Skeletal System Malformation Center for Joint Surgery Southwest Hospital

Congenital Torticollis Osteal torticollis Muscular torticollis: common

Etiology Contraction and degeneration of one side of sternocleidomastoid musle Cause of degeneration? unknown Congenital disease? unknown

Diagnosis Node found at the lower part of sternocleidomastoid muscle within 1 week after delivery. Physical sign Without red skin, rising of temp., tenderness Node change into fibrous bundle, later.

Differentiation diagnosis Congenital cervical malformation Infectious diseases Torticollis caused by poor-sighted. Torticollis caused by poor-hearing. Benign paraxysmal torticollis

Treatment Physical therapy: heat, massage, manual, orthopaedic splint, etc. Traction Surgical therapy: – Infant 1-4 years – Amputation of sternocleidomastoid muscle – Plaster fixation after surgery.

Congenital dislocation of hip, CDH Female: male = 6:1 Etiology – 20% cases have inheritance character – Delivery station: breech delivery （臀位生产） – Local custom

Pathology Malformation of bone and soft tissue structures around hip joint. – Leaning of pelvis – False acetabular – Malformation of original cup – Compensative scoliolosis （脊柱侧弯）

Diagnosis -Physical Examination Pre-standing phase – Allis sign or Galeazzi sign – Barlow test – Ortolani sign – Abduction sign

Diagnosis -Physical Examination Dislocation phase – Physical sign – Limping – Nelaton line – Trendelenburg test

Fluorenscopy examination (X ray) Perkin quadrant Acetabular index CE angle (center edge angle) Shenton line Sharp angle

Treatment Infant phase (0-6 months) Pavlik splint

Treatment Child phase (1-3 years) Manual reduction, splint, plaster

Treatment Child phase (>3 years) Surgical reduction – Salter Pelvic Osteotomy, <6 years – Pemberton Acetabular Osteotomy >6 years Acetabular index > 46° – Chiari Osteotomy: Older patients Acetabular index > 46°

Congenital Talipes Equinovarus Morbidity: 1% Male : female: 2:1 Etiology: unknown

Pathology Adduction of intertarsal joint （跗骨间关节） Dorsal flexion of ankle joint Varus of foot Tibial inversion or contracture of posterior tibial muscle

X ray examination

Treatment-Non Surgical Manual rectification Infant < 1 year 2 times / day Continue for several weeks Fixation in bandage

Treatment-Non Surgical Splints Plaster fixation

> 10 years old Soft tissue surgery Triple ankle joint union Treatment-Surgical

Scoliosis Non-structural scoliosis Idiopathic scoliosis – Infant type ( <4 years) – Juvenile type ( 4 –10 years) – Adolescent type ( >10 years)

Pathology Change of vetebraea, lamina, spinal process Ribs Intervetebrea disk, muscle, ligament Visceral leision （内脏病变）

Diagnosis Physical signs Heart and lung diseases X ray examination – A-P, lateral – Traction – Stagnara – Contrast examination

Flatfoot Loss of foot arch Etiology: Congenital: vaguls of calcaneous, vertical talus, great navacular tubercle, paranavacular bone, soft tissue diseases. Secondary

Diagnosis Flat foot Pain during long time walking X ray :lateral shot

Treatment Non-surgical treatment: – Training of anterior and posterior tibial muscle – Orthopaedic shoes – Manual treatment – Plaster fixation Sugical treatment: triple ankle joint union.

Hallux Valgus Valgus malformation of first phalanx （趾骨） Pain of the head of the first phalanx Treatment: Physical therapy Surgical therapy: – soft tissue, bone, combination MC bride, Keller, etc.