Neonatal Presentations (CTEV, Palsies, Moulding Abnormalities) Flashcards
Common orthopaedic conditions in the newborn
- Clavicle/Humerus fracture
- Obstetric brachial plexus injury
- Torticollis
- DDH
- Metatarsus adductus
- Club foot
- Calcaneovalgus
Rare orthopaedic conditions in the newborn
- Congenital limb anomalies
- Tibial/Clavicle pseudoarthrosis
- Congenital vertical talus
- Congenital knee dislocation
What to may occur due to a clavicle/humerus # in a newborn
Erb’s palsy
How to diagnose a clavicle/humerus # in a newborn
- US
- X-ray
Rx of clavicle/humerus fractures
If symptomatic
- Arm under vest
- Beware skin maceration
- Heals within 2 weeks w/ a lump
Risk factors for brachial plexus injury
- High birth weight
- Shoulder dystocia
- Maternal diabetes
- Forceps delivery
- Clavicle #
- Prolonged labour
3 types of brachial plexus palsies
- Neuropraxia
- Axonotmesis
- Neurotmesis
Define neuropraxia
- Myelin damage + axonal stretching
- Resolves within weeks
Define axonotmesis
- Axonal rupture + myelin damage, nerve sheath intact
- Resolves in months
Define neurotmesis
Total nerve rupture requiring operative repair
Rx for Erb’s palsy
- Most will spontaneously recover
- Early physio to maintain ROM + prevent shoulder stiffness/contracture is essential
What’s a good predictor of Erb’s palsy recovery
- Biceps function
- < 2 months: Full recovery (neuropraxia)
- > 4 months: Unlikely to achieve full recovery, surgical exploration considered
What is torticollis
- Shortening of SCM on 1 side (causing head turn + tilt)
- Lump can often be felt on muscle belly
- Painless
- Unclear cause, likely related to intrauterine moulding
Risk factors for torticollis
- Breech
- Difficult delivery
Rx for torticollis
- Physiotherapy
- Surgical intervention is rarely required
- US hips + X-ray c-spine for congenital abnormalities (DDH)
Usually resolves within first 12 months
What is metatarsus adductus
Bones in the front half of the foot bend or turn in toward the side of the big toe
3 types of metatarsus adductus
- Fully flexible
- Semi-flexible
- Rigid (very rare)
Rx for metatarsus adductus
-Fully flexible = Reassure, parental stretching
-Semi-flexible = Reassure, parental stretching
Refer to physiotherapist (likely to be discharged without RX)
-Rigid = May undergo 2-4 weeks of serial casting
Refer to physiotherapist for assessment
Describe calcaneovalgus
- Intrauterine packaging disorder
- A soft tissue contracture foot deformity
- Excessively dorsiflexed foot
- Dorsum of foot often in contact with ant. tibia
- Associated with DDH + oligohydramnios
Rx of calcaneovalgus
- Usually self resolving
- If very severe + parental anxiety occasional 2 weeks of casting can be done
What is clubfoot AKA
Congenital Talipes Equino Varus (CTEV)
2 types of clubfoot (CTEV)
- Positional
- Structural
Rx of clubfoot (CTEV)
Positional
-Reassurance + discharge
Structural
- Commence Ponsetti serial casting (~8wks)
- 50% require Achilles tenotomy
- Boots + bars
How to score the severity of club foot
-Piriani Score
-Total (worst) score = 6
Midfoot max score = 3
Hindfoot max score =3
Piriani score for positional clubfoot
-0.0 or 0.5
?>0.5 = structural?
Congenital vertical talus (CVT) AKA
Rocker bottom foot
Describe CVT
- Very rare
- Stiff foot
- Rigid, irreducible deformity
- Dorsal dislocation of the navicular on the talus
What is CVT associated with
Other neuro problems e.g. Myelomeningocele (type of spina bifida)
Rx for CVT
Reverse Ponsetti serial casting
