Acquired Bone Deformities

1. Acquired Bone Deformities
Integrated - based Lecture
By
Dr. Abdullah H A Juma
Dr. Mohammed A Abbas

2. Definitions
•AcquiredAcquired : adjective; arising in response to the
action of the environment on the organism. It is
opposite to congenital, familial, genetic &
hereditary. It develops after birth.
•BoneBone : noun; the hard part of the skeleton.
Functions as supportive, locomotive & protective
as well as manufacturing blood cells and
homeostasis.
See pictures of bones.
•Deformity : noun; deviation from normal form.

10. Types of
Acquired Bone Deformities (1)
•Torsional deformity : The bone is twisted
medially (inwards, internally),
e.g. intoeing gait in lower limb.see pic.
tip position in upper limb
or laterally (outwards, externally),
e.g. outtoeing gait in LL
external rotational deformity in UL

11. Pictures of internal ( inwards ) torsional
deformities

16. Pictures of external ( outward ) torsional
deformities

18. Types of
Acquired Bone Deformities (2)
•Angular deformity : The bone is seen
angulated in 2 planes,
1. Sagittal plane ( Antero / posterior ).
e.g. anteriorly ; anterior bowing.
posteriorly ; posterior bowing.see pic.
2. Coronal plane ( Medio / laterally ).
e.g. medially ; varus deformity.
laterally ; valgus deformity.

19. Pictures of angular deformity in the sagittal
plane ( anterior / posterior )

23. Pictures of angular deformity in the coronal
plane ( medial / lateral ), i.e. towards or
away from midline

32. Causes of
Acquired Bone Deformities
•Traumatic.
•Inflammatory.
•Degenerative.
•Infectious.
•Tumours.
•Dietary.
•Miscellaneous.

33. Rickets
A condition producing all types of deformities
•Softening of bone in childhood due to lack of
mineralization.
•Due to vitamin D deficiency which leads to
Calcium & Phosphorus deficiency.
•Types :
1. Dietary deficiency.
2. Secondary to liver ( biliary ), renal and
intestinal diseases.
3. Hereditary, sex-linked, vit - D resistant.

34. Pictures of rickets with all types of
deformities

45. Scoliosis
torsional and angular deformities in the spine
See pictures

49. Investigations
•Bone profile; calcium, phosphate, alkaline
phosphatase.
•Serum level of vitamin D.
•X-rays.
•Urinary excretion of calcium and
phosphate.
•Bone biopsy.
•Bone densitometry.

50. General Outline of Treatment
•Medically : treat the primary causes plus
supplement of deficient factors.
•Surgically : to correct the deformities.
•Supportive measures : orthoses and
prostheses to control deformities.
•Physical therapy.
•Occupational therapy.

51. Case report
•A 5 years old boy who presents with bowing in
both lower extremities. This has been
progressive and he takes a poor diet. Family
history is negative for a similar case and no
history of trauma exists.
•Examination shows increased inte-rcondylar
distance with varus deformity of both legs.
•How do you approach this case ?

52. Answer
•History : proper, detailed, precise and accurate.
•Examination : SOAP
S = Subjective
O = Objective
A = Assessment ( working/or definitive Dx.)
P = Plan ( investigations and treatment )

53. Requirements & Expectations
•Sound knowledge.
•Build up skills of communication with patients,
taking a proper history, conducting a proper
examination, reading x-rays and other
investigatory tests.
•Intellectuality and cognitive ability are required
for best achievement.
•Attitudes and good behavior are mandatory.
•Ending up with a safe and a competent medical
practitioner.

54. The END