The Orthopedic Evaluation of The Child

06/02/2007

The Orthopedic History

The chief complain. History of present illness. Birth history. Family history. Growth and development.

Growth and Development

Normal Control Progress

HEAD

HANDS

LEGS

Gross Motor Skills

3 m. Holds head

6 m. Sits with support

9 m. Stands with support

12 m. Walks with support

18 m. Ascends stairs

3 yrs. Pedals tricycle

Head-to-Trunk Proportion

Secondary centers of ossification

Secondary centers of ossification

The Tanner’s Stages of Development

General Principles

Inspection (Angular deformities, Skin lesions…)

Joints Range of Motion.

Grading of Muscle Strength.

Developmental Reflexes.

The Neck

Range of Motion

The Muscular Torticollis

Klippel-Feil Syndrome

The Shoulder

Range of Motion

X-ray Examination

Birth – 3 m.

6 – 18 m.

Neonatal Brachial Plexus Palsy

Congenital High Scapula(Sprengel’s deformity)

CONGENITAL PSEUDARTHROSIS OF CLAVICLE

The Elbow

Range of Motion

The Carrying Angle

- 15 degrees in the newborn- 17.8 degrees in adults

X-ray Examination CRITOE

X-ray Examination

X-ray Examination

Congenital Radial Head Dislocation

Congenital Radial Head Dislocation

Arthrogryposis Larsen’s syn. E.D. syn.

The Hand

X-ray Examination

Madelung Deformity

Polydactyly

Syndactyly

Macrodactyly

The Spine

InspectionScoliosis

Adams forward bending test

Inspection - Kyphosis

Radiographic Evaluation

Risser Sign

The Hip

DDH – The Newborn

Barlow – Ortolani

DDH – The Infant

Limited Abduction

Galeazzi SignAsymmetry of the Thigh Folds

DDH – The Infant

DDH – The InfantKlisic Sign

Contractures

Contractures

Signe du trépied

Contractures

Ely Test

Contractures

Contractures

Contractures

Thomas Test

Contractures

Patrick Test

X-ray Examination

X-ray Examination

X-ray Examination

Craig Test

X-ray Examination – DDH

X-Ray Examination - SCFE

Klein’s line

X-ray Examination – Coxa-Vara

The Knee and Leg

Normal Knee Development

Normal Knee Development

Internal Tibial Torsion

X-ray Examination

Blount’s Disease

Rickets

Congenital Dislocation

Osgood - Schlatter

Osteochondritis Dissecans

The Foot

X-ray Examination

Metatarsus Adductus

Metatarsus Adductus

Talipes Calcaneovalgus

Flexible Flatfoot

Flexible Flatfoot

Flexible Flatfoot

Cavus Foot

Cavus Foot

Meary’s angleHibbs’s angle

Talipes Equinovarus

Talipes Equinovarus

Vertical Talus

Vertical Talus

Clubfoot

VerticalTalus

Cavus Foot

Flatfoot

The Gait Analysis

The Gait Cycle

Special Consideration Based on Age Group

1 – 3 years

-Wide based gait.-Increased hip, knee flexion.-Increased cadence.

4 – 10 years-Stable velocity: 5 y.-Adult gait pattern: 7y.

Intoeing

Intoeing

Toe-walker

Idiopathic (the most common).

Spastic.

The Limping ChildToddler

1 – 3 y.Child

4 – 10 y.Adolescent

11 – 15 y.

-Transient synovitis.-Septic arthritis.-Diskitis.-Fractures.

-DDH.-Coxa-Vara.-Limb length discrepancy.-Cerebral palsy.

-Transient synovitis.-Septic arthritis.-LCP disease.-Discoid meniscus.-Limb length discrepancy.

-SCFE.-Hip dysplasia.-Chondrolysis.-Overuse syndromes.-Osteochondritis Dissecans.

Abnormal Gait Patterns Trendelenburg Gait

Abnormal Gait PatternsProximal muscle weakness

Gower’s Sign

Thank You

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من • تقديمها و إعدادها تم محاضرات سلسلة من هي المحاضرة هذه , دمشق مشفى في العظمية الجراحة شعبة في المقيمين األطباء قبل

. . ميرعلي بشار د إشراف تحت• . المحاضرة هذه في الواردة األخطاء عن مسؤول غير الموقع

•This lecture is one of a series of lectures were prepared and presented by residents in the department of orthopedics in Damascus hospital, under the supervision of Dr. Bashar Mirali.

•This site is not responsible of any mistake may exist in this lecture.

كاظم. مؤيد Dr. Muayad Kadhimد