orthopedics.Cerebral palsy.(dr.baxtyar rasul)
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Transcript of orthopedics.Cerebral palsy.(dr.baxtyar rasul)
Cerebral palsy
Group of disorders which result from
non-progressive brain damage during
early development
Incidence: 2/ 1000 lives
Causal factors:
1 -Prematurity
2 -Perinatal anoxia
3 -Kernicterus
4 -Post-natal brain infection
5 -Post-natal injury
Early Diagnosis
1 -perinatal difficulty
2 -Stiff Baby
3 -Dribbling at the mouth
2 -Difficulty in sucking and swallowing
5 -Developmental milestones delayed
( Normally holds head up at 3 months Sits up at 6 months Walking at 12 months
Later Diagnosis
3 typs:
Spastic Paresis(% 60)
SpasticityWeaknessBrisk reflexesBabiniski sign (+ve(Normal sensation
±Fits ±Impaired intelligence
Appear as (1( Hemiplegia( One side of body(
( 2 (Diplegia ( Both lower limbs(
( 3 (Total body paresis( Usually low IQ(
( 4 (Isolated asymmetrical paresis
Athetosis
Continous , involuntary writhing movements
Ataxia
Muscular incoordination during voluntary movements
Characteristic deformities
Elbow flexion
Wrist flxion
Fingers flexion
Hip adduction( scissor posture(
Knee flexion
Ankle equinus
Treatment
Medication: Fits and Hyperactivity
Physiotherapy: 1st year of life
Splintage:
) 1 (To counteract spastic deformitie
) 2 (Hold position after surgery
Botulinum A toxine:
to decrease muscle tone
Surgery:) 1 (Spastic postures which cannot be controlled by conservative
Measures.
) 2 (Fixed deformities
) 3 (Secondary complications ( Bone deformity, Hip dislocation , Joint instability(
Principles and Guidelines of Treatment
)1 (Hemiplegia = Good response to conservative or surgical treatment Will be able to walk unaided.
Diplegia = More difficult but will be able to walke
Total body involvement: Poor prognosis for walking
)2 (Surgery at 6 years age( Unless fixed deformity threatening)
)3 (Surgical options:
) a (Tight muscles are released OR Their tendons lengthened
(b (Nerve transaction when severe spasticity
) c (Correction of fixed deformities by: (1) Osteotomy
) 2 (Joint fusion
) 3 (Arthroplasty