Limb deformities

Introduction Limb deformity is a malformation that occurs in bones and joints or soft tissues. It causes abnormalities in the body and function of the trunk and limbs of the body. Spinal and limb deformities can be either a primary disease or a manifestation of a systemic disease. There are certain genetic innate causes, and there is the possibility of external injury.

Cause

Limb deformities can be divided into congenital malformations and acquired (acquired) malformations according to the time sequence of onset. Congenital malformations are often found at birth or have not been discovered but have existed. As the growth and development of individuals gradually manifested acquired deformities, the causes can be divided into two categories: one is the malunion caused by trauma. Therefore, type malformations are no longer detailed without the need for differential diagnosis. Another type of deformity caused by lesions of bone joints or soft tissues can be divided into local malformations and systemic malformations according to the extent of spinal and limb deformities. Mostly due to genetic disorders of developmental disorders or other systemic diseases (such as cartilage dysplasia, multiple exogenous osteochondromas, polysaccharide disease, Kaschin-Beck disease, rheumatoid arthritis, etc.).

an examination

Related inspection

Fetal microscopy Obstetric B-ultrasound mirror

The most valuable instrumental examination most commonly used in the diagnosis of spinal and limb deformities is X-ray radiography. Generally, it should be taken from two different directions in order to stereoscopically locate the deformity. However, for some parts of the bone overlap, such as the pelvis can only be taken from one direction. For some limb deformities that are not easy to be diagnosed, it is often necessary to do the contralateral radiograph for the regular X-ray, and the development of the deformity can be observed. With the widespread use of CT and MRI, new diagnostics have been made in the diagnosis of spinal and limb deformities. Especially for the malformation of soft tissue or the location of CT and MRI which are difficult to observe due to the overlap of bone, there are obvious advantages for the accuracy of diagnosis.

Differential diagnosis

(1) Kashin-Beck disease

Also known as "Kashin-Beck disease", the cause is still unclear, mostly in the eastern part of Siberia in the former Soviet Union and adjacent areas in the northeast of China, and distributed in a strip shape from northeast to southwest in China. The age of onset of this disease is mostly from pre-school to pre-puberty, and adults can also develop disease, but it is rare. Kaschin-Beck disease mainly invades the bones and joint system, usually chronic, with few systemic symptoms. The whole body joints are generally affected, and the limbs are more common. The damage is bilateral but not necessarily symmetrical. Among them, the interphalangeal joint is more common and early, followed by the elbow, ankle, knee, wrist, marrow and shoulder. The damage of the spine is rare. Can be heavier. The onset is more insidious. At first, there is often only pain, numbness, ant movement, or joint activity is not flexible. After the morning, the joints are stiff. The first thing to pay attention to is the interphalangeal joint or the ankle joint. Sometimes the patient has no symptoms and the joints are found to be thick or frizzy. Individual patients have only symptoms such as fatigue and fatigue, but lack local symptoms. In the examination, the joints are thickened, and there are frictional sounds during flexion and extension. The early joint movements are not necessarily limited, and the X-ray examination can also be seen without abnormalities. As the disease progresses, the joints gradually thicken and dysfunction occurs. In the later stage, the limbs and fingers were significantly shortened, the joints were thick, the pain was limited, the muscles were atrophied, and there were severe short-finger deformities and short stature. X-ray films with interphalangeal joints, tendons and knee joints are more typical, showing that the joint surface is uneven, and the subchondral bone is dense. There is currently no specific method for the diagnosis of Kashin-Beck disease, and the diagnosis is generally based on a comprehensive analysis of medical history, physical examination and X-ray examination. The area where the patient lives is helpful for diagnosis.

(two) rheumatoid arthritis

The disease is a systemic disease characterized by joint inflammation and unclear etiology. The disease is most common in women aged 25-45. Prodromal symptoms are weakness, fatigue, and loss of appetite. Then there is a joint lesion characterized by multiple, symmetric joint involvement, slow and recurrent episodes, joint swelling and pain with progressive aggravation. In general, early manifestations of the disease include joint exudation, tenderness and limited mobility, and finally deformities, including incomplete dislocation of the joints, and joint contractures. Laboratory tests can have mild anemia, increased white blood cell counts, and increased erythrocyte sedimentation rate. About 75% of patients are positive for rheumatoid factor. The joint fluid is turbid, the formation of partial protein blocks is poor, the cell count is increased, and polymorphonuclear granulocytes are increased. X-ray examination showed soft tissue swelling and osteoporosis in the early stage, and the joint space was narrowed, erosion and deformity in the later stage.

(3) Congenital polyarticular contracture

The disease is a congenital malformation, involving the joints of the extremities. It is characterized by limited active and passive activities of the joint, fixed in the straight or flexed position, and the joint has only a few degrees of painless passive activity. The skin is not normally wrinkled and tightened; the skin of the joint has a small pit flexion deformity on the flex side with a span formed by skin and subcutaneous tissue. Often there are deformities such as clubfoot, dislocation of the silver joint, dislocation of the bones, scoliosis, etc., and may be accompanied by congenital heart disease and kidney deformity.

(4) Vitamin D deficiency. Long-term illness

Mainly due to the lack of vitamin D, the absorption of calcium and phosphorus in the intestine is reduced, and the product of blood calcium and phosphorus is decreased, causing the temporary calcification zone to thicken and bone. It can increase the rib beading and hand silver seen in the clinic. The ankles are marked by X and the growth of the bones is stagnant. The main skeletal system of the disease changes as follows;

1, the head: Skull softening, more common in 3-6 months of babies, fingers gently press the occipital bone or the center of the parietal bone, like the feeling of pressing table tennis. Square skull, more common in patients 8-9 months or more, severe cases can be saddle-shaped, cruciform cranial. The front bunker is closed. Delayed teething.

2, chest: rib beads, ribs, chicken chest or funnel chest, the above deformity is more common in children around 1 year old.

3, limbs: wrist deformity, more common in patients over 6 months, the distal end of the long bones of the forearm can be and even see the thick bone marrow, forming a blunt ring-shaped bulge, called rickets or foot silver. An "O" shaped leg or an "X" shaped leg may appear after the patient walks.

4, other: pediatrics can cause posterior or lateral curvature of the spine after sitting, and the anterior and posterior diameter of the severe pelvis becomes shorter to form a flat pelvis.

The diagnosis of this disease is not difficult to make based on the child's nutritional history and X-ray examination.

(5) Cartilage malnutrition

The head is large, the forehead is prominent, the long bone marrow bulges, the chest is easy to see beading, the abdomen is similar to the rickets, but the limbs and fingers are short and thick, the five fingers are flush, the lumbar vertebrae are lordosis, and the hips are kyphosis. Blood calcium and phosphorus are normal. The X-ray shows that the long bone is short and thick and curved, and the dry energy end is widened and has a flared shape, but the contour is still smooth, and sometimes some of the bone marrow is buried in the dry energy end.

A physical examination can be diagnosed.

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