Types of orthopaedic impairment

Osteomyelitis is a chronic bacterial bone and joint infection that progressively destroys the bone and may also affect the joints. When the bone is infected, pus is produced within the bone, resulting in a foul-smelling discharge. The condition often causes severe physical impairment if left untreated.

Risk factors for developing osteomyelitis, more common in developing countries, include malnutrition, poor hygiene, diabetes, poor circulation, extensive scarring, chronic wounds, walking barefoot on rough grounds (as that causes minor abrasions and allows bacteria to enter the body), smoking, chronic oedema, an impaired immune system (e.g. through malnutrition and chronic malaria) and exposure to harmful bacteria. Intravenous antibiotics, administered early, can help eliminate the infection Once the infection becomes chronic, however, surgical removal of dead and infected bone tissue and subsequent antibiotic treatment is necessary, and reconstructive surgery is often needed.

This is a condition that causes paralysis of muscles without loss of sensation. Contractures deform joints and interfere with the patient's ability to walk. The initial disease, polio (short for poliomyelitis), is a viral disease that can damage the nerves in the spinal cord, causing paralysis of the arms, legs, or trunk. Polio mainly affects children under the age of three.

This is an infection of the spinal column. The disease progressively destroys the backbone and causes severe physical impairment and may lead to death if left untreated. Tuberculosis can be recognised by a sharp bend in the middle section of the backbone that goes along with shortening and thickening of the chest.

Cerebral palsy describes a group of chronic conditions affecting body movement, muscle coordination, and often mental capability. The conditions are characterised by stiff muscles and a loss of control and coordination of movements. This often makes walking impossible or even causes difficulties in sitting.

Hydrocephalus translates as "water on the brain" and describes a condition characterised by excess cerebrospinal fluid in the brain. This leads to pressure build-up under the skull, causing the head to swell and possibly brain damage.

Shunts, or bypass tubes, are the primary method to treat hydrocephalus: With this lifelong treatment, the cerebrospinal fluid is shunted to another area of the body and generally allows patients to lead active lives.

Another method is a newer neurosurgical procedure that decompresses the brain without a permanent shunt.

Clubfoot, also known as ‘congenital talipes equinovarus’ (CTEV), is a condition in which the child is born with the foot turned inwards and pointing down; either one or both feet may be affected. If left untreated, the condition causes the person to walk painfully on the top of the foot. The majority of clubfoot cases are congenital (present at birth) hereditary and result from abnormal development of the muscles, ligaments, tendons and bones while the baby is forming in the uterus. The exact causes of clubfoot are not known. Scientific studies have found that familial inheritance, genetics and environment are all likely to be factors which interact to cause clubfoot but how this happens is not well understood.
 
Around the world, 150,000 – 200,000 babies with clubfoot are born each year.  Approximately 80% of these will be in low and middle income countries. The incidence of clubfoot varies around the world but is on average 1 in 800 live births.
 
What can be done for clubfoot?

• Manipulation and casting (the Ponseti technique): Slowly stretching the tightened soft tissues and muscles and holding the foot in the improved position with a plaster cast which is changed every week. This will take about 6 weeks. After this correction the baby needs to wear foot splints at night (and at the beginning also during the day).
• Surgery: If the foot is too rigid and cannot be corrected with just plaster casts, then additional surgery will be necessary. Casts are applied after surgery and remain on for 4-6 weeks. Often foot splints and orthopaedic shoes need to be used which are important to maintain the correction. This has to be continued over a period of months and sometimes for years.

Cleft lip and palate is a common congenital deformity. It occurs when the separate areas of the face that develop individually and then join together, do not join properly.

It is especially important to detect and treat cleft lip and palate early, as neglect of the condition may lead to malnutrition or even death due to the difficulty of feeding children with a cleft lip and palate. Reconstructive surgery can have a beneficial effect, enabling normal feeding.

Angular bone deformities are bent bones, most often occurring just above or just below the knee. The condition causes severe knock knees (genu valgus) or bow legs (genu varus) that develop and worsen with growth. The deformities make walking difficult and may damage the joints, resulting in arthritis.

It is vital to raise awareness of this physical disability in developing countries because angular bone deformity incidence is more common where malnutrition is also present, yet simple and effective surgery can be used to re-align the bones.

What Causes Angular Bone Deformity?

Burn contractures describe a permanent shortening of burn scar tissue that pulls joints out of position and results in physical impairment.

Burn contractures may occur after thermal injury. Not every burn results in burn contractures but when burn wounds are left untreated or exposed to dirt, the chances of the condition occurring increases. Surgery and subsequent skin transplants are used to release the contracture. The treatment should be followed by physiotherapy to stretch the joints.