1. Skeletal System Malformation Center for Joint Surgery Southwest Hospital

2. Congenital Torticollis Osteal torticollis Muscular torticollis: common

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

4. 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.

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

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

7. 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

8. 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）

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

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

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

12. Treatment Infant phase (0-6 months) Pavlik splint

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

14. 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°

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

16. 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

17. X ray examination

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

20. Treatment-Non Surgical Splints Plaster fixation

21. > 10 years old Soft tissue surgery Triple ankle joint union Treatment-Surgical

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

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

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

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

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

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

28. 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.