Lower limb deformities MUDr Zdenk Matjovsk CSc Ortopedick

Lower limb deformities MUDr. Zdeněk Matějovský, CSc. Ortopedická klinika 1. LF UK FN Bulovka Praha

Definition n Deformity is mutilation caused by: -congenital / developmental aberration -as result of accident or disorder n any n In deviation of normal proportions strict sense any deviation of axis

Sorting according to origin Congenital n Transversal (whole cross-section) 1/3 n Longitudinal (in sagital plaine) distal to elbow/knee Acquired n disorder (rachitis, arthtrosis) n after injury

Sorting according to plane of deformity 1/ Sagital plane: bone - antecurvation, retrocurvation joint - flexion, extension n 2/ Frontal plane: varous, valgous joint– adduction, abduction n 3/ Rotation anteversion, retroversion n 4/ Combined: equinovarus n

Congenital deformities of lower limb n Endogenic factors - genetic f. n Exogenic factors - teratogenic f. , uterus abnormality, machanical force, ionisation, drugs

Congenital deformities of lower limb n n n Amnial bands syndrom (Thalidomid) Femur-fibula-(ulna) syndrom (FFU) Congenital pseudoarthrosis of shin – distal tibia. Boyd (antecurvation/thickness/cyst/ stress fracture). Therapy allograft from mother, resection, compression and distraction on external fixateur, amputation Congenital pseudoarthrosis of femur (PFFD) – proximal femur. Pappas I. -IX. Treatment: reposition, retention, PF distraction, renewal, plastic surgery DCC, PEC

Acquired deformities of lower limb n Result of injury Epiphyseal fractures – SH III, IV, SH V, med. tibia, distal femur Adult fractures – losing, comminutive fractures n Disorders: Bones - M. Blount, Rachitis Joints - osteoartrosis, RA, inflamations n Acquired deformities of foot and digits

Hip joint n Coxa valga subluxans n Coxa vara congenita n Part of DCC, rotational and valgus component n Acquired deformity with capital slide (slipped femoral capital epiphysis) n treatment: DVO, eventual pelvic osteotomy n Treatment: intertrochanteric or cervical OT

Knee joint n Genu varum n Genu valgum After inflammation, n After inflammation, Blount disease, rachitis. chondrodystrophy. n Therapy: High tibial OT n Therapy Epiphyseodesis, supracondylic femoral epiphyseal distraction, OT, epifyzeodesis, extension by external epifyzeodistraction, fixateur prolongation. n

Knee joint Genu recurvatum n Rachitis, result of injury n Therapy: symptomatic, wedged OT, correction with external fixateur Genu flextum n degenerative arthrosis, rheumatic arthritis, haemophilia n total knee arthroplasty, redress

Foot deformities n Congenital -structural (non-reducible) -positional (reducible) n Acquired -static(due to overloading) -secondary (after injuries/disorders)

Foot deformities n Pes equinus n Pes excavatus n Pes planovalgus (valgus foot) n Pes transversoplanus (flatfoot)

Static deformities of forefoot n Hallux valgus n Hallux varus n Hallux rigidus n Digitus malleus (Drumstick finger) DIP n Digitus hamatus (Hammer finger) PIP