Developmental Disorders

Question 1

what is syndactyly

Answer 1

two digits (fingers or toes) fused due to failure of separation of skin / soft tissues of phalanges 
surgical separation may be required (usually at age 3 or 4)

Question 2

what is polydactyly

Answer 2

extra digit formed and can be treated with amputating it

Question 3

what is fibular hemimelia

Answer 3

partial or complete absence of fibula
leads to short limb, bowing of tibia and ankle deformity
mild cases = treat with limb lengthening with circular frame external fixator
more severe = treat with through ankle amputation at 10 months to 2 years

Question 4

what does absence or hypoplasia of radius lead to and how is this treated

Answer 4

underdevelopment (usually absence of thumb) and marked deformity (radial club hand)
surgical reconstruction = thumb reconstruction from index ray (pollicisation) and deformity correction

Question 5

what is tarsal coalition

Answer 5

fusion of two of the tarsal bones of foot which may cause painful flat feet later in childhood
may need surgically divided

Question 6

what is obstretic brachial plexus palsy

Answer 6

brachial plexus injury during vaginal delivery

Question 7

who does branchial plexus palsy most commonly arise in

Answer 7

large babies (macrosomia in diabetes)
twin deliveries
shoulder dystocia (difficult delivery of shoulder after head with compression of shoulder on pubic symphysis)

Question 8

what are the two types of brachial plexus palsy

Answer 8

Erbs palsy (common)
Klympke's palsy (rarer)

Question 9

what is erbs palsy

Answer 9

injury to upper (c5 and c6) nerve roots resulting in loss of motor innervation of deltiod, supraspinatus, infraspinatus, biceps and brachialis muscles

Question 10

what is symptoms of erbs palsy

Answer 10

internal rotation of humerus (from unopposed subscapularis)

may lead to classic waiters tip posture

Question 11

what is treatment of erbs palsy

Answer 11

physio to prevent contractures early on
prognosis predicted by return of biceps function by 6 months with good outcome in >80% cases
surgical release of contractures and tendon transfer may be required if no recovery

Question 12

what is klumpke’s palsy

Answer 12

lower brachial plexus injury (C8 and T1) caused by forceful adduction which results in paralysis of the intrinsic hand muscles +/- flexors and possible Horner’s syndrome (due to disruption of first sympathetic ganglion from T1)

Question 13

what is symptoms of klumpke’s palsy

Answer 13

fingers typically flexed due to paralysis of interossei and lubricals which assist extension at the PIP joints

Question 14

is there a treatment for klympkes palsy

Answer 14

no specific treatment

prognosis poorer than for erbs with less than 50% recovery