The main congenital diseases of the ODS. ODS diseases and injuries

Traumatology and Orthopedics- closely related branches of medicine. Traumatology studies damage to the musculoskeletal system (bones, ligaments, joints, muscles and tendons), deals with the diagnosis and treatment of these injuries. Orthopedics specializes in prevention, diagnosis and treatment functional disorders and deformities of the musculoskeletal system resulting from disease, injury or birth defect development.

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The role of traumatology in modern world is constantly increasing. Every year, car crashes and accidents result in the deaths of millions of people around the world. Injuries often result in long-term disability and deterioration in the quality of life of people.

Most often, damage to the musculoskeletal system occurs with road, domestic, industrial and sports injuries. The level and severity of damage depend on the mechanism of injury (features of traumatic effects on the human body).

Per recent decades Traumatology has undergone significant changes. In the past, plaster casts and skeletal traction were the main treatments for fractures. Today, various surgical techniques are widely used in traumatology.

The technique of osteosynthesis (fixation of fractures with intraosseous, extraosseous and transosseous structures) is constantly being improved. Osteosynthesis allows to reduce the time of treatment of fractures, to avoid dangerous complications as a result of prolonged immobility (pressure sores, pneumonia, thromboembolism) and prevent the development of contractures (limitation of joint mobility).

Actively used modern technologies. The severed fingers are sutured using microsurgical techniques. Joint surgeries are performed using endoscopic equipment. Arthroplasty is developing (replacement of a destroyed or damaged joint with a biocompatible prosthesis).

The possibilities of traumatology are constantly expanding. However, recovery from injury is still not possible without the active participation of the patient. During this period, it is very important to follow the doctor's recommendations, develop joints, do therapeutic gymnastics etc. Remember: the more time has passed since the injury, the more difficult it is to restore the lost function of muscles, bones and joints.

Traumatology is a branch of medicine that most people encounter only for a short time. In contrast, orthopedics usually deals with chronic diseases requiring long-term treatment.

Along with modern surgical techniques, orthopedics widely uses traditional conservative methods: massage, manual therapy, physiotherapy exercises and physiotherapy.

In the treatment of orthopedic diseases, as well as in the recovery period after injuries, great importance has the attitude of the patient, his readiness to follow the recommendations of the doctor and to make an active contribution to the process of his own recovery.

We hope that the section "Traumatology and Orthopedics" of the Medical Directory of Diseases of the site "Beauty and Medicine" will help you get all the necessary information about injuries and diseases of the musculoskeletal system and how to treat them.

Our well-being, the state of the body as a whole, health and, of course, longevity directly depend on the health of our musculoskeletal system(ODS). Today, the number of diseases of the spine, muscles and joints is growing rapidly. According to statistical studies, approximately 80-90 percent of the population suffers from them. These diseases are the second most common after diseases of the heart and blood vessels. This is due to a sedentary lifestyle and sedentary work.

Due to the catastrophic lack of time, we do not do enough physical exercises, the necessary chemical compounds and elements do not always enter our body with food in the right amount, and often they come in excessive amounts. unnecessary substances that harm our body, such as salt. Therefore, it is very important to treat the identified diseases of ODS in a timely manner, to pay due attention to recovery and rehabilitation after treatment or surgery. Special orthopedic rehabilitation means, for example, those shown in the figures, significantly help to speed up the process of restoring the body.

Why are ODS diseases dangerous?

The insidiousness of ODS diseases lies in the fact that in addition to discomfort in Everyday life, the patient may eventually become disabled. To prevent this, you should immediately consult a doctor when the first signs of illness or mechanical damage to the spine, muscles or joints appear.

Among all ODS diseases, spinal diseases are the most dangerous. Injuries of the spinal column are quite difficult and lengthy to treat and require proper rehabilitation. Thanks to modern diagnostic methods, many diseases of the musculoskeletal system can be prevented. Unpleasant sensations in the joints, aching or sharp pain, creaking, which are permanent or appear occasionally, are the reason for contacting a doctor. Do not hope that everything will go away by itself, that your body will be able to cope with the violations that have arisen.

Often, over the years, problems with the joints, muscles or spine only get worse. Various swelling, fever, redness in the joints indicate the onset of the disease, and try not to postpone a visit to the doctor for a long time, because this is fraught with sad consequences.

How to recover after an illness or surgery?

Each of us may find ourselves in such a situation that after an operation or treatment of the organs of the musculoskeletal system or the spine, he or his relatives need high-quality rehabilitation. It depends on the timeliness and correctness of the chosen rehabilitation methods whether the patient will be able to return to the previous active life and how soon it will happen. Often, exercise, massage, and medication alone are not enough, and special devices are needed to make life easier for yourself or your loved ones (see Figure 1-2).

Rehabilitation is the way to the former full life. The use of various orthopedic products can significantly reduce pain in the joints and spine. They allow you to compensate for violations of the patient's musculoskeletal system. And special corsages, bandages, various products for the spine and joints not only support and help restore lost functions, but also contribute to a speedy recovery.

Lecture plan:

Introduction.

Dysplasia hip joint and congenital

hip dislocation.

Pathogenesis, prevention, early diagnosis.

Features of treatment in different age groups.

Congenital clubfoot. Clinic, diagnosis, treatment.

Congenital muscular torticollis. Klippel-Feil disease,

Grisel, cervical ribs. Congenital high standing of the scapula.

Diagnostics, treatment.

congenital diseases upper limb:syndactyly,

polydactyly, extradactyly, club hand. Diagnosis, treatment.

To be able to: evaluate the current problems of this section, use

to be in modern ways and methods of diagnosis and

Congenital diseases of the musculoskeletal system

are of practical interest for both the pediatrician and the medical doctor

textbook, which is related to the identification and treatment of the consequences

congenital diseases in adolescence, youth and adulthood

Among the diseases of childhood, increasing attention

attract various pathological conditions associated with congenital

malformations of individual organs or entire systems of the

ma. Numerous survey data of newborns show

they know that congenital anomalies(malformations) of development occur with frequent

toy from 0.3% to 12% -13%, on average in 3-4% of children.

According to M.V. Volkov, there are more than 1500 only hereditary

diseases, moreover, half of them are congenital diseases

of the musculoskeletal and neuromuscular systems.

Among etiological factors congenital diseasesaccepted

There are three main groups: exogenous, endogenous and genetic.

At the same time, you should also be reminded that genetic factors

tori can be a consequence external influences or wear heritage

tvenny character (inheritance by recessive and dominant mutations)

Congenital diseases of ODS in children account for about 50% of all

pathologies of ODS in childhood. According to the Republic of Belarus, congenital diseases

ODS accounted for 25.3% of all orthopedic diseases.

Among the congenital diseases of ODS dominate: pelvic dysplasia

hip joint and congenital dislocation of the hip (from 30 to 70-80% of all

consisting of pathological OSD children) followed by torticollis

(10-30%), clubfoot (1.3-34.4%), syndactyly, polydactyly, etc.

anomalies of the hand and foot, ectromelia, etc. (10-15%).

Hip dysplasia, congenital dislocation (subluxation)

wih) hips.

__________________________________________________________________

Congenital dislocation of the hip occurs in 5 out of 1000 newborns.

It is more difficult to determine the incidence of hip dysplasia, because

this is due to the level of organization of the primary detection of pathology

Based on the available research, this pathology should be

be considered as one of the manifestations of malformation

hip joint, which occurs on early stages inside-

uterine development of the fetus.

Anatomical and functional changes in the joint with all

forms of anomalies progress with age. Therefore, effective

is a treatment started in the first days or weeks of a child's life.

However, early treatment possible only with early diagnosis.

ki, which is feasible in the training of all physicians in this section, and

at proper organization examination of newborns in maternity

max. It should be remembered that special attention of the doctor should be

children born in breech presentation. In this group, disp-

hip lasia occurs in about 20% of

Of all the many symptoms, primacy must be given to

the following, in our opinion the most reliable:

Asymmetry of skin (adductor, gluteal) folds,

Restriction of leg abduction

External rotation of the lower limb

Slip symptom (Ortolani), "click" symptom, symptom

The listed symptoms allow only, most often, to suspect

pathology. Unfortunately, X-ray diagnostic methods in this

age is unreliable and radiography is used only from 3

one month old. The latest advances in intrascopy technology allow

hope for new methods of laboratory diagnostics

(NMR-tomography, ultrasound diagnostics, etc.).

Early x-ray signs of hip dysplasia

joint and congenital dislocation hips are:

Triad Putti - underdevelopment or aplasia of the nucleus of ossification of the go-

hip dexterity, sloping roof acetabulum, high standing

and lateroposition of the proximal end of the femur.

Moreover, the evaluation of the radiograph three month old baby complicated

requires considerable skill. Some help in this regard

provided by special constructions on the radiograph (scheme

Hilgenreiner and others).

Treatment of dysplasia and congenital dislocation of the hip in multi-

shares the age of the patient. It is possible to conditionally divide patients according to

ages into a number of groups:

Newborns and children up to 3 months of age,

Children from 3 months. up to 9 months - 1 year,

Children from 1 to 3 years old,

Children from 3 to 5 years old,

Children from 5 to 14 years old,

Teenagers over 14 years old

Adults.

In the first group, the diagnosis is not yet completely reliable and wears, in

mostly conjectural.

Assign: exercise therapy, wide swaddling, special envelopes for

born with a wedge, Pavlik's stirrups, Freyka's pad,

Visible taverns of Vilensky.

In the second group, the diagnosis after the analysis of radiographs became

seems obvious. However, functional treatment still remains

quite effective. It is similar to that described, but requires more

more close attention of the orthopedist, on which it depends, mainly,

his success.

At an older age (group from 1 to 3 years), as a rule,

we are already dealing with contractures, muscle stiffness and counting

on the centering of the head in the acetabulum by simple abduction of the stem

hardly possible. At this age, preliminary stretching is used.

according to special techniques with subsequent reduction of the hip

fixing it in the allotted position with internal rotation in hypnosis

owl bandage. Maintaining patients in fixing bandages can lead to

follow various methods, of which there are a lot.

at one time, the Lorentz method was widely known, requiring a stay

keeping a child in a fixing bandage for a long time (9 months) in

three positions. However, at the same time, such a quantity was obtained

complications ( aseptic necrosis femoral head, relapses), which from

the Lorenz method was rejected everywhere, but some of its elements

underlie the gops bandages that fix the first three months.

During these periods, instead of plaster bandages some clinics use

special tires (for example, plastic tire Volkov M.V.)

The duration of treatment at this age is different, but fluctuates in pre-

cases from 4 to 6-7 months. Control - according to x-ray data

clinics. Complications 8.9%, failures - 1.2% of cases.

Older than three years (but sometimes from 9 months) resort to open

reduction of congenital dislocation of the hip. At the age of 5 years older

simple reduction often fails. Therefore, its combination

with derotation osteotomies, osteotomies with shortening of the ber

in the trochanteric region (soeotomy according to Zahradnichek, Bogdanov),

hollowing out the acetabulum and wrapping the head of the femur with a capsule

hip joint (column operation).

At the age of 14 years and older often resort to extra-articular

operations (Salter, Chiari, canopy according to Koenig, petal, etc.

construction of the roof of the acetabulum, etc.).

In the future, problems of dysplastic coccus may arise.

sarthrosis, avascular necrosis of the femoral head, contractures, which

partly considered by us in other lectures, and partly not

can be placed in a short curriculum your preparation.

Congenital clubfoot (pes equino-excavato-adducto-varum)

__________________________________________________________

Congenital clubfoot occurs more often than boys (68%),

moreover, it is bilateral in 38-40% of patients.

Conservative treatments for congenital clubfoot have been

developed by V.O. Orlov (1874) and N.F. Gagman (1878).

Early diagnosis is generally not difficult. Focus on the following

blowing main symptoms:

Flexion contracture (equinus) of the foot

Casting anterior section(adduction) feet,

hollow foot,

Heel varus.

Treatment includes the following elements:

The first two weeks of exercise therapy and bandaging the foot according to Fink-Ettinge-

Staged plaster casts with successive elimination of

the deformations listed above with the change of plaster casts every two

local information. Depends on the timeliness, quality and after-

suitability of treatment. With proper treatment, the vast majority

patients recover.

With inefficiency in children, they resort to operations on capsular

but-ligamentous apparatus (capsulo-fascio-ligamentotomy operations on

Zatsepin, Shturm).

The skeleton is operated on after 14 years - crescent resection of the

py according to Kuslik, three-joint arthrodesis according to Lambrinudi, etc.

In recent years, the methods of G.A. Ilizarov have been widely used. One

BGMI, Director of the Kazan Orthopedic Center.

Congenital muscular torticollis (torcicolli)

_________________________________________

Congenital muscular torticollis is one of the most common

common anomalies of the ODS. For example, according to orthopedic

binetovg. St. Petersburg amounted to 31% in relation to congenital

orthopedic diseases and 3% of all orthopedic

some diseases.

Theories: traumatic, inflammatory, dysplastic, etc.

With this deformation, the shortening of one of

m.sternokleidomastoideus leads to a tilt of the head towards the change

muscle, turn in the opposite direction. In addition to the asymmetry

ca, skull, there is a secondary deformation of the body, asymmetry of the supra-

treatment and scoliotic posture, which can be the beginning of scoliosis

tic disease.

Breast nipple on the side corresponding to the shortening of the sternum

but the clavicular-nipple muscle is located higher and can be shifted to a hundred

Ron of the anterior axillary line. The clavicle is raised and displaced. Over-

humerus and scapula on the diseased side are higher and the inner edge

Diagnosis is not difficult at the age of 3 weeks or more.

nyaya diagnosis is difficult.

Treatment: at the first stage - exercise therapy, fixing bandages.

At the age of # years and older - operations on the muscles of the neck. Most

popular operations - the operation of T.S. Zatsepin with resection of the sternal

noah and clavicular legs of the sternocleidomastoid muscle and rass-

neck facies.

Grisel's disease, Klippel-Feil, cervical ribs.

Osteochondrosis is the most common cause of back pain. The disease spreads, acquiring the character of an epidemic. Even children began to get sick with osteochondrosis!

Osteochondrosis is a lifestyle disease. With osteochondrosis of the spine, the first changes occur in the muscles. Spasms occur in them, then local muscle compactions - myogelloses, which is expressed by the development of the so-called myotonic and myofascial syndromes. It is the prolonged spasm of the muscles of the spine that is the most common cause pain in the back, contrary to the popular belief that if the back hurts, then necessarily “a hernia infringes on the nerve” or “displaced vertebrae”.

In spasmodic muscles, blood flow decreases, metabolic products accumulate. Fluid supply interrupted intervertebral discs, they lose height, become less elastic, they begin to structural changes. The bone part of the vertebrae also undergoes changes - but at later stages. To reduce the burden on the victim intervertebral disc, the vertebral bodies begin to grow, increasing their area. Osteophytes are formed - bone outgrowths.

If such an outgrowth is directed towards the intervertebral foramen through which spinal nerve- there are sharp and sudden pains, accompanied by a violation and distortion of sensitivity along the nerve fibers irritated by the osteophyte. If the osteophyte is directed into the lumen of the canal of the vertebral artery in the cervical spine, severe headaches occur on the side of the lesion. With osteochondrosis of the spine, sooner or later the intervertebral joints suffer - spondylarthrosis develops.

The most dangerous thing is that we have adapted to use the "fifth point of support" as the only one, although this part of the body is not at all intended by nature for the supporting function. Look at the animals, when they sit, they rely on three points of support, and more often on five. The sitting position is one of the most rarely used by animals. They are usually either standing or lying down.

Man, in addition to inventing a device for sitting, made this position almost the main one. In a sitting position, the load on intervertebral discs much more than standing or lying down. All these negative factors can cause a herniated disc, pain in the head, limbs and internal organs cause osteochondrosis and scoliosis.

Osteochondrosis - insidious disease. Except pain, it leads to a decrease physical performance, impaired reproductive function. The limitations that a patient with osteochondrosis experiences do not allow him to feel free in everyday life, to engage in most types of recreational sports.

The reasons for the development of osteochondrosis, that is, degeneration of the intervertebral disc, have not yet been precisely established, there are mainly several reasons, these are: metabolic disorders in the body, weak physical development, genetic predisposition and others. A disc herniation is formed due to a large load on the disc, naturally, the weaker the disc and the muscular corset, the less load can cause a hernia.

The difficulty in determining the causes of the development of osteochondrosis lies in the fact that this disease occurs both in the elderly and in the young and in both physically developed people and in people who neglect sports.

So, reasons can be identified:

• decrease in motor activity,
• overweight, putting excessive stress on the intervertebral discs,
• long sedentary work
• posture disorders.

Osteochondrosis of the cervical spine (cervical osteochondrosis)

Signs of cervical osteochondrosis

The most common manifestations cervical osteochondrosis- pain in the neck, a feeling of tightness in the shoulder area, headaches, dizziness, pain in the shoulder blade, numbness or "goosebumps" in the hands, backache, in which the pain spreads to the fingers - these are the troubles that the development of osteochondrosis in the cervical spine is fraught with. Frequent companion osteochondrosis of the cervical spine - humeroscapular periarthrosis.

Risk factors

Risk factors for the development of osteochondrosis of the cervical spine are prolonged static loads on the muscles of the neck. They are observed when driving for a long time, in front of a computer, near the dental chair or at the operating table, with posture disorders, when the head is habitually lowered.

Inside the vertebrae of the cervical spine passes the canal of the vertebral artery - the most important vessel that supplies blood to the brain. Therefore, muscle spasm in this area or pathological bone growths are often the cause of intense headaches. Therefore, with osteochondrosis of the cervical spine, it is important to clarify the state of the vertebral arteries.

disco hernia in the cervical spine, even with small sizes, they give very strong manifestations. This is due to the small size of the spinal canal and intervertebral foramina at the cervical level.

Osteochondrosis of the lumbar spine

The heaviest loads are lumbar spine. Therefore, manifestations of osteochondrosis in this department are very frequent. This may be an acute pain in the lower back - lumbago, pain that radiates along sciatic nerve- sciatica (sciatica). Only on rare occasions does it occur nerve root prolapsed hernia fragment (3-5%).

The vast majority of manifestations of osteochondrosis of the lumbar spine occurs as a result of the so-called "reflex" syndromes. The fact is that when a pathological impulse occurs from the affected focus, a protective spasm develops. deep muscles spine - myopically.

Tense muscles, on the one hand, prevent movements in the spine, which can lead to deterioration of the intervertebral disc. On the other hand, the muscles themselves compress the intervertebral disc and spinal nerves, which causes the so-called neuropathic pain, impaired sensitivity and reflexes.

Degenerative changes in the intervertebral discs underlie osteochondrosis of the spine. The development of these changes is facilitated by repeated injuries, excessive static or dynamic loads, and hereditary predisposition.

The intervertebral disc gradually loses water, shrinks, loses its shock-absorbing function and becomes more sensitive to mechanical stress. The fibrous ring, located along the periphery of the disc, becomes thinner, cracks appear in it, along which the central part of the disc - the nucleus pulposus - shifts to the periphery, forming a protrusion (protrusion). Due to injury or intense load, protrusion can increase abruptly, which leads to protrusion of the pulpous nucleus and part of the fibrous ring in spinal canal, which is denoted as disc herniation (prolapse).

Hernia usually retains a connection with the body of the disc, but sometimes its fragments fall into the spinal canal, forming a sequester. Depending on the location of the disc herniation, it is subdivided

DEPARTMENT OF TRAUMATOLOGY AND ORTHOPEDICS

V. V. NIKITIN. COURSE OF LECTURES ON TRAUMATOLOGY AND ORTHOPEDICS.

Main congenital diseases ODS.

Lecture plan:

Introduction.

Hip dysplasia and congenital dislocation of the hip. Pathogenesis, prevention, early diagnosis. Features of treatment in different age groups.

Congenital clubfoot. Clinic, diagnosis, treatment.

Congenital muscular torticollis.

Klippel-Feil disease, Grisel disease, cervical ribs.

Congenital high standing of the scapula. Diagnosis, treatment.

Congenital diseases of the upper limb: syndactyly, polydactyly, extradactyly, clubhand. Diagnosis, treatment.

Target :be able to assess the current problems of this section, use modern methods and methods of diagnosis and treatment.

Congenital diseases of the musculoskeletal system are of practical interest both for a pediatrician and a general practitioner who is related to the identification and treatment of the consequences of congenital diseases in adolescence, youth and adulthood.

Among diseases of childhood, various pathological conditions associated with congenital malformations of individual organs or entire body systems are attracting more and more attention. Numerous survey data of newborns show that congenital anomalies (malformations) occur with a frequency of 0.3% to 12%-13%, on average in 3-4% of children.

According to M.V.Volkov, there are more than 1500 hereditary diseases alone, and half of them are congenital diseases of the musculoskeletal and neuromuscular systems.

Among the etiological factors of congenital diseases, it is customary to distinguish three main groups: exogenous, endogenous and genetic.

At the same time, you should also be reminded that genetic factors can be the result of external influences or be hereditary in nature (recessive and dominant inheritance).

Congenital diseases of ODS in children account for about 50% of the total pathology of ODS in childhood. According to the Republic of Belarus, congenital diseases of ODS accounted for 25.3% of all orthopedic diseases.

Among the congenital diseases of ODS dominate: hip dysplasia and congenital hip dislocation (from 30 to 70-80% of all children with the pathology of ODS) Then follows torticollis (10-30%), clubfoot (1, 3-34, 4%), syndactyly, polydactyly, and other anomalies of the hand and foot, ectromelia, etc. (10-15%).

Hip dysplasia, congenital dislocation (subluxation) of the hip.

Congenital dislocation of the hip occurs in 5 out of 1000 newborns. It is more difficult to determine the frequency of hip dysplasia, because it is associated with the level of organization of the primary detection of ODS pathology.

Based on the available research, this pathology should be considered as one of the manifestations of abnormal formation of the hip joint, which occurs in the early stages of intrauterine development of the fetus.

Anatomical and functional changes in the joint in all forms of anomalies progress with age. Therefore, treatment started in the first days or weeks of a child's life is effective. However, early treatment is possible only if early diagnosis, which is feasible with the training of all doctors in this section, and with the correct organization of the examination of newborns in maternity hospitals. It should be remembered that the special attention of the doctor should be attracted to children born in the breech presentation. In this group, hip dysplasia occurs in approximately 20%.

Of all the numerous symptoms, priority should be given to the following, in our opinion, the most reliable:

asymmetry of skin (adductor, gluteal) folds,

restriction of leg abduction,

external rotation of the lower limb,

slip symptom (Ortolani), "click" symptom, "piston" symptom.

The listed symptoms allow only, most often, to suspect a pathology. Unfortunately, X-ray diagnostic methods at this age are not very reliable and radiography is used only from 3 months of age. The latest advances in intrascopy technology allow us to hope for new methods of laboratory diagnostics (MRI tomography, ultrasound diagnostics, etc.).

Early x-ray signs of hip dysplasia and congenital hip dislocation are:

Putti's triad - underdevelopment or aplasia of the nucleus of ossification of the femoral head, sloping of the roof of the acetabulum, high standing and lateroposition of the proximal end of the femur.

Moreover, the assessment of the radiograph of a three-month-old child is complex and requires significant skills. In this regard, some help is provided by special constructions on the radiograph (Hilgenreiner scheme

Treatment of dysplasia and congenital dislocation of the hip is largely determined by the age of the patient. Patients can be conditionally divided by age into a number of groups:

newborns and children up to 3 months of age,

children from 3 months. up to 9 months - 1 year,

children from 1 to 3 years old,

children from 3 to 5 years old,

children from 5 to 14 years old,

teenagers over 14 years old,

adults.

In the first group, the diagnosis is not yet completely reliable and is mostly presumptive.

Assign: exercise therapy, wide swaddling, special envelopes for a newborn with a wedge, Pavlik's stirrups, Freik's pad, Vilensky's sliding shank.

In the second group, the diagnosis after the analysis of radiographs becomes obvious. However, functional treatment is still quite effective. It is similar to the one described, but requires closer attention of the orthopedist, from which

At an older age (group from 1 to 3 years), as a rule, we are already dealing with contractures, muscle rigidity, and it is hardly possible to count on the centering of the head in the acetabulum by simply abducting the leg. At this age, preliminary traction is used according to special methods, followed by reduction of the thigh and its fixation in the allotted position with internal rotation in a plaster cast. At one time, the Lorenz method was widely known, requiring the child to stay in a fixing bandage for a long time (9 months) in three positions. However, at the same time, such a number of complications were obtained (aseptic necrosis of the head was rejected everywhere, but its individual elements underlie the plaster bandages fixing the first three months.

During these periods, instead of plaster casts, in some clinics special splints are used (for example, a plastic splint by Volkov M.V.).

The terms of treatment at this age are different, but range from 4 to 6-7 months. Control - according to X-ray and clinical data. Complications 8.9%, failures - 1.2% of cases.

Older than three years (but sometimes from 9 months) resort to open reduction of congenital dislocation of the hip. At the age of 5 years and older, simple reduction often fails. Therefore, it is combined with derotation osteotomies, osteotomies with shortening of the femur in the trochanteric region (osteotomy according to Zahradnicek, Bogdanov), with deepening of the acetabulum and wrapping the femoral head with a hip joint capsule (Column operation).

At the age of 14 years and older, extra-articular operations are often resorted to (Salter, Chiari, a canopy according to Koenig, petal, etc. reconstruction of the roof of the acetabulum, etc.).

In the future, there may be problems of dysplastic coxarthrosis, avascular necrosis of the femoral head, contractures, which were partly considered by us in other lectures, and partly cannot fit into the short curriculum of your training.

Congenital clubfoot (pes equino-excavato-adducto-varum)

Congenital clubfoot is observed more often in boys (68%), moreover, it is bilateral in 38-40% of patients.

Conservative methods for the treatment of congenital clubfoot were developed by V.O. Orlov (1874) and N.F. Gagman (1878).

Early diagnosis is generally not difficult. Focus on the following main symptoms:

flexion contracture (equinus) of the foot,

adduction of the forefoot (adduction) of the foot,

hollow foot,

heel varus.

Treatment includes the following elements:

the first two weeks of exercise therapy and bandaging the foot according to Fink-Oettingen,

staged plaster casts with sequential elimination of the above deformities with a change of plaster casts every two weeks.

With inefficiency in children, they resort to operations on the capsular-ligamentous apparatus (capsulo-fascio-ligamentotomy operations according to Zatsepin, Sturm).

The skeleton is operated on after 14 years - sickle resection of the foot according to Kuslik, three-joint arthrodesis according to Lambrinudi, etc.

In recent years, the methods of G.A. Ilizarov have been widely used. One of the supporters and authors of metrodics is Gafarov, a graduate of BSMI, director of the Kazan Orthopedic Center.

Congenital muscular torticollis (torcicolli)

Congenital muscular torticollis is one of the most common anomalies of ODS. For example, according to orthopedic rooms in St. Petersburg, they accounted for up to 31% in relation to congenital orthopedic diseases and 3% in relation to all orthopedic diseases.

Theories: traumatic, inflammatory, dysplastic, etc.

With this deformation, the shortening of one of the m.sternokleidomastoideus leads to a tilt of the head in the direction of the altered muscle, and a turn in the opposite direction. In addition to the asymmetry of the face and skull, there is a secondary deformation of the trunk, asymmetry of the shoulder girdle and scoliotic posture, which can be the beginning of scoliotic disease.

The pectoral nipple on the side corresponding to the shortening of the sternocleidomastoid muscle is located above and can be shifted towards the anterior axillary line. The clavicle is raised and displaced. The shoulder girdle and scapula on the affected side are higher and the inner edge of the scapula is further away from chest etc.

Diagnosis is not difficult at 3 weeks of age or more. Earlier diagnosis is difficult.

Treatment: at the first stage - exercise therapy, fixing bandages.

At the age of 3 years and older - operations on the muscles of the neck. The most popular operations are T.S. Zatsepin's operation with resection of the sternal and clavicular legs of the sternocleidomastoid muscle and dissection of the neck facies.

Grisel's disease, Klippel-Feil, cervical ribs.

Congenital diseases of the upper limb.