Module 72, General Orthopaedist Level
This male was born premature and was in the hospital for 3-1/2 weeks.
He started walking by cruising at 18 months. He is now 7 years old and
walking using his crutches and a walker. He uses a combination of the bilateral
Lofstrand crutches, a K-posture walker and a light-weight wheelchair depending
on the distance that he has to ambulate. He is in a regular class room
and has normal speech. In the last year his ambulation has become more
difficult because of toe dragging and his feet rolling over. On physical
examination he has markedly asymmetrical hip abduction and internal rotation,
a large amount of spasticity in the rectus femoris muscle, and severe planovalgus
feet.
Question 72A
Any consideration of surgery will likely prevent this boy from walking.
Question 72B
The
hip subluxation with the windblown deformity is a significant problem with
his current ambulatory difficulty.
Question 72C
The
planovalgus feet also contribute to his walking difficulty.
Question 72D
The
mother is very concerned about his toe drag because he wears out a pair
of shoes in several weeks. You reassure her that this is due to the increased
deformity of the feet.
Question 72E
One
option for treatment of this boy is to recommend a femoral varus osteotomy
for the right subluxated hip and subtalar fusions of both feet.
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