acquired bone deformities
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Acquired Bone DeformitiesIntegrated - based Lecture
ByDr. Abdullah H A Juma
Dr. Mohammed A AbbasDepartment of
Orthopaedics & Trauma
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Definitions•• AcquiredAcquired : adjective; arising in response to the
action of the environment on the organism. It is opposite to congenital, familial, genetic & hereditary. It develops after birth.
•• BoneBone : noun; the hard part of the skeleton. Functions as supportive, locomotive & protective as well as manufacturing blood cells and homeostasis.See pictures of bones.
• Deformity : noun; deviation from normal form.
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Types of Acquired Bone Deformities (1)
• Torsional deformity : The bone is twistedmedially (inwards, internally),
e.g. intoeing gait in lower limb.see pic.tip position in upper limb
or laterally (outwards, externally),e.g. outtoeing gait in LL
external rotational deformity in UL
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Pictures of internal ( inwards ) torsional deformities
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Pictures of external ( outward ) torsional deformities
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Types of Acquired Bone Deformities (2)
• Angular deformity : The bone is seen angulated in 2 planes,1. Sagittal plane ( Antero / posterior ).
e.g. anteriorly ; anterior bowing.posteriorly ; posterior bowing.see pic.
2. Coronal plane ( Medio / laterally ).e.g. medially ; varus deformity.
laterally ; valgus deformity.
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Pictures of angular deformity in the sagittal plane ( anterior / posterior )
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Pictures of angular deformity in the coronal plane ( medial / lateral ), i.e. towards or
away from midline
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Causes ofAcquired Bone Deformities
• Traumatic. • Inflammatory.• Degenerative.• Infectious.• Tumours.• Dietary.• Miscellaneous.
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RicketsA condition producing all types of deformities
• Softening of bone in childhood due to lack of mineralization.
• Due to vitamin D deficiency which leads to Calcium & Phosphorus deficiency.
• Types :1. Dietary deficiency.2. Secondary to liver ( biliary ), renal and intestinal diseases.3. Hereditary, sex-linked, vit - D resistant.
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Pictures of rickets with all types of deformities
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Scoliosistorsional and angular deformities in the spine
See pictures
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Investigations
• Bone profile; calcium, phosphate, alkaline phosphatase.
• Serum level of vitamin D.• X-rays.• Urinary excretion of calcium and
phosphate.• Bone biopsy.• Bone densitometry.
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General Outline of Treatment
• Medically : treat the primary causes plus supplement of deficient factors.
• Surgically : to correct the deformities.• Supportive measures : orthoses and
prostheses to control deformities.• Physical therapy.• Occupational therapy.
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Case report
• A 5 years old boy who presents with bowing in both lower extremities. This has been progressive and he takes a poor diet. Family history is negative for a similar case and no history of trauma exists.
• Examination shows increased inte-rcondylar distance with varus deformity of both legs.
• How do you approach this case ?
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Answer• History : proper, detailed, precise and accurate.• Examination : General, Systemic & Local.
Tools of Examination: Look(Inspection)Feel(Palpation)Move
SOAP S = Subjective = HistoryO = Objective = ExaminationA = Assessment ( working/DD/definiteDx.)P = Plan ( investigations and treatment )
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Requirements & Expectations
• Sound knowledge.• Build up skills of communication with patients,
taking a proper history, conducting a proper examination, reading x-rays and other investigatory tests.
• Intellectuality and cognitive ability are required for best achievement.
• Attitudes and good behavior are mandatory.• Ending up with a safe and a competent medical
practitioner.
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The END
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• You can download this lecture from the website of : Dr. Abdullah H. A. Juma
www.slideshare.net/slideaj
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