Epidemiology Congenital metatarsus varus 1/1000 live birth Common Male=female 1-5% together with CDH Single or with other deformity(club foot)

Types Mild corection +overcorection moderate only corection sever no corection & medial tranvers crease& 1th 2th web space widening

Xray

} TREATMENT Mild no treatment MODERATE SEVER Stretching & cast 6-12 weaks

Club foot Congenital talipes equinovarus deformity

1/1000 live births Male>female 50% bilateral Genetic epidemiology 1/1000 live births Male>female 50% bilateral Genetic autozomal dominant

Etiology 1-Primary germ plasm dis of talonavicular Secondary soft tissue changes 2-soft tissue

Clinical findings 1 -hypotrophy of Tibialis anterior? 2-internal tibial tortion 3-./5-1cm small involved foot 4-heel varus&equinus&adduction of forfoot

Types Flexible rigid

pathology

Xray AP LATERAL FORCED DORSIFLEXION AP STANDING LATERAL SRANDING در بچه ها يي كه راه نميروند AP STANDING LATERAL SRANDING دربچه هايي كه راه ميروند

TREATMENT 6 weaks 1-NON SURGICAL Manipulation Serial cast A-adduction B-varus C-equinus 15%-80% ankle foot orthosis 6 weaks

SURGICAL 1-TURCO postero medial release درموارد خفيف 2-Mcky posterolaterral relea در موارد شديد 10-12 weaks cast در كمتر از 2 سال

5-فيوژن كال كا نئو كو بوئيد 2-12 سال 1- تطويل آشيل 2-آزاد كردن مديال 3-استئوتومي كال كا نئوم 4-انتقال 5-فيوژن كال كا نئو كو بوئيد TA

>12 YEARS TRIPLE ARTHRODESIS

1- displasic 2-subluxation 3- dislocation types Congenital hip displasia types 1- displasic 2-subluxation 3- dislocation

Developmental Dyplasia of The hip DDH CDH

Spectrum of disorders of development of the hip That present in different forms at different ages

Epidemiology 1-1/1000 live births 2-female.>male 5times 3-left>right 4-bilateral>right 5-first birth>other 6-breech delivry> 7-family history + 10% 8-whites>black

Etilogy 1-Ligament laxity 2-mechanical (breech ) 3-genetic 70% 4-enviromental

بيماري همراه 1- torticoli 2- metatarsus adductus 3-talipes calcaneovalgus

Clinical findings 1- skin fold 2-barllo 3-ortolani 4-Allis sign 5- limitation of adduction 6-telescoping 7-telendelenburg 8-waddling gait 9-lumbar lordosis 10-widening of prinum(bilateral CDH)

Radiography AP PELVIS SONOGRAPHY Acetabular index 30digree Hilgenriner CE angle Shenton line Perkins line AP PELVIS SONOGRAPHY

treatment

0-6 mounth Pavlic harnes

6-18 MOUNTH Traction Adductor tenotomy Close reduction Arthrography Open reduction may be necesary

18-36 mounth Open reduction Pelvus osteotomy OR femoral osteotomy OR both

3-8 years FOR AVN Femoral shortening Open reduction Adductor tenotomy DECREASE AVN & REDISLOCATION Femoral shortening Open reduction Adductor tenotomy Pelvis osteotomy

>8 YEARS Bilateral Unilateral open reduction femoral shortening pelvic osteotommy no arthrodesis Bilateral no treatment (total hip replacement in future