Congenital Deformities: Lower & Upper Limbs Deformity is an alternation in shape of limbs. Causes of deformity can be broadly grouped as:
a) Congenital deformities
b) Acquired deformities
Congenital deformities:
The exact cause is still not established. There are several factors causing these deformities such as genetic factors operating on the developing fetus during intra uterine development. Teratogenous influence of drugs and chemicals can also cause congenital deformities.
Congenital deformities of upper limbs:
a) Shoulder – Sprengel’s shoulder.
b) Elbow – congenital superior radio ulnar synostesis.
c) Wrist – Madelung’s deformity.
d) Hand – syndactylism, poly dactylism
Congenital deformities of lower limbs:
a) Congenital talipus equino varus (club foot)
b) Congenital dislocation of hip
c) Congenital genu recurvatum, genu varus (bow knees)
d) Congenital pseudoarthrosis of tibia (bow legs)
Acquired deformities:
The most common causes of acquired deformities are;
a) Trauma
b) Infection
c) Degeneration
d) Tumor
e) Metabolic disorder
Trauma:
Injuries to bones, nerves, vascular and soft tissues cause deformities such as malunited fractures, claw hand, burns contractures etc.
Infections
Infections of bone and joints are one of the most common causes of deformities. Tuberculosis and septic infections cause the largest number of deformities. Infected non-union of long bones is indeed a big challenge. Degeneration:
Degeneration of the joints plays a major role in deformities and most commonly occurs in the knee joints. (Osteoarthritis)
Metabolic and other systemic disorders:
Metabolic and hormonal disorders may cause skeletal deformities. For example:- rickets, vitamin D deficiency, hyper parathyroidism, senile osteoporosis and Paget’s disease.
Management:
Conservative Methods :
Conservative methods must always be tried first. These include methods such as
Physiotherapy: Splints and casts: this is the commonest method used to correct deformities in children.
Traction: may be used for deformities caused by muscle spasm.
Manipulation of joints under anesthesia can be done to release adhesions.
Surgical methods: When conservative methods fall and deformity causes disability, surgical methods are used. Surgical procedures include
Soft tissue procedures:
These are always tried first to correct deformities.
a)Postero medial soft tissue release in club foot.
b)Tendoachilles lengthening and posterior capsulotomy in equinous foot.
c)Bony procedures
d)In severe deformities bony procedures are done along with soft tissue surgeries.