KBK: Kinderorthopedie
SPINA BIFIDA EN NEUROMUSCULAIRE AANDOENINGEN (EEN ORTHOPEDISCH PERSPECTIEF) .......................................... 5
SPINA BIFIDA ............................................................................................................................................................................5
Wat is spina bifida ...........................................................................................................................................................5
Types spina bifida ............................................................................................................................................................5
SB.....................................................................................................................................................................................5
SB geassocieerde problematiek .......................................................................................................................................6
Prenatale fase .................................................................................................................................................................6
Natuurlijk beloop .............................................................................................................................................................6
Kliniek SB .........................................................................................................................................................................7
Waarom is orthopedisch chirurg betrokken in zorg SB? .................................................................................................7
Waar hebben we geen invloed op? .................................................................................................................................7
Waar hebben we wel invloed op? ...................................................................................................................................7
Orthopedisch management.............................................................................................................................................8
Functionele mogelijkheden..............................................................................................................................................8
Orthopedisch management.............................................................................................................................................9
Heup............................................................................................................................................................................................ 10
Knie ............................................................................................................................................................................................. 10
Anterieure hemi epifysiodese distale femur ter correctie flexie contractuur ....................................................................... 10
Rotatie......................................................................................................................................................................................... 10
Voet & enkel ............................................................................................................................................................................... 11
Scoliose ....................................................................................................................................................................................... 11
Behoud ambulantie .......................................................................................................................................................12
NEUROMUSCULAIRE AANDOENINGEN..........................................................................................................................................12
Duchenne musculaire dystrofie .....................................................................................................................................13
Klinisch verloop ........................................................................................................................................................................... 14
Orthopedisch management ........................................................................................................................................................ 14
Spinale musculaire atrofie (SMA) ..................................................................................................................................14
3 types......................................................................................................................................................................................... 15
Diagnostiek SMA ......................................................................................................................................................................... 15
Orthopedisch management ........................................................................................................................................................ 15
Algemeen management .............................................................................................................................................................. 16
Charcot Marie Tooth / heriditeire Motorische Sensorische Neuropathie (HMSN) ........................................................16
HMSN: orthopedisch management............................................................................................................................................. 16
Principes voor behandeling ......................................................................................................................................................... 16
Oprichtings osteotomie 1e straal ................................................................................................................................................ 17
Pees transfers bij CMT ................................................................................................................................................................ 17
SAMENVATTEND .....................................................................................................................................................................17
VOETEN & ONDERSTE LIDMAAT STOORNISSEN .............................................................................................................. 18
DEEL 1: PIJN IN DE VOET ...........................................................................................................................................................18
Pes planus......................................................................................................................................................................18
Normale 2-jarige: bilaterale flexibele pes planovalgus ............................................................................................................... 18
Niet-gecorrigeerde platvoeten bij een adolescent: .................................................................................................................... 18
Behandeling ................................................................................................................................................................................ 19
Natuurlijke evolutie: ................................................................................................................................................................... 19
Rigide (stijve) platvoet: ............................................................................................................................................................... 19
Tarsale coalitie ............................................................................................................................................................................ 19
Ziekte van Freiberg ........................................................................................................................................................20
Ziekte van Kohler ...........................................................................................................................................................20
Ziekte van Sever (= Calcaneaire apophysitis).................................................................................................................20
Pes cavus .......................................................................................................................................................................20
Progressieve carovarus: .............................................................................................................................................................. 20
1
, DEEL 2: CONGENITALE VOETAANDOENINGEN ................................................................................................................................20
Calcaneovalgus..............................................................................................................................................................21
Differentiaal diagnoses ............................................................................................................................................................... 21
Behandeling ................................................................................................................................................................................ 21
Metatarsus adductus: ...................................................................................................................................................21
Behandeling ................................................................................................................................................................................ 21
Clubfoot .........................................................................................................................................................................22
Oorzaak: ...................................................................................................................................................................................... 22
Indeling volgens Dimeglio: .......................................................................................................................................................... 22
Behandeling: ............................................................................................................................................................................... 23
DEEL 3: LOOPSTOORNISSEN – ONGELIJKE LENGTE VAN DE BENEN......................................................................................................24
Inwendige rotatie – toeing in ........................................................................................................................................24
Toeing out .....................................................................................................................................................................25
X- en O-benen ................................................................................................................................................................25
Beenlengteverschillen....................................................................................................................................................25
Behandeling ................................................................................................................................................................................ 25
CONGENITALE & VERWORVEN HEUPPROBLEMEN BIJ KINDEREN ................................................................................... 26
ONTWIKKELINGSDYSPLASIE VAN DE HEUP: DDH ............................................................................................................................26
Prevalentie ....................................................................................................................................................................26
Risicofactoren voor DDH ...............................................................................................................................................26
Diagnose........................................................................................................................................................................26
.......................................................................................................................................................................................27
Klinische tekenen van instabiliteit .................................................................................................................................27
Beeldvorming ................................................................................................................................................................27
Welke heupen moeten behandeld worden? ..................................................................................................................28
Behandeling...................................................................................................................................................................28
Complicatie van de behandeling ...................................................................................................................................28
Behandeling bij oudere kinderen > 2 jaar: femorale verkorting en acetabuloplastie ...................................................29
Residuele dysplasie ........................................................................................................................................................29
TRANSIËNTE SYNOVITIS.............................................................................................................................................................29
Behandeling...................................................................................................................................................................29
LEGG-CALVÉ-PERTHES ..............................................................................................................................................................29
Prognose........................................................................................................................................................................30
Behandeling...................................................................................................................................................................30
Onze huidige houding ................................................................................................................................................................. 30
Lange termijn evolutie ...................................................................................................................................................30
EPIFYSIOLYSIS VAN DE HEUPKOP .................................................................................................................................................30
Diagnose........................................................................................................................................................................30
Classificatie ....................................................................................................................................................................31
Behandeling...................................................................................................................................................................31
Complicaties ..................................................................................................................................................................31
Prognose........................................................................................................................................................................31
MANKEN ...............................................................................................................................................................................31
SPORTLETSELS BIJ KINDEREN .......................................................................................................................................... 33
DE SCHOUDER ........................................................................................................................................................................33
Luxatie & instabiliteit ....................................................................................................................................................33
Behandeling ................................................................................................................................................................................ 33
Osteochondrosis proximal humerus ..............................................................................................................................33
Impingement .................................................................................................................................................................34
Behandeling ................................................................................................................................................................................ 34
DE ELLEBOOG .........................................................................................................................................................................34
Little league elleboog ....................................................................................................................................................34
Behandeling ................................................................................................................................................................................ 34
2
, DE POLS ................................................................................................................................................................................34
Gymnast wrist ...............................................................................................................................................................34
DE WERVELKOLOM ..................................................................................................................................................................34
Cervicaal ........................................................................................................................................................................34
Lumbaal .........................................................................................................................................................................35
Behandeling ................................................................................................................................................................................ 35
HEUP & PELVIS .......................................................................................................................................................................35
Apofysaire avulsie .........................................................................................................................................................35
Behandeling ................................................................................................................................................................................ 35
BOVENBEENLETSELS (THIGH LESIONS) ..........................................................................................................................................35
Hamstringsverrekking ...................................................................................................................................................35
Behandeling ................................................................................................................................................................................ 35
Dijcontusio en myositis ..................................................................................................................................................35
Behandeling ................................................................................................................................................................................ 35
KNIELETSELS...........................................................................................................................................................................35
Voorste kruisband ruptuur ............................................................................................................................................36
Meniscusletsels..............................................................................................................................................................36
Patella luxatie ................................................................................................................................................................36
Iliotibiaal frictie syndroom ............................................................................................................................................36
Behandeling ................................................................................................................................................................................ 36
AANDOENINGEN VAN DE WERVELKOLOM BIJ KINDEREN ............................................................................................... 37
RUGPIJN BIJ KINDEREN .............................................................................................................................................................37
Discus hernia .................................................................................................................................................................37
Discitis ...........................................................................................................................................................................38
Tumoren ........................................................................................................................................................................38
THORACIC HYPERKYFYSOSIS .......................................................................................................................................................38
Hyperkyfose ...................................................................................................................................................................38
SCOLIOSIS ..............................................................................................................................................................................38
Structurele scoliose........................................................................................................................................................39
Idiopathische scoliose ....................................................................................................................................................39
Infantiele scoliose ..........................................................................................................................................................39
Juvenale scoliose ...........................................................................................................................................................39
Adolescent scoliosis .......................................................................................................................................................39
Behandeling...................................................................................................................................................................39
Evolutie ..........................................................................................................................................................................40
Posterieure arthodese ...................................................................................................................................................41
TORTICOLLIS...........................................................................................................................................................................41
Musculair .......................................................................................................................................................................41
Skeletaal ........................................................................................................................................................................42
Inflammatoir/ neoplastisch ...........................................................................................................................................42
Andere oorzaken ...........................................................................................................................................................42
KISS SYNDROOM ....................................................................................................................................................................42
Kritische geluiden ..........................................................................................................................................................43
KNIEPIJN BIJ KINDEREN .................................................................................................................................................. 44
APOPHYSITIS ..........................................................................................................................................................................44
OSGOOD SCHLATTER ...............................................................................................................................................................44
Diagnose........................................................................................................................................................................45
Behandeling...................................................................................................................................................................45
OSTEOCHONDRITIS DISSECANS ...................................................................................................................................................45
ANTERIEURE KNIEPIJN VAN DE ADOLESCENT ..................................................................................................................................46
GROEIPIJNEN..........................................................................................................................................................................46
ORTHOPEDISCHE BEHANDELING BIJ CP (SPASTICITEIT) ................................................................................................... 48
3
, PRIMAIR ................................................................................................................................................................................48
SECUNDAIR ............................................................................................................................................................................48
Mal-rotated Lever arm ..................................................................................................................................................50
Unstable Fulcrum ..........................................................................................................................................................51
TERTIAIRE PROBLEMEN .............................................................................................................................................................51
4
SPINA BIFIDA EN NEUROMUSCULAIRE AANDOENINGEN (EEN ORTHOPEDISCH PERSPECTIEF) .......................................... 5
SPINA BIFIDA ............................................................................................................................................................................5
Wat is spina bifida ...........................................................................................................................................................5
Types spina bifida ............................................................................................................................................................5
SB.....................................................................................................................................................................................5
SB geassocieerde problematiek .......................................................................................................................................6
Prenatale fase .................................................................................................................................................................6
Natuurlijk beloop .............................................................................................................................................................6
Kliniek SB .........................................................................................................................................................................7
Waarom is orthopedisch chirurg betrokken in zorg SB? .................................................................................................7
Waar hebben we geen invloed op? .................................................................................................................................7
Waar hebben we wel invloed op? ...................................................................................................................................7
Orthopedisch management.............................................................................................................................................8
Functionele mogelijkheden..............................................................................................................................................8
Orthopedisch management.............................................................................................................................................9
Heup............................................................................................................................................................................................ 10
Knie ............................................................................................................................................................................................. 10
Anterieure hemi epifysiodese distale femur ter correctie flexie contractuur ....................................................................... 10
Rotatie......................................................................................................................................................................................... 10
Voet & enkel ............................................................................................................................................................................... 11
Scoliose ....................................................................................................................................................................................... 11
Behoud ambulantie .......................................................................................................................................................12
NEUROMUSCULAIRE AANDOENINGEN..........................................................................................................................................12
Duchenne musculaire dystrofie .....................................................................................................................................13
Klinisch verloop ........................................................................................................................................................................... 14
Orthopedisch management ........................................................................................................................................................ 14
Spinale musculaire atrofie (SMA) ..................................................................................................................................14
3 types......................................................................................................................................................................................... 15
Diagnostiek SMA ......................................................................................................................................................................... 15
Orthopedisch management ........................................................................................................................................................ 15
Algemeen management .............................................................................................................................................................. 16
Charcot Marie Tooth / heriditeire Motorische Sensorische Neuropathie (HMSN) ........................................................16
HMSN: orthopedisch management............................................................................................................................................. 16
Principes voor behandeling ......................................................................................................................................................... 16
Oprichtings osteotomie 1e straal ................................................................................................................................................ 17
Pees transfers bij CMT ................................................................................................................................................................ 17
SAMENVATTEND .....................................................................................................................................................................17
VOETEN & ONDERSTE LIDMAAT STOORNISSEN .............................................................................................................. 18
DEEL 1: PIJN IN DE VOET ...........................................................................................................................................................18
Pes planus......................................................................................................................................................................18
Normale 2-jarige: bilaterale flexibele pes planovalgus ............................................................................................................... 18
Niet-gecorrigeerde platvoeten bij een adolescent: .................................................................................................................... 18
Behandeling ................................................................................................................................................................................ 19
Natuurlijke evolutie: ................................................................................................................................................................... 19
Rigide (stijve) platvoet: ............................................................................................................................................................... 19
Tarsale coalitie ............................................................................................................................................................................ 19
Ziekte van Freiberg ........................................................................................................................................................20
Ziekte van Kohler ...........................................................................................................................................................20
Ziekte van Sever (= Calcaneaire apophysitis).................................................................................................................20
Pes cavus .......................................................................................................................................................................20
Progressieve carovarus: .............................................................................................................................................................. 20
1
, DEEL 2: CONGENITALE VOETAANDOENINGEN ................................................................................................................................20
Calcaneovalgus..............................................................................................................................................................21
Differentiaal diagnoses ............................................................................................................................................................... 21
Behandeling ................................................................................................................................................................................ 21
Metatarsus adductus: ...................................................................................................................................................21
Behandeling ................................................................................................................................................................................ 21
Clubfoot .........................................................................................................................................................................22
Oorzaak: ...................................................................................................................................................................................... 22
Indeling volgens Dimeglio: .......................................................................................................................................................... 22
Behandeling: ............................................................................................................................................................................... 23
DEEL 3: LOOPSTOORNISSEN – ONGELIJKE LENGTE VAN DE BENEN......................................................................................................24
Inwendige rotatie – toeing in ........................................................................................................................................24
Toeing out .....................................................................................................................................................................25
X- en O-benen ................................................................................................................................................................25
Beenlengteverschillen....................................................................................................................................................25
Behandeling ................................................................................................................................................................................ 25
CONGENITALE & VERWORVEN HEUPPROBLEMEN BIJ KINDEREN ................................................................................... 26
ONTWIKKELINGSDYSPLASIE VAN DE HEUP: DDH ............................................................................................................................26
Prevalentie ....................................................................................................................................................................26
Risicofactoren voor DDH ...............................................................................................................................................26
Diagnose........................................................................................................................................................................26
.......................................................................................................................................................................................27
Klinische tekenen van instabiliteit .................................................................................................................................27
Beeldvorming ................................................................................................................................................................27
Welke heupen moeten behandeld worden? ..................................................................................................................28
Behandeling...................................................................................................................................................................28
Complicatie van de behandeling ...................................................................................................................................28
Behandeling bij oudere kinderen > 2 jaar: femorale verkorting en acetabuloplastie ...................................................29
Residuele dysplasie ........................................................................................................................................................29
TRANSIËNTE SYNOVITIS.............................................................................................................................................................29
Behandeling...................................................................................................................................................................29
LEGG-CALVÉ-PERTHES ..............................................................................................................................................................29
Prognose........................................................................................................................................................................30
Behandeling...................................................................................................................................................................30
Onze huidige houding ................................................................................................................................................................. 30
Lange termijn evolutie ...................................................................................................................................................30
EPIFYSIOLYSIS VAN DE HEUPKOP .................................................................................................................................................30
Diagnose........................................................................................................................................................................30
Classificatie ....................................................................................................................................................................31
Behandeling...................................................................................................................................................................31
Complicaties ..................................................................................................................................................................31
Prognose........................................................................................................................................................................31
MANKEN ...............................................................................................................................................................................31
SPORTLETSELS BIJ KINDEREN .......................................................................................................................................... 33
DE SCHOUDER ........................................................................................................................................................................33
Luxatie & instabiliteit ....................................................................................................................................................33
Behandeling ................................................................................................................................................................................ 33
Osteochondrosis proximal humerus ..............................................................................................................................33
Impingement .................................................................................................................................................................34
Behandeling ................................................................................................................................................................................ 34
DE ELLEBOOG .........................................................................................................................................................................34
Little league elleboog ....................................................................................................................................................34
Behandeling ................................................................................................................................................................................ 34
2
, DE POLS ................................................................................................................................................................................34
Gymnast wrist ...............................................................................................................................................................34
DE WERVELKOLOM ..................................................................................................................................................................34
Cervicaal ........................................................................................................................................................................34
Lumbaal .........................................................................................................................................................................35
Behandeling ................................................................................................................................................................................ 35
HEUP & PELVIS .......................................................................................................................................................................35
Apofysaire avulsie .........................................................................................................................................................35
Behandeling ................................................................................................................................................................................ 35
BOVENBEENLETSELS (THIGH LESIONS) ..........................................................................................................................................35
Hamstringsverrekking ...................................................................................................................................................35
Behandeling ................................................................................................................................................................................ 35
Dijcontusio en myositis ..................................................................................................................................................35
Behandeling ................................................................................................................................................................................ 35
KNIELETSELS...........................................................................................................................................................................35
Voorste kruisband ruptuur ............................................................................................................................................36
Meniscusletsels..............................................................................................................................................................36
Patella luxatie ................................................................................................................................................................36
Iliotibiaal frictie syndroom ............................................................................................................................................36
Behandeling ................................................................................................................................................................................ 36
AANDOENINGEN VAN DE WERVELKOLOM BIJ KINDEREN ............................................................................................... 37
RUGPIJN BIJ KINDEREN .............................................................................................................................................................37
Discus hernia .................................................................................................................................................................37
Discitis ...........................................................................................................................................................................38
Tumoren ........................................................................................................................................................................38
THORACIC HYPERKYFYSOSIS .......................................................................................................................................................38
Hyperkyfose ...................................................................................................................................................................38
SCOLIOSIS ..............................................................................................................................................................................38
Structurele scoliose........................................................................................................................................................39
Idiopathische scoliose ....................................................................................................................................................39
Infantiele scoliose ..........................................................................................................................................................39
Juvenale scoliose ...........................................................................................................................................................39
Adolescent scoliosis .......................................................................................................................................................39
Behandeling...................................................................................................................................................................39
Evolutie ..........................................................................................................................................................................40
Posterieure arthodese ...................................................................................................................................................41
TORTICOLLIS...........................................................................................................................................................................41
Musculair .......................................................................................................................................................................41
Skeletaal ........................................................................................................................................................................42
Inflammatoir/ neoplastisch ...........................................................................................................................................42
Andere oorzaken ...........................................................................................................................................................42
KISS SYNDROOM ....................................................................................................................................................................42
Kritische geluiden ..........................................................................................................................................................43
KNIEPIJN BIJ KINDEREN .................................................................................................................................................. 44
APOPHYSITIS ..........................................................................................................................................................................44
OSGOOD SCHLATTER ...............................................................................................................................................................44
Diagnose........................................................................................................................................................................45
Behandeling...................................................................................................................................................................45
OSTEOCHONDRITIS DISSECANS ...................................................................................................................................................45
ANTERIEURE KNIEPIJN VAN DE ADOLESCENT ..................................................................................................................................46
GROEIPIJNEN..........................................................................................................................................................................46
ORTHOPEDISCHE BEHANDELING BIJ CP (SPASTICITEIT) ................................................................................................... 48
3
, PRIMAIR ................................................................................................................................................................................48
SECUNDAIR ............................................................................................................................................................................48
Mal-rotated Lever arm ..................................................................................................................................................50
Unstable Fulcrum ..........................................................................................................................................................51
TERTIAIRE PROBLEMEN .............................................................................................................................................................51
4
