17. Neonatal Presentations Flashcards
When do Neonatal Presentations become apparent?
- Sometimes be in the Antenatal Period
2. Some after birth / are a result of Delivery
What are the common Orthopaedic conditions of the Newborn Child?
- Clavicle / Humerus Fracture
- Obstetric Brachial Plexus Injury
- Torticollis
- Developmental Dysplasia of the Hip
- Metatarsus Adductus
- Calcaneovalgus
- Clubfoot
What should be assessed for after a Clavicle Fracture in a Newborn Child?
Erb’s Palsy
When is a Clavicle Fracture in a Newborn Child treated?
Symptomatically:
- Arm Under Vest
- Beware of Skin Maceration
- Calpol
What is Obstetric Brachial Plexus Injury associated with?
- High Birth Weight
- Shoulder Dystocia
- Maternal Diabetes
- Foreceps Delivery
- Clavicle Fractures
- Prolonged Labour
What are the 3 types of Nerve Damage which can occur?
- Neuropraxia
- Axonotmesis
- Neurotmesis
What are the Anatomical Classifications of Obstetric Brachial Plexus Injury?
- Erb’s Palsy (65%)
- Total Plexus Involvement (35%)
- Klumpke’s Palsy (0.6%)
- Horner’s Syndrome
How does Erb’s Palsy present?
- Waiters Tip appearance
- Lack of Elbow Flexion
- Lack of Shoulder Elevation . Abduction
- Loss of Hand Movements
What are the Differential Diagnoses for Erb’s Palsy?
- Arthrogrypsosis
2. Pseudoparalysis (Fracture / Infection)
What is the management of Erb’s Palsy?
- Most will spontaneously recover
- Early Physiotherapy
Note - Biceps Function is a good predictor of recovery
What is Torticollis?
Painless shortening of the Sternocleidomastoid Muscle
Note - Unknown Aetiology
How does Torticollis present?
The Head is turned and Tilted due to Sternocleidomastoid Tightening
What is the treatment of Torticollis?
- Physiotherapy
- Ultrasound Scan of the Hips
- Plain Radiograph C-Spine for Congenital Abnormalities
- Surgical Intervention
Note - Typically Resolves in first year
What is the Spectrum of Developmental Dysplasia of the Hip?
- Immature Hip
- Shallow Socket (Variable Severity)
- Unstable Hip
- Dislocated Hip
- Irreducible Hip
What are the Risk Factors for getting Developmental Dysplasia of the Hip?
- Female
- First Born
- Intrauterine Position (Breech)
- Family History
- Oligo / Twins
Note - over 50% have no risk factors
What is looked for in a Clinical Examination?
- Hips - Barlow / Ortolani / Galeazzi
- Spine
- Feet
- Neck
What is Barlow’s procedure?
Examiner Adducts the Hip, whilst applying a Posterior Force on the Knee to promote Dislocation
What is Ortolani’s procedure?
Examiner Abducts the Hip, whilst applying an Anterior Force on the Femur to Reduce the Hip Joint
What is Galeazzi’s Sign?
With the Knees Flexed, and Heels carefully aligned, the Knees are seen to be at different Levels
This implies that the Femoral (or Tibial) Segment is short
What Radiographic procedure is done on a Child with suspected Developmental Dysplasia of the Hip?
Ultrasound
What is the treatment of Developmental Dysplasia of the Hip?
Dependent on Clinical Findings:
- Hip Abduction Brace
- Pavlik Harness
- None - for Mild Dysplasia it is delayed fro 6-12 weeks as many hips are immature and will correct themselves
What happens in Metatarsus Adductus?
The Metatarsal Bones are Deviated Inwards
Note - This is Bilateral in 50% of the Cases
What is Metatarsus Adductus associated with?
- Developmental Dysplasia of the Hip
2. Intrauterine Moulding
How is Metatarsus Adductus classified?
Based on Ease of Correction
How is Metatarsus Adductus examined for?
- Hold the heel in Neutral and Abduct the Forefoot away from the Midline of the Foot
- Observe the End Position of the Forefoot in relation to the Hindfoot
- Look for the Presence of a Medial Crease
What is the treatment for a
- Fully Flexible Metatarsus Adductus patient?
- Semi-Flexible Metatarsus Adductus patient?
- Rigid Metatarsus Adductus patient?
- Reassure, parental Stretching
- 1 + Physiotherapy Assessment
- 2 + 2-4 weeks of Serial Casting
Note - Rigid Metatarsus Adductus is often associated with other foot / neurological problems
What is Calcaneovalgus?
An Intrauterine Packaging Disorder, leading to a Soft-Tissue Contracture Foot Deformity
What is Calcaneovalgus associated with?
- Oligohydramnios
2. Developmental Dysplasia of the Hip
What is Calcaneovalgus characterised by?
Excessively Dorsiflexed Hindfoot, correctible to Neutral, with some Valgus
Note - The Dorsum of the Foot is often in contact with the Anterior Tibia
What is the treatment of Calcaneovalgus?
- Self-Resolving
- Reassurance to Parent
- Passive Stretching
What is Clubfoot also known as?
Congenital Talipes, Equino, Varus
In relation to Clubfoot, what are the Clinical Findings in the Foot?
- Smaller
- Hindfoot - Equinus and Varus (Supination
- Fore/Midfoot - Adduction and Cavus
In relation to Clubfoot, what are the Clinical Findings in the Leg?
- Mild Limb Length Discrepancy
2. Muscle Wasting
What are the 2 sybtypes of Clubfoot?
- Positional - Intrauterine Positioning
- Fixed / Structural - True Bone Malalignment (Clubfoot) -
Does not Correct
What is the score used to measure Clubfoot severity?
Piriani Score
What is the treatments of Positional Clubfoot?
- Reassured
2. Discharged
What is the treatments of Structural (Fixed) Clubfoot?
- Ponsetti Serial Casting
- Achilles Tenotomy
- Boots and Bar
