Deformities dnbid

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Deformity is the congenital malformation, or acquired deformation due to disease or injury, of any component of the body. The malformation may be the result of bony distortion or alterations in the topography of soft tissues. The deformity could lead to an impairment or even loss of function along with cosmetic disfigurement.

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The word ‘deformity’ may be applied to a person, a bone or joint. Shortness of stature is a kind of deformity; it may be due to shortness of the limbs or of the trunk, or both. An individual bone also may be abnormally short; this is rarely important in the upper limbs, but it is in the lower. If a limb appears to be crooked, it is important to establish whether the deformity is in the bone or in the joint. A joint may be held in an unnatural position either because of faulty alignment or because of it lacks full movement.

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The more common deformities are designated by special terms. Varus and valgus Kyphosis and lordosis Scoliosis.

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Postural deformity : A postural deformity is one which the patient can, if he chooses, corrects by voluntary effort; for example, a postural kyphosis due to slumped shoulders, or a sciatic ‘scoliosis’ due to spasm of the paravertebral muscles.

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Structural deformity : A deformity which results from a permanent change in anatomical structure can not be voluntarily corrected. It is important to distinguish postural scoliosis from structural (fixed) scoliosis. The former is non progressive, benign and needs no treatment in itself; the latter is usually progressive and may require treatment.

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Fixed deformity : This term is ambiguous. It seems to mean that a joint is deformed and immobile. Not so – it means that one particular movement cannot be completed. Thus, if a knee can flex fully but cannot extend fully it is said to have a ‘fixed flexion deformity’.


JOINT DEFORMITY There are four basic causes of joint deformity: 1. Contracture of the overlying soft tissues 2. Muscle imbalance 3. Dislocation 4. Joint destruction


BONE DEFORMITY Bone deformity in a child may be the result of distorted growth due to a genetic abnormality, injury or disease. Examples are Achondroplasia (genetic), physeal fractures (trauma) and rickets (vitamin D deficiency). In adults the more likely causes are malunion of a fracture, Paget’s disease and bone tumors.

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Again, the deformity may be of two types: 1. Congenital 2. Acquired

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Congenital deformity: Incorrect positions in the uterus, failure to develop normally or abnormal development due to a combination of genetic and environmental factors are the principal causes of congenital deformity. The congenital deformity may or may not be hereditary.

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Acquired deformity : The acquired deformity is the deformity which was not present at birth, and has developed after birth.

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It can be produced as a result of the following causes: Bone disease : diseases like TB, carcinoma, rickets. Chronic infections - osteomyelitis . Joint diseases : Like arthritis, gout etc. Muscular causes : Muscle Paralysis: Muscle spasticity: Muscular disease: muscular dystrophy. Trauma : Malunited fractures;. Epiphyseal injuries; Scar formation following burns or soft tissue injuries. Postural causes : Nerve lesions : e.g. in leprosy.


CLASSIFICATION OF THE DEGREE OF DEFORMITY First degree: The deformity is mild and can be corrected completely by passive stretching. Second degree : Shortening in the soft tissues prevents full passive correction of the deformity. Attempted passive correction results in pain. Slight degree of bony changes may be present. Third degree : The deformity is rigid and cannot be corrected by passive maneuvers. It is invariably associated with bony changes.


METHODS OF MANAGEMENT ASSESSMENT The extent of deformity is evaluated objectively by goniometry. Passive correction, if possible, should be recorded. Related body segments should be examined for any influence of the deformity. The causative factors of the deformity should be ascertained. Overall influence of the deformity over function and cosmesis should be assessed.


PRINCIPLES OF MANAGEMENT Treat the causative factor, i.e. muscular imbalance, poor posture or any underlying disease. Correct the deformity to the maximum. Passive maintenance of the correction of the deformity. Functional reeducation of muscles to actively maintain the correction. Control the factors which can produce secondary deformity. Avoid recurrence of the deformity.


MANAGEMENT OF FIRST AND SECOND DEGREE DEFORMITIES It can be corrected by measures like: Graduated passive stretching. Exercises to correct muscular imbalance. Strapping of the deformity in an overcorrected position. Maintenance of correction by adequate immobilization. Regular check up of the correction during immobilization. Functional reeducation exercises. Corrective splints and orthosis to maintain the correction. Functional reeducation with the splints and orthosis. Emphasize on reporting for regular follow up and advice to avoid recurrence.


MANAGEMENT OF THIRD DEGREE DEFORMITIES In the presence of third degree deformity the management is difficult, time-consuming with unpredictable results. The treatment involves series of corrective manipulations and/or surgical procedures on soft tissues and bones.