Mansoor Kassim

FRCS Trauma and Orthopaedics Exam: A guide to clinicals and vivas

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    b5731182232has quoted7 years ago
    is more than 20-30%.
    -failed reconstructions.
    -Performed at about one year of age.
    -Trimming of the condyles is not necessary in children.
    b5731182232has quoted7 years ago
    cm.
    -nonfunctional foot
    -severe cosmetic problems
    -a patient who may not tolerate multiple surgeries over an extended period.
    -Supramalleolar osteotomy to correct valgus or
    -Gruca procedure: a lateral malleolus is created byperforming an oblique sliding distal tibial osteotomy.
    -Resection of talar coalitions or fusion.
    -Lengthening (up to maximum of 7 cm lengthening during each lengthening process).
    B) Syme amputation
    -Relative indications:
    -if there is an unstable non/poorly-functional.
    -if the limb-length discrepancy
    b5731182232has quoted7 years ago
    lateral translation; c) combined ankle and subtalar deformities; d) malorientation of subtalar joint.
    Type 4: Fixed equino-varus ankle (clubfoot type).
    Management:
    The goal is to enable the child to gain maximal function by achieving adequate lower extremity alignment, length and stability. Amputation was the treatment of choice in the past but advances in limb reconstruction techniques have made reconstructions more common and allows to reconstruct more complex deformities.
    A) Limb reconstruction with lengthening.
    -If there is a good functional foot and ankle.
    -Relative contraindications:
    -maximum discrepancy 7.5-15
    b5731182232has quoted7 years ago
    or miniature fibula;III=complete absence of the fibula.
    Tibiotalar joint and distal tibial epiphyseal morphology:H=horizontal; V=valgus (triangular distal tibial epiphysis; S=spherical (ball and socket).
    Presence of a tarsal coalition = “c”.
    Number of foot rays: 1-5
    Stanitski DF, Stanitski CL. Fibular hemimelia: a new classification system. J Pediatr Orthop 2003;23(1):30-4.
    Paley classification:
    Type 1: Stable normal ankle.
    Type 2: Dynamic valgus ankle.
    Type 3: Fixed equino-valgus ankle. a) ankle type: ankle in procurvatum (apex anterior) and valgus; b) subtalar type: malunited subtalar coalition in equino-valgus with lat
    b5731182232has quoted7 years ago
    external rotation
    4. ACL and PCL deficiency
    5. Patella subluxation
    6. Genu valgus
    7. Short and/or bowed tibia (anteromedial bow)
    8. Ankle valgus
    9. Absent lateral rays
    10. Ball and socket ankle joint
    11. Tarsal coalitions
    12. Coxa vara
    13. Absent foot rays
    Classification:
    Achterman and Kalamchi:
    Type I: part of fibula present.
    Type II: fibula is absent.
    Achterman C, Kalamchi A. Congenital deficiency of the fibula. J Bone Joint Surg-Br 1979;61(2):133-7.
    Stanitski:
    Fibula:
    I=nearly normal fibula; II=small
    b5731182232has quoted7 years ago
    The term postaxial hypoplasia has been suggested.
    -Minimal shortening to complete absence of the fibula.
    -Most common congenital longitudinal lower limb deficiency.
    -1 in 40000 live births.
    Associations:
    1. Proximal Femoral Focal Ddeficiency
    2. Hypoplastic lateral femoral condyle
    3. Femoral hypoplasia with ex
    b5731182232has quoted7 years ago
    pes valgus (congenital vertical talus). The condition and its treatment: a review of the literature. Acta Orthop Belg 2007;73(3):366-72.
    Chalayon O, Adams A, Dobbs MB. Minimally invasive approach for the treatment of non-isolated congenital vertical talus. J Bone Joint Surg Am 2012;94(!!):e731-7.
    Dobbs MB, Purcell DB, Nunley R, Morcuende JA. Early results of a new method of treatment for idiopathic congenital vertical talus. J Bone Joint Surg Am 2006;88(6):1192-200.
    12. Fibular hemimelia
    b5731182232has quoted7 years ago
    Three patients who did not have pin fixation had recurrent dorsal subluxation of the navicular at follow-up.
    Chalayan/Dobbs et al reported on 15 patients with 25 rigid vertical Talus deformities associated with syndromes. The treatment consisted of serial manipulation and casting followed by percutaneous Achilles tenotomy and either pin fixation of the talonavicular joint through a small medial incision to assure joint reduction and pin placement in five feet or capsulotomies of the talonavicular joint and anterior aspect of the subtalar joint in twenty feet. The results at a minimum of 2 years follow-up were excellent with a recurrence in 5 feet.
    Bosker BH, Goosen JH, Castelein RM, Mostert AK. Congenital convex
    b5731182232has quoted7 years ago
    -application of above knee plaster. Removal of wires at 6 weeks followed by walking plaster for another 4 to 6 weeks.
    -More recently, a minimally invasive surgical approach has been described using early serial manipulation and casting (“reversed Ponseti”) after birth. Dobbs et al reported excellent short term (minimum of 2 years follow-up) correction of idiopathic congenital vertical talus deformities in 11 patients with 19 affected feet with serial manipulation and casting and percutaneous Achilles tendon tenotomy. Additional surgery involved fractional lengthening of the anterior tibial tendon in two feet, lengthening of the peroneal brevis tendon in one and percutaneous pin fixation of the talonavicular joint in 12 feet.
    b5731182232has quoted7 years ago
    and peroneal tendons if contracted,
    -reduction of the navicular onto the talus and pin fixation,
    -reefing of the talonavicular joint capsule,
    -the plantar calcaneonavicular ligament is sutured under tension to the base of the 1st metatarsal,
    -the posterior tibial tendon is tightened and sutured to the inferior surface of the first cuneiform,
    -the tibial anterior tendon may be transferred completely or split and sutured to the undersurface of the head of the talus and navicular,
    -a second wire can be passed transverse through the calcaneum and incorporated into the cast or longitudinally into the calcaneum and talus,
    -reconstruction of the spring ligament.
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