جراحة العظام / علاج العظام في الاردن / افضل دكتور عظام في الاردن / افضل اخصائي عظام في الاردن / استشاري عظام/افضل استشاري عظام في الاردن /جراحة عظام / /عمليات تطويل العظام في الاردن / اطباء العظام في الاردن / دكتور طب عظام في الاردن / الاطباء في الاردن / خلع ورك / عمليات اليزاروف في الاردن /علاج الكسور /خلع الولادة / تركيب المفصل / اوجاع العظام /افضل طبيب عظام اطفال في الاردن / استشاري اطفال عظام في الاردن / /علاج خلع الكتف / علاج التواء الكاحل / التواء الكاحل / علاج الام العظام / علاج هشاشة العظام / ارقام اطباء عظام في الاردن / مشاكل العظام والمفاصل /مستشار جراحة العظام والمفاصل والكسور/مستشار جراحة عظام الأطفال. امراض الارجل عند الاطفال اضطرابات الاطراف السفليه عند الاطفال

1. Freih Abu Hassan
Jordan University
Freih Odeh AbuHassan,
F.R.C.S.(Eng.),F.R.C.S.(Tr.& Orth.)
Professor of Orthopedics
The University of Jordan

2. Freih Abu Hassan
Jordan University
*Hip =Anteversion
=Retroversion
=Internal rotation
=External rotation
*Knee=Varus
=Valgus

3. Freih Abu Hassan
Jordan University
*Ankle= Equinus (Plantar flexion)
= Calcaneus (Dorsiflexion)
= Varus
= Valgus
*Subtalar Joint= Inversion
= Eversion
*Foot= Adduction
= Supination
= Pronation

4. Freih Abu Hassan
Jordan University
Knee & leg disorders1-Angular deformity=Bow legs =Knock knees2-Rotational deformity3-Tibial bowing=Congenital bowing=Cong. pseudoarthrosis of tibia=Tibial hemimelia=Fibular hemimelia

5. Freih Abu Hassan
Jordan University
Bowlegs
Knock knees
Varum
Valgum

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Jordan University

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Jordan University

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Jordan University
= Physiological
= Pathological

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Jordan University
N. up to 3 Y old
Common 3 -7 Y
RESOLVEby 8-10 Y

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Jordan University
1-Metabolice.g rickets, renal.
2-Skeletal dysplasia, M.P.
3-Blount’s
3-Growth disturbanceinjury or
infection.
4-Tumors: Osteochondroma,
Olliers, neurofibromatosis

11. Freih Abu Hassan
Jordan UniversityRickets

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Jordan University
Skeletal dysplasia
M D

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Jordan University
Tibia vara (Blount’s dis.)

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Jordan University
= Shoe modifications
= Exercises to correct deformity
= Manipulation and encouraged
posture for sitting
= Orthosis

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Jordan University
The occurrence of the physiological
variations at that time was considered as a manifestations of serious disease
= Correction of the deformity.
= Delighted family
= The physician impressed

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Jordan University

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Jordan University
Shoe wedges

18. Freih Abu Hassan
Jordan UniversityKAFO = Long leg braces

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Jordan University

20. Freih Abu Hassan
Jordan UniversityNo relation between bowlegs & O.A

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Jordan University

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Jordan University

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Jordan University

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Jordan University

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Jordan University
Intoe gait

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Jordan University
*<1y Metatarsus A
*1-3 y Med.tibial T.
*3-10 y Med.femoral T.

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Jordan University
Metatarsus Adductus Dx: Medial deviation of the forefoot or metatarsals ,on neutral Hind foot. (I.U malposition)

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Jordan University

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Jordan University

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Jordan University
Mangement1-90% resolve at walking age. (no value of straight or reverse shoes) 2-Stretching + Cast. *For failure of correction after 1Y. *Rigid adductus 10%(Deep med. crease). 3-Soft tissue surgery at 5y. 4-Bony surgery after 8y.

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Jordan University

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Jordan University

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Jordan University

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Jordan University

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Jordan University
Tibial torsionTreatment
•Spontaneous correction
•No value of Denis-browne bar, heel wedges or any orthosis

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Jordan University

37. Freih Abu Hassan
Jordan UniversityFemoral Torsion*>in girls, prefers to sit W position*On standing & walking the patella pointing inwards

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Jordan University

39. Freih Abu Hassan
Jordan University
Mangement
*No R/ < 8-10 years of age.
*Spontaneous correction
*Rarely surgical corrections
needed (<0.001%)
*No value of using twisting
cables , night splints Or
inverted shoes.

40. Freih Abu Hassan
Jordan University

41. Freih Abu Hassan
Jordan University
*Bilat. 1.Lat. torsion of the hip secondary to I.U. position--Tight Ext. rot. 2.Bilat. Calcaneovalgus. 3.Ext. tibial torsion.
Out-toeing

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Jordan University

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Jordan University
= Congenital bowing
= Cong.pseudoarthrosis of
tibia
= Tibial hemimelia
= Fibular hemimelia

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Jordan University
1-Cong.Post.med angulation
of the T&F-Kyphosis
Calcaneo valgus foot.
Congenital bowing

45. Freih Abu Hassan
Jordan University
= Calcaneus position of the foot.
= Dorsiflexion contracture of the
ankle.
= Calcaneo valgus foot.
= Limited plantar flexion of foot.
= Small Calf.
At birth

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Jordan University

47. Freih Abu Hassan
Jordan University2-Cong. Ant.lat. ang. of the T&F -Lordosis. Cal. varus foot

48. Freih Abu Hassan
Jordan UniversityCong. pseudoarthrosis of tibia

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Jordan University

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Jordan University

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Jordan University

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Jordan University

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Jordan University

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Jordan University

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Jordan University

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Jordan University

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Jordan University
1-Calcaneovalgus deformity
2-Metatarsus adductus
3-Cong. talipus equinovarus
4-Flat feet
5-Neurogenic foot
-C.P -Polio.-Spinal diseases
Feet disorders

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Jordan University
Calcaneovalgus deformity

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Jordan University
CTEV

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Jordan University
•Incidence: 1 in 1000
•M:F ratio 2:1
•Bilateral in 1/3 of cases

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Jordan University

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Jordan University

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Jordan University

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Jordan University

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Jordan University

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Jordan University
Flat Feet
No Longitudinal arch of the foot

67. Freih Abu Hassan
Jordan University
TypesPhysiological Pathological * Very common. * Rare* Flexible. * Stiff. * Asymptomatic. * Symptomatic!! * > 99%. * < 1%.

68. Freih Abu Hassan
Jordan UniversityHow to assess flat feet?.
*Observe the feet standing, tip toes, sitting.
*Check flexibility. -Dorsiflexion! (T.A.). -Inversion and Eversion. -Pronation & Supination.

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Jordan University

70. Freih Abu Hassan
Jordan UniversityPhysiological flat feet.
*Nearly all infants.
*Most children.
*15% of normal adult. JBJS-A, 1987, Staheli.

71. Freih Abu Hassan
Jordan UniversityP.F to Physiological flat feet
*Hereditary.(Familial)
*Genu valgum.
*Limb torsion.
*Generalized laxity.
*Over weight.

72. Freih Abu Hassan
Jordan University
Low arch feet & high arch feet.
*Less stress inj. with low arch.
*High arch more stress inj.
*Low arch better than high arch for military recruits. Giladi etal 1985.

73. Freih Abu Hassan
Jordan University
Pathological flat feet1.Congenital : CVT. 2.Painless :-Tight T.A. -Paralytic (C.P,Spina B.) 3.Painful or peroneal spasmodic flat feet. -Tarsal coalition-Accessory navicular bone

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Jordan University

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Jordan University

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Jordan University

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Jordan University

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Jordan University

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Jordan University
Prospective
controlled
study

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Jordan University

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Jordan University

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Jordan University

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Jordan University

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Jordan University

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Jordan University
Neurogenic disordersThe real indications for Orthosis

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Jordan University

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Jordan University

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Jordan University

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Jordan University

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Jordan University

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Jordan University

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Jordan University

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Jordan University

94. Freih Abu Hassan
Jordan UniversityNerve injury

95. Freih Abu Hassan
Jordan University
Appliances
Deformity
ML-paralysed
AFO + inside bar &Outside T strap
Inversion
Evertors
1-Foot
AFO + 90 / foot drop stop
Foot drop
Dorsiflexors
2-Ankle
AFO + reverse 90/ stop
Calcanecus
Plantar Flexors
AFO + limited motion ankle joint
Flail foot
All muscles
3-Ankle &Foot
KAFO +back knee support
Genu Recurvatum
Extensor: quadriceps
4-Knee

96. Freih Abu Hassan
Jordan UniversityOrthosis used only for abnormal child or child with chronic problem

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Jordan University

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Jordan University

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Jordan University
Normal child needs
normal shoes

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Jordan University
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101. Freih Abu Hassan
Jordan UniversitySevereFamily HistoryUnilat. Shortstature

102. Freih Abu Jordan University Hassan