Deformities and Their Management PDF

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Summary

Deformities or malformations that are present at birth (e.g., clubsoot) are known as congenital deformities. Although some of these anomalies are present from birth, they may not be seen until later in life (e.g. spina bifida). The deformity can be severe and life-threatening (e.g., osteogenesis imp...

Description

Deformities and Their Management An anomaly in the bone (e.g., a mal-united fracture), joint (e.g., TB of the knee), or soft-tissues can cause deformities (e.g., clubfoot). These conditions might be congenital or acquired. Deformities or malformations that are present at birth (e.g., clubsoot) are known as congenital deformities. Although some of these anomalies are present from birth, they may not be seen until later in life (e.g. spina bifida). The deformity can be severe and life-threatening (e.g., osteogenesis imperfecta congenita), and it only affects stillborn babies. On the other hand, it could be insignificant and have no practical implications. The underlying causal variables could include: I a genetic abnormality (e.g., diaphysial aclasis, mongolism, etc. ); (ii) environmental factors (e.g., phocomelia); or (iii) a combination of genetic and environmental factors (e.g., phocomelia) (e.g., congenital dislocation of the hip, clubfoot). Deformities acquired later in life can be classified as those that arise at a joint or in a bone as described below: Deformities at a joint: A joint can become deformed as a result of one or more of the following factors: a) Dislocations and subluxations: These can be traumatic (e.g., most dislocations and subluxations seen in day-to-day practise) or pathological (e.g., most dislocations and subluxations seen in day-to-day practise) (e.g., following

acute septic arthritis). Some subluxation or dislocation causes classic malformations b) Muscle imbalance: Two opposing sets of muscles span all joints. Normally, these muscles keep the joint in a state of equilibrium. It's possible to keep it in any position. An uneven activity of the muscles may retain the joint in a specific position in some illnesses. The capsule, ligaments, and other soft tissues around the joint contract with time, preventing the joint from returning to its neutral position. Muscle imbalance can result from group paralysis (e.g., polio) or excessive activity (e.g.. spasticity in cerebral palsy). c) Muscle and tendon tethering or contracture: Joint movement is normally coupled with muscle contraction and elongation, as well as tendons sliding to and fro. If these functions are disrupted by a disease, the joint is unable to move to its entire range of motion, resulting in deformity. Muscles or tendons may become attached to the bone beneath them (e.g., tethering of the quadriceps to the femur in a fracture). The muscle may lose its natural suppleness (for example, Volkmann's ischemic contracture of the long flexor muscles of the forearm causes wrist and finger flexion desormity). d) Contracture of soft-tissues other than muscles: Joint deformity can be caused by contracture of other soft-tissues such as skin, deep lascia, and other soft-tissues. Contracture of the palmar aponeurosis, for example, might cause one or more singers' metacarpophalangeal and proximal interphalangeal joints to deform (Dupuytren's contracture). Similarly, after burns, rigidity of the scarred skin on the slexor surface of the elbow or knee can cause flexion deformity of the elbow or knee.

e) Arthritis: Arthritis can cause joint deformities. This can happen as a result of a group of muscles spasming in response to discomfort, or as a result of injury to essential structures including ligaments and cartilage. F) Posture: A deformity can develop if a joint is kept in a distorted position on a regular basis. Women who wear thin pointed shoes, for example, have lateral displacement of the great toe (hallux valgus). g) Unknown causes: Some joint abnormalities occur for no obvious reason. Knock-knee deformity (genu valgum), for example, is frequently found in youngsters and has no known cause. Fractures, bone disorders, and improperly growing bones are the three main causes of deformities in bones. a) Fracture: The most common cause of bone deformation is a fracture. When a fracture joins in a misaligned place, this happens. Table-11.1 lists some of the most frequent abnormalities caused by fracture malunion. Bone disorders: Some bone illnesses cause softening and bending of the bones. The majority of these are generalised illnesses that affect multiple or all of the bones. Some instances are as follows: • Metabolic diseases such as rickets and osteomalacia Cushing's syndrome, parathyroid osteodystrophy, and other endocrine problems Paget's disease is a disorder with an unknown cause. Senile osteoporosis, fibrous dysplasia

Bone deformities can be caused by abnormal bone growth. Uneven growth at the epiphyseal plate or unequal growth of two bones in a limb segment are examples of such abnormalities (forearm or leg). The following are some of the most common causes of irregular epiphyseal plate growth: The epiphyseal bone is crushed in a crushing fracture. the plate (Grade-V. Salter and Harris epiphyseal injury). From neighbouring osteomyelitis or arthritis, infection spreads to the epiphyseal plate. • A tumour (e.g., enchondroma in Ollier's disease) can stifle the growth of an adjacent epiphyseal plate. It can sometimes cause local hyperaemia, which stimulates uneven growth of the neighbouring plate (e.g., haemangioma). Dysplasia: Some epiphyseal dysplasias cause joint abnormalities due to improper epiphyseal development.

TREATMENT Many abnormalities do not require treatment because they are not functional or cosmetically significant to the patient. Other abnormalities are not correctable with current treatment options. In all other circumstances, a correction or improvement of the malformation must be attempted. In appropriate instances, the following are some of the methods used. These can be either non-operative or surgical: Nonoperative procedures: Nonoperative methods are tried first if possible.

a) Manipulative correction: This is beneficial for correcting softtissue contracture-related joint abnormalities. The contracture is stretched by gently manipulating it. It is maintained in the corrected position in a plaster cast or splint once it has been repaired.

b) Wedging cast: A cast is put to the distorted joint on the limb. On the convex side of the malformation, a wedge of plaster is carved away. By pressing the portion into the correct place, the plaster wedge is closed. c) Traction: With gradual traction, you can straighten out your legs. soft-tissues contracture The position is then held in a splint or with callipers. d) Splints: These are specialised splints that allow for gradual soft-tissue stretching, resulting in the correction of deformities caused by soft-tissue contractures (e.g., turn-buckle splint). Surgical procedures: If nonoperative methods fail or the abnormality is largely bony, surgical correction may be necessary. The following techniques are employed: a) Soft-tissue release: The soft-tissues that have been contracted are released. Soft-tissue tethering is eliminated. b) Osteotomy : This procedure is used to fix deformities in the bones. The malformed bone is cut and repositioned in the proper location (e.g., for genu varum and valgum). Moto c) Arthrodesis (joint fusion): In this procedure, a malformed joint is opened, the cartilage is removed, and the joint is held in a corrected position so

that the bone components fuse together (e.g., in severely deformed T.B. of the knee).

d) Arthroplasty: A portion of the damaged joint is excised and replaced with an artificial joint to repair the deformity (excision arthroplasty) (replacement arthroplasty). e) Epiphyseal growth selective retardation: This is used to treat abnormalities caused by unequal epiphyseal growth. Surgical interserence stops the growth of the growing side of the epiphysis. This is done in a few cases with genu varum or valgum, although it is a risky procedure. Ilizarov's technique: Ilizarov's technique is a versatile deformity correction technique. When the deformity is accompanied with shortening or occurs in more than one plane, it is more useful. The apparatus allows for extremely precise correction of the malformation....