Orthopaedics in neonates

Question 1

Features of clavicle and humerus fractures

Answer 1

Assess for Erb’s palsy
diagnosis by radiography or ultrasound, sometime incidental
Treatment symptomatic (rm under vest, calpol)
Heals within 2 weeks with a lump

Question 2

What is horner’s syndrome

Answer 2

interruption of the stellate ganglion

Ptosis, myosis, enopthalmos

Question 3

Features of torticollis

Answer 3

Shortening of SCM muscle
Painless
Associated with plagiocephaly, DDH and metatarsus adductus
RFs - breech and difficult delivery

Question 4

Torticollis assessment and treatment

Answer 4

Head turned and tiled due to SCM tightening
Lump often be felt in muscle belly
Treatment - physio, USS hips, plain radiograph
Typically resolves within first 12 months

Question 5

Features of DDH

Answer 5

Rfs - female, first born, IU position, FH, packaging factors

Examination - Ortolani and galeazzi

Question 6

Treatment of DDH

Answer 6

DIslocateable or dislocated - start treatment early
Mild - delay up to 6-12 weeks
repeat scans every 3-4 weeks till hip normal, radiographs from 1 year

Question 7

Features of Metatarsus adductus

Answer 7

Bilateral in half of cases

Assesment - degree of flexibility/correction

Question 8

Features of calcaneovalgus

Answer 8

Intauterine packaging disorder
Association with oligohydramnios and DDH
Soft tissue contracture foot deformity
Excessively dorsiflexed hind foot with some valgus

Question 9

Features of clubfoot

Answer 9

CTEV
B>G
PRenatal diagnosis
Foot - smaller, hind foot (equinus and supination), forefoot (adduction and caves)
Leg - mild limb length discrepancy, muscle wasting

Question 10

Treatment of clubfoot

Answer 10

Positional - Piriani score 0.5 or 0, reassurance, discharged

Structural - commence serial casting, boots and bars

Question 11

Features of CVT (congenital vertical talus)

Answer 11

Rare
Stiff foot
Rigid irreducible deformity
Dorsal dislocation of navicular on talus
Association with other neurology
Treat with reverse ponsetti serial casting