KELAINAN KONGENITAL TULANG

BAMBANG AGUS TEJA

KUSUMAH . SPOT
SMF BEDAH ORTHOPAEDI DAN
TRAUMATOLOGI RSUD PROF DR
MARGONO SOEKARDJO / BAGIAN BEDAH
FAKULTAS KEDOKTERAN UNIVERSITAS
JENDRAL SOEDIRMAN

PURWOKERTO

RUANG LINGKUP
ORTHOPAEDI
1. KELAINAN BAWAAN
- CTEV ( CONGENITAL TALIPES EQUENO
VARUS ) / CLUB FOOT
- CONGENITAL DYSPLASIA OF THE HIP
- POLYDACTILY
- TORTICOLIS
- SPINA BIFIDA DLL

2. INFEKSI
OSTEOMYELITIS
3. TRAUMA
FRAKTUR DAN DISLOKASI
4. TUMOR
5. DEGENERATIF
- OSTEOARTHRITIS
6. MICELENIOUS
- PENYAKIT METABOLIK
- CEREBRAL PALSY
- POST POLIOMYELITIS

ORTHOPAEDI TIDAK HANYA

MENGURUSI TULANG SAJA.!
DEFINISINYA ?
Consist of art and science of
prevention, investigation,
diagnosis, and treatment of
disorders and injuries of the
musculoskeletal system by
medical, surgical, and physical
means

CONGENITAL TALIPES EQUENUS

VARUS ( CLUB FOOT )

Kompleks organ yang diperlukan untuk menjadi Stabil : untuk

mendukung berat badan dalam performa Resilient : untuk
berjalan dan berlari Ponsel : untuk mengakomodasi variasi
permukaan kosmetik

THE NORMAL FOOT

Complex organ that is required to be
Stable: for supporting the body weight in
standing
Resilient: for walking and running
Mobile: to accommodate variations of surface
Cosmetic

CTEV/CLUB FOOT

Gambaran klinis : 1. angkle di equinus 2. tumit terbalik

3. kaki depan adduksi dan supinated 4. tumit ussually
kecil dan tinggi 5. lipatan mendalam muncul posterior
dan medial

Clinical features:
1.
2.
3.
4.
5.

angkle is in equinus
the heel is inverted
the forefoot adducted and supinated
the heel ussually small and high
deep creases appear posteriorly and
medially

Planus : kelasi Cavus : footVarus sangat melengkung : menyembuhkan

akan menuju garis tengah Valgus : tumit akan pergi
dari garis tengah Adduksi : kaki depan akan
menuju garis tengah Penculikan : kaki depan akan
pergi Dari Kaki depan garis tengah
kaki belakang

Planus:
Cavus:

flatfoot
highly arched footVarus: heal going
towards
the midline
Valgus:
heel going away
from the midline
Adduction:
forefoot going
towards the midline
Abduction:
forefoot going away
From the midline
Forefoot
foot

Hind

Types
Idiopathic (Unknown Etiology) :
Congenital Talipes Equino-Varus CTEV
Acquired, Secondary to :
CNS Disease : Spina bifida, Poliomyelitis
Arthrogryposis
Absent Bone : fibula / tibia

Etiology
Unknown

etiologi Beberapa faktor tersebut adalah : Pasukan intrauterin abnormal Perkembangan

janin Ditangkap Otot dan tendon insersi Abnormal Abnormal rotasi talus di tanggam
Cacat plasma nutfah

Etiology
Some of these factors are :
Abnormal intrauterine forces
Arrested fetal development
Abnormal muscle and tendon insertions
Abnormal rotation of the talus in the
mortise
Germ plasm defects

Incidence
Occurs approximately in one of every
1000 live birth
In affected families, clubfeet are about
30 times more frequent in offspring
Male are affected in about 65% of cases
Bilateral cases are as high as 30 40 %

Geographic Distribution
Middle East , KSA common
Mediterranean Coast & North
Africa
White race

Diagnosis
General Examination :

Exclude

Neurological lesion that can cause the deformity

Spina Bifida
Other abnormalities that can explain the deformity
Arthrogryposis, Myelodysplasia
Presence of concomitant congenital anomalies
Proximal femoral focal deficiency
Syndromatic clubfoot
Larsens syndrome, Amniotic band Syndrome

Spina Bifida

Paralytic TEV

Diagnosis
Characteristic Deformity :
Hind foot
Equinus
(Ankle joint)
Varus
(Subtalar joint)
Fore foot
Adduction
(Med tarsal joint)
Supination fore foot
Cavus

DIAGNOSIS

HINDFOOT : EQUINUS, VARUS

ADDUCTION,SUPINATION,CAVUS

FOREFOOT :

diagnosa Achilles tendon pendek Tinggi dan kecil tumit Tidak ada
lipatan belakang Heel Abnormal lipatan di tengah kaki Foot lebih
kecil dalam kasih sayang unilateral Callosities di daerah tekanan
abnormal Torsi internal kaki Otot betis membuang-buang Cacat
tidak mencegah berjalan

Diagnosis
Short Achilles tendon
High and small heel
No creases behind Heel
Abnormal crease in middle of the foot
Foot is smaller in unilateral affection
Callosities at abnormal pressure areas
Internal torsion of the leg
Calf muscles wasting
Deformities dont prevent walking

pengobatan Tujuan dari pengobatan untuk kaki pengkor adalah untuk

mendapatkan kaki plantigrade yang fungsional , tanpa rasa sakit , dan stabil
dari waktu ke waktu Sebuah penampilan kosmetik menyenangkan juga tujuan
penting dicari oleh ahli bedah dan keluarga

Treatment
The goal of treatment for clubfoot
is to obtain a plantigrade foot that
is functional, painless, and stable
over time
A cosmetically pleasing appearance
is also an important goal sought by
the surgeon and the family

pengobatan Pengobatan bedah Non harus dimulai segera setelah

lahir manipulasi lembut imobilisasi - Strapping ???? POP atau sintetis cor - Ponseti Metode

Treatment
Non surgical treatment should begin shortly after birth
1. Gentle manipulation

2. Immobilization
- Strapping ????
- POP or synthetic cast
- PONSETI Methode

pengobatan Pengobatan bedah Non harus dimulai segera setelah lahir

Splints untuk mempertahankan koreksi - Dennis Brown belat

Treatment
Non surgical treatment should begin shortly after
birth
3. Splints to maintain correction
- Dennis Brown splint

Pengobatan bedah indikasi Presentasi 1.Late , setelah usia 6

bulan ! 2.Complementary terhadap pengobatan konservatif
3.Failure pengobatan konservatif Deformitas 4.Residual setelah
pengobatan konservatif 5.Recurrence setelah pengobatan
konservatif

Surgical Treatment
Indications
1.Late presentation, after 6 months of age !
2.Complementary to conservative treatment
3.Failure of conservative treatment
4.Residual deformities after conservative
treatment
5.Recurrence after conservative treatment

Torticollis

What is it?
Also known as Wryneck
Head and chin are tilted at
opposite angles, causing head to
twist
Asymmetrical Appearance

Effected
muscle:sternocleidomastoid

Bisa ada sebelum atau pada saat lahir Bawaan Muscular Tortikolis Dapat terjadi
selama masa kanak-kanak melalui usia dewasa Acquired / Noncongenital Muscular
Tortikolis Keduanya menyebabkan penampilan asimetris dan fungsi di leher dan
kepala mereka yang menderita

What is it?
Can exist before or at birth
Congenital Muscular Torticollis

Can occur during childhood up through

adult age
Acquired/Noncongenital Muscular Torticollis
Both cause asymmetrical appearance and
function in the neck and head of those afflicted

Prevalence
Less than .4% of newborns
Torticollis does not prefer one side
of head or the other
In CMT, ratio of boys to girls is 3:2
Increased head size in male babies

Pada orang dewasa , tortikolis otot noncongenital memiliki onset rata-rata

berusia 40 tahun Wanita dua kali lebih mungkin menderita daripada lakilaki Distribusi biasanya sama antara kanan dan kiri tubuh menderita
Tortikolis Sedikit lebih tepat pada populasi perempuan yang lebih tua

Prevalence
In adults, noncongenital muscular
torticollis has an average onset of 40
years old
Females twice as likely afflicted than males

Usually equal distribution between right

and left side of body afflicted
Slightly more right torticollis in older female
populations

Tidak dipahami dengan baik Hampir 80 entitas telah dilaporkan

menyebabkan tortikolis Penyebab umum : Gangguan perkembangan
yang mempengaruhi otot sternokleidomastoid Ketidakseimbangan
dalam fungsi otot serviks Kelainan lain di tengkorak / daerah serviks

Causes?
Not well understood
Almost 80 entities have been reported to
cause torticollis

Common causes:
Developmental disorders affecting
sternocleidomastoid muscle
Imbalance in function of cervical muscles
Other abnormalities in skull/cervical area

cacat genetik Posisi bayi selama kehamilan atau persalinan Tumor

di kepala atau leher Arthritis leher Pseudotumors pada bayi obatobat tertentu gen Lebih mungkin menderita jika anggota keluarga
memiliki tortikolis atau gangguan serupa

Other Causes
Genetic defect
Infants position during pregnancy or
delivery
Tumors in head or neck
Arthritis of neck
Pseudotumors in infants

Certain medications
Genes
More likely to be afflicted if family member
had torticollis or similar disorder

Dewasa dan Anak-anak : Kontraksi yang abnormal dari leher Jangkauan

terbatas gerak Otot leher kaku Kemungkinan pembengkakan dan rasa
sakit Sering keliru untuk kondisi yang lebih serius Lihat profesional
medis

Symptoms
Adults and Children:
Abnormal contraction of the neck
Limited range of motion
Stiff neck muscles
Possible swelling and pain

Can often be mistaken for more serious

condition
See medical professional immediately

bayi : Miring dagu Massa kecil ( pseudotumor ) di leher Leher

kejang kecil Didiagnosis sebelum = terapi fisik lebih pendek
berusia 1 bulan

Symptoms
Infants:
Tilting of chin
Small mass
(pseudotumor) in neck
Small neck spasms

Diagnosed before 1
month old = shorter
physical therapy

Paling membantu diagnosis dibuat awal Tidak mengancam

kehidupan Semoga diri benar sendiri Mungkin kronis dan
reoccurring Komplikasi dapat terjadi akibat akar saraf dikompres

Prognosis
Most helpful diagnosis is made
early
Not life threatening
May self correct itself
May be chronic and reoccurring
Any complications may result from
compressed nerve roots

Peregangan dan memperpanjang otot leher yang terkena Menerapkan panas , pijat ,
analgesik Dapat dikombinasikan dengan TENS Transcutaneous Electrical Nerve
Stimulation Medis pengobatan Bacolfen atau Botox Injeksi setiap tiga bulan

Treatments
Stretching and lengthening
affected neck muscles
Applying heat, massage,
analgesics
Can be combined with TENS
Transcutaneous Electrical Nerve
Stimulation

Medical treatmentBacolfen or

Bedah pada kasus yang berat Pasien yang patologi tidak menyelesaikan
setelah 12 bulan terapi fisik atau yang mengembangkan asimetri wajah
Risiko cedera saraf tulang belakang

Treatments
Surgery in severe cases
Patients whose pathology does not
resolve after 12 months of physical
therapy or who develops facial
asymmetry
Risk of injury to spinal nerves

Hampir tidak mungkin untuk mencegah Menjadi akrab dengan gejala Cari bantuan
medis Kondisi serius lainnya mungkin bingung untuk Tortikolis dan tidak diperlakukan
dengan benar

Preventive Measures
Nearly impossible to prevent
Become familiar with symptoms
Seek medical attention
Other serious conditions may be
confused for Torticollis and are not
treated correctly