Mb--兒童非創傷之骨科急症(2)-邱德發+張玉.ppt

小組教學 兒童非創傷性骨科急症 個案討論一 15個月大小女孩活潑好動,走路很穩,但是跑步常跌倒,媽媽注意到她的腳趾頭和哥哥相比,較朝向內側彎,雖然常跌倒,但可立即爬起並繼續遊戲,小女生其它方面很健康,沒有其他疾病,沒有服用藥物,也沒過敏病史. 醫生,嚴不嚴重? 初級評估(1/2) PAT Appearance: Playful and alert Work of breathing: Normal Circulation: Normal Vital sign PR 100/min RR 22/min BT 36C 初級評估(2/2) ABCDE: normal except bilateral toes pointed in. 重要病史 S: often falls when she runs A: No allergies, formulafed M: No medicne P: L: 2 hours ago E: bilateral toes point inward when she walk 過去史 出生史: NSVD,Full-term,Apgar score 1’(9)—5’(9), BBW 3700gm Normal developmental milestones on scheduled and started walking at 12 months. She eats a diverse diet,including meats, fruits,and vegetables,and drinks whole milk. No prefenerce for either hand and uses both well. 家族史 There is no family history of cerebral palsy, learning disabilities, brain tumors, progressive neurological diseases, or spina bifida. The child’s father’s toes pointed in when he was a toddler; he wore corrective shoes connectly by a bar and currently has a normal gait. 詳細理學檢查(1/3) She is at the 50th percentile for height, weight, and head circumference. HEENT,Chest,Heart,ABD: normal Neuro: Normal neurologic exam and a normal spine without evidence of a dimple or tuft of hair at the sacrum. 詳細理學檢查(2/3) Extrimities Her legs are of equal length No clicks or clunks with Ortolani and Barlow maneuvers and the hips have a full range of motion. The lateral aspect of the the feet are straight, the feet are easy dorsiflexed above the neutral position(90 degree) and the heel is midline without varus or valgus deformity. 詳細理學檢查(3/3) The child sit on the examination table with her leg dangling over the edge, you find the lateral malleolus to be aligned with the medial malleolus. Her feet pointed inward and her patellae point forward as she ambulate. No evidence of spasticity, ataxia, or pain. 問題 診斷為何? 如何治療? 需要轉診小兒骨科嗎? Metatarsus adductus Severity of Metatarsus adductus Metatarsus adductus 治療metatarsus Adductus 2-4月大前可用s