Kelainan Sistem

Gerak
Dr. Andreas Siagian, SpOT

Tabel KIPDI (Kurikulum Induk Pendidikan Dokter

Indonesia)
Mata
Pelajaran
(MP)

Kelainan
Sistem
Gerak Atas
& Bawah

Tujuan Instruksi
Umum (TIU)

1. Memahami
cara-cara
pemeriksaan
sendi panggul
dan sendi alat
gerak bawah

2. Memahami
kelainan dan
penyakit pada
anggota alat
gerak bawah

Tujuan perilaku
khusus (TPK)

Tingkat
Kemampu
an

Bentuk
Pengalaman
Belajar

1.1 Menjelaskan
pengertian
valgus, varus,
recurvatum, torsi
equinos planus

P3

K DK KL

1.2 Melakukan
pemeriksaan
lingkup gerak
sendi (range of
motion) dengan
benar &
sistematis

P3

K DK KL

2.1 Mengetahui
beberapa
penyakit dan
kelainan pada
panggul & gerak
bawah (3
penyakit)

C1

K DK KL

2.2 Menjelaskan

C2

K DK KL

Terminology

Torsi
Valgus
Varus
Recurvatum
Planus

Terminology
Version: normal twisting of long bone on its
anatomic longitudinal axis
Torsion: Abnormal / deformity, version beyond
(+or-)2 SD
Reference axis: a line joining designated bony
landmarks at the end of a long bone
Anteversion: the prox ref axis is lat twisted
relative to the distal (X-retroversion(

Reference axis

In ligamentous laxity
notelat.Widening
Of knee joints

In Blount angulation at
med.tib metaphysis

In cong. Pseudarthrosis of
tibia,the angulation is in the
distal

In coxa vara ,angulation at the

neck shaft level

X-ray
3 years and older
Getting worse
Abnormal site of
angulation
Large physis and
epiphysis
History taruma,
infection, possible metal
intoxication(lead or floride)

Metaphysial/diaphys
ial angle 18

Finding
Physis,

thick and frayed

in rickets

In physiologic
genu varum no
intrinsic bone disease,
gentle curve, medial
cortices thickening,
horizontal joit lines of the
knee & ankle are tilted
medially

Knock Knees / Genu

Valgum
Legs are bowed
inwards in the
standing position.
Bowing occurs at
or around the
knee. On standing
with knees
together, the feet
are far apart.

Normal Development
Most children are bowlegged from birth
until around3 years old, then become knock
kneed until age 4 to 5, and straighten
towards adult alignment by age 6 to 7.

Investigations 1
Measurement of intermalleolar distance. i.e
distance between two malleoli when the
knees are gently touching with legs in
adduction.
Up to 3 and a half inches (9 centimeters)
with child lying down is acceptable.
75% of children aged 2 - 4 years have
some degree of intermalleolar separation.

Investigations2
Intermalleolar separation under 3
inches is normal at any age.
Periodic observation and
measurement if less than 3.5 inches.
If > 3.5 inches, need AP X-Ray with
both legs on same film for knee
deformity, hip and ankle joints and
view of both long bones.

Indicators of Serious
Disease
Pronounced
asymmetry
Short stature
Other skeletal
abnormalities
Intermalleolar
separation greater
than 3.5 inches

When to refer
Age > 7 with knock knee
Unilateral problem i.e Asymmetry of
legs
Intermalleolar distance > 3.5 inches
(9 cms)
Associated symptoms e.g Pain, Limp

Treatment
Surgical options:
Medial epiphyseal stapling at 10 to 11
years
Corrective osteotomy at maturity.

FLAT FOOT
Flat foot(Pes Planus)
Absent or depressed
longitudinal arch

Pes Planovalgus:
associated hindfoot
eversion, forefoot
abd and everted

Types
Flexible
Developmental

the

most common

Hypermobile

(ligamentous
hyperlaxity; Ehlers-Donlos,
Marfan, Down)

Neurogenic( rare and

usually cause the reverse-Pes

Cavus)

Rigid, very rare

Congenital

(Tarsal
coalition,Vertical talus)

Aquired

) inflammatory)

Management
Physiologic flat foot is NORMAL up to 6 years ( the
foot fat pad shrinks and ligaments become taut)
If there is pain look for other pathologic conditions
Foot orthoses not a ttt but relief strain, improve
gait pattern,even shoe wear, may prevent
structural tarsal deformities
Surgery- very rare, not before 12 years

Melakukan pemeriksaan lingkup

gerak sendi (range of motion)
dengan benar & sistematis