1. Professor of Orthopedics
Deformities By
Prof.Dr./ Lotfy Yones
Professor of Orthopedics
Tanta University

2. Definition
It is a visible abnormality in shape of any part of the body .

3. Causes A- Congenital : it is seen at birth .may be due to :
1- Chromosomal .
2- Some drugs
3- Abnormal intrauterine fetal posture .
B- Acquired :
1- Developmental .{genetic , metabolic or hormonal }
2- Traumatic { skin , muscles , joints or bone }
3- Nerve injuries .
4- Inflammation { arthritis , myositis }
5- Bone softening diseases {rickets, osteomalacia etc }
6- Infection .

4. Diagnosis 1-History taking 2-Laboratory investigations 3-Imaging :
a-X-ray
b- CT
C-MRI

5. Spinal Deformities

7. A-Kyphosis

8. It is a backward angulations above 40 degrees .
Types :
I-Mobile
Compensatory { exaggerated lordosis}
Postural {bad habit of sitting in adolescence }
Muscle weakness
II-Fixed
Angular {fracture , T.B., Calve disease}
Rounded (regular) {Scheuermann disease , senile kyphosis ,ankylosing spondylitis }
Treatment
1- of the cause
2- Conservative {physiotherapy , brace }
3- Surgery

9. B-Scoliosis

10. Lateral angulation of the spine with vertebral rotation .
Types :
I-Non structural ( correctable , angulation without rotation )
Postural { in adolescent girls due to bad habit of sitting}
Compensatory {short limb , secondary curve }
Muscle abnormalities
II- Structural { not correctable}
Idiopathic
Congenital
Neuromuscular
Treatment
1- Observation
2- Conservative {exercise , brace }
3- Surgery (curves above 50º)

11. Elbow Deformities

13. A-Cubitus varus

14. The carrying angle is below normal (10-15º) .
Causes :
I- Malunited supra-condylar fracture
II- Alternation of the epiphyseal growth of the distal humerous

15. B-Cubitus valgus

16. The carrying angle is above normal .
Causes
I-Non united fracture lateral humeral condyle
II- Mal united supracondylar fracture
III- Assymetrical bone growth in the lower humeral condyle
Both deformities are cosmotic rather than functional .Tardy ulnar neuritis may complicate both deformities .
Treatment
1- Corrective supracondylar oestotomy .
2- In tardy ulnar neuritis : anterior trasposition of the nerve .

17. C- Flexion deformity The patient can not fully extend the elbow .
Causes :
1- Post-traumatic ( fibrosis or myositis ossificans)
2- Post infection
Treatment
1- Physiotherapy
2- Manipulation
3- Surgery (excision of myositis or corrective ostotomy )

18. KNEE DEFERMOTIES

19. A-Genu Varum

20. In ligamentous laxity notelat.Widening
Of knee joints
In Blount angulation at med.tib metaphysis

21. Causes
I- Physiological (up to 2 years )
II- Bone softening disease
III- Trauma to the upper tibial plate growth
VI- O.A. of the knee
V- Blount disease

22. B-Genu Valgum

23. Causes :
The same causes of genu varum except the physiological type appears after the age of 4 years and there is no Blount like disease.
Treatment
In both varus and valgus the treatment is :
1- Treatment of the cause .
2- Observation in physiological types .
3- High tibial osteotomy in genu varum and supracondylar femoral osteotomy in genu valgum.

24. HIP DEFERMOTIES

25. Hip deformities 1-flexion deformity. 2-Abduction deformity.
may be :
1-flexion deformity.
2-Abduction deformity.
3-adduction deformity.
4-external rotation deformity.
5-internal rotation deformity.
6- Coxa vara deformity.
7-coxa valga.

26. COXA VARA

27. coxa vara describes angle smaller than normal.

28. causes: according to the level of affection, it may be:
It is a decrease neck shaft angle .
causes: according to the level of affection, it may be:
1 – Epiphyses:
* septic epiphystitis in infancy .
*Perthes’ disease.
2- Epiphyseal Plate :
*Congenital coxa vara.
*Slipped upper femoral capital epiphysis
3- Femoral neck:
* bone softining diseases.
*Fractures
4-Trochantric area :
*as in femoral neck
5-Skeletal dyspalsia :
*Mucopolysaccharidosis & achondroplasia

29. COXA VALGA

30. Coxa valga describes excessive angle

31. Causes :
1- Commonly in paralytic conditions as poliomyelitis and C.P.
2- Malunited fractures
3- After trochantric valgus osteotomy .
4- Achondroplasia , Hand-Schuller-Christion disease .and metaphyseal dysplasia
Treatment
Both varus and valgus deformities are corrected by subtrochanteric osteotomies.

32. Flexion deformity Causes : 1- Iliac adenitis : flexion deformity only
2- Synovitis : flexion abduction and external rotation (position of maximal capacity )
3- Artheritis : flexion , adduction and internal rotation
4- Posterior dislocation : flexion , adduction and internal rotation .
5- Anterior dislocation : flexion , abduction and external rotation
6- Poliomyelitis : flexion , abduction and external rotation due to contracture of iliotibial band .

33. Ankle and foot DEFERMOTIES

34. Equinus deformity (fixed plantar flexion )
Ankle deformity
Equinus deformity (fixed plantar flexion )
Causes :
1- Congenital as in CTVE
2- Compensatory :Short limb or flexion deformity in the hip or knee
3- Postural : weight of blanket in long bed ridding or in female wearing high heel
4- Paralytic : in poliomyelitis ,C.P. or lateral popliteal nerve injury
Treatment :
1- of the cause
2- Surgery by ETA and posterior capsulotomy and tendon transfer

35. Foot deformity A-Flat foot
It is flattening of the longitudinal arch of the foot
Causes :
1- Congenital
Vertical talus
Tarsal coalition (talonavicular and calcaneocuboid bones)
Accessory navicular bone
2- Infantile : very frequent in infant and children-disappears with growth due to arch development
3- Static : seen in adolescence with long standing due to fatigue of muscles supporting the arch of the foot .Early it is mobile but it becomes rigid later .
4- In poliomyelitis and C.P. : Due to muscle imbalance
5- Traumatic : fracture of tarsal bone .

36. Flat feet mobile or fixed

37. Foot deformity B-Pes Cavus It is high arched foot Causes :
1- Idiopathic (Most common)
2- Neurogenic : poliomelitis , spina bfida , Friederich attaxia and Charcot-Marie –Tooth disease .
3- Posttraumatic : with tarsal bone fracture
4- Compartmental syndromes : High arched fot is usually associated with clawing of the toes

38. THANK YOU