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-MSK Diseases > 17. Neonatal Presentations > Flashcards

17. Neonatal Presentations Flashcards

1
Q

When do Neonatal Presentations become apparent?

A
  1. Sometimes be in the Antenatal Period

2. Some after birth / are a result of Delivery

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2
Q

What are the common Orthopaedic conditions of the Newborn Child?

A
  1. Clavicle / Humerus Fracture
  2. Obstetric Brachial Plexus Injury
  3. Torticollis
  4. Developmental Dysplasia of the Hip
  5. Metatarsus Adductus
  6. Calcaneovalgus
  7. Clubfoot
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3
Q

What should be assessed for after a Clavicle Fracture in a Newborn Child?

A

Erb’s Palsy

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4
Q

When is a Clavicle Fracture in a Newborn Child treated?

A

Symptomatically:

  1. Arm Under Vest
  2. Beware of Skin Maceration
  3. Calpol
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5
Q

What is Obstetric Brachial Plexus Injury associated with?

A
  1. High Birth Weight
  2. Shoulder Dystocia
  3. Maternal Diabetes
  4. Foreceps Delivery
  5. Clavicle Fractures
  6. Prolonged Labour
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6
Q

What are the 3 types of Nerve Damage which can occur?

A
  1. Neuropraxia
  2. Axonotmesis
  3. Neurotmesis
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7
Q

What are the Anatomical Classifications of Obstetric Brachial Plexus Injury?

A
  1. Erb’s Palsy (65%)
  2. Total Plexus Involvement (35%)
  3. Klumpke’s Palsy (0.6%)
  4. Horner’s Syndrome
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8
Q

How does Erb’s Palsy present?

A
  1. Waiters Tip appearance
  2. Lack of Elbow Flexion
  3. Lack of Shoulder Elevation . Abduction
  4. Loss of Hand Movements
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9
Q

What are the Differential Diagnoses for Erb’s Palsy?

A
  1. Arthrogrypsosis

2. Pseudoparalysis (Fracture / Infection)

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10
Q

What is the management of Erb’s Palsy?

A
  1. Most will spontaneously recover
  2. Early Physiotherapy
    Note - Biceps Function is a good predictor of recovery
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11
Q

What is Torticollis?

A

Painless shortening of the Sternocleidomastoid Muscle

Note - Unknown Aetiology

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12
Q

How does Torticollis present?

A

The Head is turned and Tilted due to Sternocleidomastoid Tightening

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13
Q

What is the treatment of Torticollis?

A
  1. Physiotherapy
  2. Ultrasound Scan of the Hips
  3. Plain Radiograph C-Spine for Congenital Abnormalities
  4. Surgical Intervention
    Note - Typically Resolves in first year
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14
Q

What is the Spectrum of Developmental Dysplasia of the Hip?

A
  1. Immature Hip
  2. Shallow Socket (Variable Severity)
  3. Unstable Hip
  4. Dislocated Hip
  5. Irreducible Hip
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15
Q

What are the Risk Factors for getting Developmental Dysplasia of the Hip?

A
  1. Female
  2. First Born
  3. Intrauterine Position (Breech)
  4. Family History
  5. Oligo / Twins
    Note - over 50% have no risk factors
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16
Q

What is looked for in a Clinical Examination?

A
  1. Hips - Barlow / Ortolani / Galeazzi
  2. Spine
  3. Feet
  4. Neck
17
Q

What is Barlow’s procedure?

A

Examiner Adducts the Hip, whilst applying a Posterior Force on the Knee to promote Dislocation

18
Q

What is Ortolani’s procedure?

A

Examiner Abducts the Hip, whilst applying an Anterior Force on the Femur to Reduce the Hip Joint

19
Q

What is Galeazzi’s Sign?

A

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

20
Q

What Radiographic procedure is done on a Child with suspected Developmental Dysplasia of the Hip?

A

Ultrasound

21
Q

What is the treatment of Developmental Dysplasia of the Hip?

A

Dependent on Clinical Findings:

  1. Hip Abduction Brace
  2. Pavlik Harness
  3. None - for Mild Dysplasia it is delayed fro 6-12 weeks as many hips are immature and will correct themselves
22
Q

What happens in Metatarsus Adductus?

A

The Metatarsal Bones are Deviated Inwards

Note - This is Bilateral in 50% of the Cases

23
Q

What is Metatarsus Adductus associated with?

A
  1. Developmental Dysplasia of the Hip

2. Intrauterine Moulding

24
Q

How is Metatarsus Adductus classified?

A

Based on Ease of Correction

25
Q

How is Metatarsus Adductus examined for?

A
  1. Hold the heel in Neutral and Abduct the Forefoot away from the Midline of the Foot
  2. Observe the End Position of the Forefoot in relation to the Hindfoot
  3. Look for the Presence of a Medial Crease
26
Q

What is the treatment for a

  1. Fully Flexible Metatarsus Adductus patient?
  2. Semi-Flexible Metatarsus Adductus patient?
  3. Rigid Metatarsus Adductus patient?
A
  1. Reassure, parental Stretching
  2. 1 + Physiotherapy Assessment
  3. 2 + 2-4 weeks of Serial Casting
    Note - Rigid Metatarsus Adductus is often associated with other foot / neurological problems
27
Q

What is Calcaneovalgus?

A

An Intrauterine Packaging Disorder, leading to a Soft-Tissue Contracture Foot Deformity

28
Q

What is Calcaneovalgus associated with?

A
  1. Oligohydramnios

2. Developmental Dysplasia of the Hip

29
Q

What is Calcaneovalgus characterised by?

A

Excessively Dorsiflexed Hindfoot, correctible to Neutral, with some Valgus
Note - The Dorsum of the Foot is often in contact with the Anterior Tibia

30
Q

What is the treatment of Calcaneovalgus?

A
  1. Self-Resolving
  2. Reassurance to Parent
  3. Passive Stretching
31
Q

What is Clubfoot also known as?

A

Congenital Talipes, Equino, Varus

32
Q

In relation to Clubfoot, what are the Clinical Findings in the Foot?

A
  1. Smaller
  2. Hindfoot - Equinus and Varus (Supination
  3. Fore/Midfoot - Adduction and Cavus
33
Q

In relation to Clubfoot, what are the Clinical Findings in the Leg?

A
  1. Mild Limb Length Discrepancy

2. Muscle Wasting

34
Q

What are the 2 sybtypes of Clubfoot?

A
  1. Positional - Intrauterine Positioning
  2. Fixed / Structural - True Bone Malalignment (Clubfoot) -
    Does not Correct
35
Q

What is the score used to measure Clubfoot severity?

A

Piriani Score

36
Q

What is the treatments of Positional Clubfoot?

A
  1. Reassured

2. Discharged

37
Q

What is the treatments of Structural (Fixed) Clubfoot?

A
  1. Ponsetti Serial Casting
  2. Achilles Tenotomy
  3. Boots and Bar

-MSK Diseases (43 decks)

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