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Samenvatting/ eigen cursus kinderorthopedie
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Samenvatting/ eigen cursus van kinderorthopedie Deelvak van pediatrie
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KINDERORTHOPEDIEINHOUDSTAFEL
HOOFDSTUK 1 TRAUMATOLOGIE BOVENSTE LIDMAAT ......................................................................... 4
1) Inleiding traumatologie ............................................................................................................... 4
2) Groei............................................................................................................................................ 4
3) Type fracturen............................................................................................................................. 6
1. Distale raduis facturen ............................................................................................................ 6
2. Antiichrachii fractuur .............................................................................................................. 7
3. Raduiskop fracturen ................................................................................................................ 7
4. Supracondylaire fracturen ...................................................................................................... 7
5. Humerus schact fracturen....................................................................................................... 8
6. Proximale humerus fracturen ................................................................................................. 9
4) Inleiding congenitale ................................................................................................................... 9
1. Congenitale bovenste lidmaatafwijkingen............................................................................ 10
HOOFDSTUK 2 : Rugafwijkingen bij kinderen en infecties .................................................................... 15
1) Scoliose ..................................................................................................................................... 15
1. Klinisch onderzoek ................................................................................................................ 15
2. Classificatie............................................................................................................................ 16
3. Oorzaken scoliose ................................................................................................................. 16
4. Behandeling .......................................................................................................................... 17
7. Take home message.............................................................................................................. 18
2) Kromming rug ........................................................................................................................... 18
1. Posturele kyfose .................................................................................................................... 18
2. Scheuerman kyfose ............................................................................................................... 19
3) Lumbale rugklachten................................................................................................................. 19
1. Spondylolysis ......................................................................................................................... 19
2. Spondylolistesis =slip ............................................................................................................ 19
4) Osteomyelitis ............................................................................................................................ 20
5) Spetische arthiritis .................................................................................................................... 21
6) Take home message.................................................................................................................. 22
HOOFDSTUK 3 : HEUP AFWIJKINGEN.................................................................................................... 23
1) Manken door heupklachten...................................................................................................... 23
2) Heupdysplasie definitie............................................................................................................. 23
1. Screening/ diagnostiek / Klinisch onderzoek ........................................................................ 24
1
, 2. Ultrasound & RX ................................................................................................................... 24
3. Behandeling .......................................................................................................................... 25
4. CASUS 1 ................................................................................................................................. 26
5. CASUS 2 ................................................................................................................................. 26
6. CASUS 3 ................................................................................................................................. 26
7. Casus 4 .................................................................................................................................. 26
3) Legg calve perthes..................................................................................................................... 27
4) Epifysiolyse= Slipped capital femoral epifysis (SCFE)................................................................ 28
HOOFDSTUK 4 : Statiek en lengteafwijkingen bij kinderen .................................................................. 29
1) Groei.......................................................................................................................................... 29
2) As-deviatie ................................................................................................................................ 29
1. X- en O-benen: casus 1.......................................................................................................... 29
2. Ziekte van Blount : Casus 2 ................................................................................................... 30
3. Fibro-cartilagineuse dysplasie (FCD) ..................................................................................... 30
4. Post-traumatische valgus : casus 3 ....................................................................................... 30
5. Buiging v/d tibia .................................................................................................................... 30
6. Take home message.............................................................................................................. 31
3) Rotationele afwijking ................................................................................................................ 31
1. Anteversie : casus 4............................................................................................................... 31
2. Metatarsus adductus ............................................................................................................ 31
4) Beenlengteverschil .................................................................................................................... 32
1. Progressief beenlengteverschil : casus 5 .............................................................................. 33
Hoofdstuk 5 : voetafwijkingen en sportletsels bij kinderen ................................................................. 34
1) Pediatrische platvoeten ............................................................................................................ 34
1. Definitie................................................................................................................................. 34
2. Anamnese ............................................................................................................................. 34
3. Lichamelijk onderzoek .......................................................................................................... 34
4. Wat te doen met de platvoet? .............................................................................................. 35
5. Conclusie ............................................................................................................................... 35
2) Matatarsus adductus ................................................................................................................ 35
1. Inleiding................................................................................................................................. 35
2. Prognose & behandeling ....................................................................................................... 36
3) Pes cavus ................................................................................................................................... 36
4) Afwijking v/d kleine teen .......................................................................................................... 36
5) Hallux varus ............................................................................................................................... 36
6) Idiopathische klompvoet .......................................................................................................... 36
2
, 7) Voetpijn bij kinderen................................................................................................................. 37
1. Ziekte van Kohler .................................................................................................................. 37
2. Ziekte van Freiberg................................................................................................................ 37
3. Unguis incarnatus ................................................................................................................. 37
8) Sport specifieke blessures......................................................................................................... 37
9) Overbelastingsletsels ................................................................................................................ 37
10) Osteochondritis dissecans OCD ........................................................................................... 38
11) OCD vs ziekte van Panner ..................................................................................................... 38
12) Sportletsels ........................................................................................................................... 38
1. Sportletsels v/d wervelzuil .................................................................................................... 38
2. Sportletsels v/d heup ............................................................................................................ 38
3. Sportletsels rond de knie ...................................................................................................... 39
4. Fracturen v/d voet/enkel bij kinderen .................................................................................. 40
HOOFDSTUK 6 : orthopedische behandeling bij neurologische aandoeningen cerebral palsy ............ 41
1) Neuromusculaire ziekten/ cerebrale parese ............................................................................ 41
2) Cerebrale parese : classificatie.................................................................................................. 41
3) Statisch VS dynamisch onderzoek............................................................................................. 41
4) Algemene behandelprincipes Cerebrale parese ....................................................................... 42
5) Spasticiteitsbehandeling CP ...................................................................................................... 42
1. BTX-A : botuline toxine ......................................................................................................... 42
2. SDR : selectieve dorsale rhizotomie ...................................................................................... 44
3. ITB : intrathecale baclofen pomp.......................................................................................... 44
6) Principes van orthopedische ingrepen bij CP/ neurologische ziekten ...................................... 45
1. Wekedelen chirurgie peesverlengingen/ transfers .............................................................. 45
2. Ossale chirurgie ..................................................................................................................... 46
3
, HOOFDSTUK 1 TRAUMATOLOGIE BOVENSTE LIDMAAT
1) Inleiding traumatologie
• Lichamelijk orthopedisch onderzoek v/h kind
o Inspectie begint in de wachtzaal en tijdens hetero anamnese
o Actief bewegingsonderzoek
▪ Volledige lidmaat met wervelzuil
o Passief bewegingsonderszoek
▪ Pijnlijk gewricht laatst
▪ Steeds selectief
o Palpatie
▪ Voorzichtig
• Risico gedrag
o Verschillend tss jongens en meisjes
▪ 40% kans op fractuur bij jongens en lager bij meisjes
o I/d zomermaanden meer fracturen
2) Groei
• Secundaire ossificatie centra
• Meeste groei BL thv schouders en pols en minder i/d elleboog
• Meeste groei OL i/d knie en minder bij heup en enkels
• Secundaire ossificatie kernen elleboog
o CRITOE : Ossification ages ¨Paeds elbow
o 6 Verschillende ossifaties gebeurt tijdens de jeugd
o 1ste jaar
o 3de jaar
o 5de jaar
o 7de jaar
o 9de haar
o 11de jaar
4
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