUrl:’ /-/media/manual/professional/images/m3500175-genu-varum-bowleg-science-photo-library-high_de.jpg?la=de&thn=0 ‘, title : ‘genu varum (bow legs),’ description ‘ u003Ca id = “v37897603 ” class = “”anchor “” u003e u003c / a u003e u003cdiv class = “”para “” u003e u003cp u003eDieses photo shows a small child with Genu varum

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