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MSK > Neonatal Presentations (CTEV, Palsies, Moulding Abnormalities) > Flashcards

Neonatal Presentations (CTEV, Palsies, Moulding Abnormalities) Flashcards

1
Q

Common orthopaedic conditions in the newborn

A
  • Clavicle/Humerus fracture
  • Obstetric brachial plexus injury
  • Torticollis
  • DDH
  • Metatarsus adductus
  • Club foot
  • Calcaneovalgus
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2
Q

Rare orthopaedic conditions in the newborn

A
  • Congenital limb anomalies
  • Tibial/Clavicle pseudoarthrosis
  • Congenital vertical talus
  • Congenital knee dislocation
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3
Q

What to may occur due to a clavicle/humerus # in a newborn

A

Erb’s palsy

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4
Q

How to diagnose a clavicle/humerus # in a newborn

A
  • US

- X-ray

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5
Q

Rx of clavicle/humerus fractures

A

If symptomatic

  • Arm under vest
  • Beware skin maceration
  • Heals within 2 weeks w/ a lump
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6
Q

Risk factors for brachial plexus injury

A
  • High birth weight
  • Shoulder dystocia
  • Maternal diabetes
  • Forceps delivery
  • Clavicle #
  • Prolonged labour
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7
Q

3 types of brachial plexus palsies

A
  • Neuropraxia
  • Axonotmesis
  • Neurotmesis
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8
Q

Define neuropraxia

A
  • Myelin damage + axonal stretching

- Resolves within weeks

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9
Q

Define axonotmesis

A
  • Axonal rupture + myelin damage, nerve sheath intact

- Resolves in months

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10
Q

Define neurotmesis

A

Total nerve rupture requiring operative repair

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11
Q

Rx for Erb’s palsy

A
  • Most will spontaneously recover

- Early physio to maintain ROM + prevent shoulder stiffness/contracture is essential

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12
Q

What’s a good predictor of Erb’s palsy recovery

A
  • Biceps function
  • < 2 months: Full recovery (neuropraxia)
  • > 4 months: Unlikely to achieve full recovery, surgical exploration considered
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13
Q

What is torticollis

A
  • 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
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14
Q

Risk factors for torticollis

A
  • Breech

- Difficult delivery

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15
Q

Rx for torticollis

A
  • Physiotherapy
  • Surgical intervention is rarely required
  • US hips + X-ray c-spine for congenital abnormalities (DDH)

Usually resolves within first 12 months

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16
Q

What is metatarsus adductus

A

Bones in the front half of the foot bend or turn in toward the side of the big toe

17
Q

3 types of metatarsus adductus

A
  • Fully flexible
  • Semi-flexible
  • Rigid (very rare)
18
Q

Rx for metatarsus adductus

A

-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

19
Q

Describe calcaneovalgus

A
  • 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
20
Q

Rx of calcaneovalgus

A
  • Usually self resolving

- If very severe + parental anxiety occasional 2 weeks of casting can be done

21
Q

What is clubfoot AKA

A

Congenital Talipes Equino Varus (CTEV)

22
Q

2 types of clubfoot (CTEV)

A
  • Positional

- Structural

23
Q

Rx of clubfoot (CTEV)

A

Positional
-Reassurance + discharge

Structural

  • Commence Ponsetti serial casting (~8wks)
  • 50% require Achilles tenotomy
  • Boots + bars
24
Q

How to score the severity of club foot

A

-Piriani Score
-Total (worst) score = 6
Midfoot max score = 3
Hindfoot max score =3

25
Q

Piriani score for positional clubfoot

A

-0.0 or 0.5

?>0.5 = structural?

26
Q

Congenital vertical talus (CVT) AKA

A

Rocker bottom foot

27
Q

Describe CVT

A
  • Very rare
  • Stiff foot
  • Rigid, irreducible deformity
  • Dorsal dislocation of the navicular on the talus
28
Q

What is CVT associated with

A

Other neuro problems e.g. Myelomeningocele (type of spina bifida)

29
Q

Rx for CVT

A

Reverse Ponsetti serial casting

MSK (28 decks)

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