Acquired Bone Deformities Integrated - based Lecture By Dr. Abdullah H A Juma Department of Orthopaedics & Trauma

Definitions AcquiredAcquired : adjective; arising in response to the action of the environment on the organism. It is opposite to congenital, familial, genetic & hereditary. It develops after birth. BoneBone : noun; the hard part of the skeleton. Functions as supportive, locomotive & protective as well as manufacturing blood cells and homeostasis. See pictures of bones. Deformity : noun; deviation from normal form.

Types of Acquired Bone Deformities (1) Torsional deformity : The bone is twisted medially (inwards, internally), e.g. intoeing gait in lower limb.see pic. tip position in upper limb or laterally (outwards, externally), e.g. outtoeing gait in LL external rotational deformity in UL

Pictures of internal ( inwards ) torsional deformities

Pictures of external ( outward ) torsional deformities

Types of Acquired Bone Deformities (2) Angular deformity : The bone is seen angulated in 2 planes, 1. Sagittal plane ( Antero / posterior ). e.g. anteriorly ; anterior bowing. posteriorly ; posterior bowing.see pic. 2. Coronal plane ( Medio / laterally ). e.g. medially ; varus deformity. laterally ; valgus deformity.

Pictures of angular deformity in the sagittal plane ( anterior / posterior )

Pictures of angular deformity in the coronal plane ( medial / lateral ), i.e. towards or away from midline

Causes of Acquired Bone Deformities Traumatic. Inflammatory. Degenerative. Infectious. Tumours. Dietary. Miscellaneous.

Rickets A condition producing all types of deformities Softening of bone in childhood due to lack of mineralization. Due to vitamin D deficiency which leads to Calcium & Phosphorus deficiency. Types : 1. Dietary deficiency. 2. Secondary to liver ( biliary ), renal and intestinal diseases. 3. Hereditary, sex-linked, vit - D resistant.

Pictures of rickets with all types of deformities

Scoliosis torsional and angular deformities in the spine See pictures

Investigations Bone profile; calcium, phosphate, alkaline phosphatase. Serum level of vitamin D. X-rays. Urinary excretion of calcium and phosphate. Bone biopsy. Bone densitometry.

General Outline of Treatment Medically : treat the primary causes plus supplement of deficient factors. Surgically : to correct the deformities. Supportive measures : orthoses and prostheses to control deformities. Physical therapy. Occupational therapy.

Case report A 5 years old boy who presents with bowing in both lower extremities. This has been progressive and he takes a poor diet. Family history is negative for a similar case and no history of trauma exists. Examination shows increased inte-rcondylar distance with varus deformity of both legs. How do you approach this case ?

Answer History : proper, detailed, precise and accurate. Examination : General, Systemic & Local. Tools of Examination: Look(Inspection) Feel(Palpation) Move SOAP S = Subjective = History O = Objective = Examination A = Assessment ( working/DD/definiteDx.) P = Plan ( investigations and treatment )

Requirements & Expectations Sound knowledge. Build up skills of communication with patients, taking a proper history, conducting a proper examination, reading x-rays and other investigatory tests. Intellectuality and cognitive ability are required for best achievement. Attitudes and good behavior are mandatory. Ending up with a safe and a competent medical practitioner.

The END

You can download this lecture from the website of : Dr. Abdullah H. A. Juma