This is a small presentation on orthopedic problems in new borns and children. This presentation gives a brief idea about the conditions and treatment methods.

1. ORTHOPEDIC PROBLEMS IN
NEWBORN
Dr.A.Mohan Krishna
Consultant Orthopedic surgeon
Apollo Hospitals

2. Dr. A.MOHAN KRISHNA
M.S.ORTHO, MCh ORTH(U.K)
Consultant Orthopaedic surgeon ,
Trauma, Arthroscopy,
Arthroplasty Surgeon
Apollo hospitals, Hyderabad
9247258989
9441184590
www.drmohankrishna.com

3. FLAIL EXTREMITY
Orthopedic consultation in
NICU after delivery:
Failure to move the limb or
limbs
- Fractures
- Infection
- Brachial plexus palsy in
upper limb
- Pseudoparalysis : fracture or
infection

4. FRACTURES
Birth related fractures:
Risk factors:
- Breech position
- Forceps delivery
- Vaginal delivery
- Macrosomia
Postdelivery:
- Child abuse
- Osteogenesis imperfecta
- Neonatal rickets
Common fractures:
- Clavicle
- Femur
- Humerus

5. FRACTURES
Diagnosis:
- Flail extremity after delivery
- Deformity in case of long bone fractures
- Irritable during feeds
Radiographs: by the time radiographs are
ordered callus formation is seen in neonates
Management:
Fractures heal rapidly in neonates and
outcome is good if proper splinting is done
- Neonatal fractures require
immobilization for 2 weeks
- Femur fractures : pavilik harness, or
spica cast
- Humerus fractures : sling or splint
immobilization

6. HEALING IN FRACTURE FEMUR

7. INFECTION
Most commonly involves joints
Causes:
- Immunocompromised
- Premature delivery
- Multiple IV lines or central lines
Diagnosis:
- Clinically flail limb
- Irritable child
- Signs of inflammation around
joint

8. INFECTION
Investigations:
Blood tests:
- Leukopenia (<5000cells/ml)
(Normal:WBC : 9000 to 30000)
- ESR/CRP supportive
Blood culture
Aspirate culture
X-rays: widened joint space
USG
Organisms:
- Staph.aureus
- Group B Streptococci
- Recent trend towards Gram-ve
infections

9. INFECTION
Investigations:
X-rays :
- Septic arthritis: widened joint space, destruction of epiphysis in long
standing cases
- Osteomyelitis: destruction, seqestrum formation in long standing cases
Ultrasound :
- Detect fluid collection and also aids in aspiration

10. BRACHIAL PLEXUS PALSY
Cause for flail limb
- Incidence 0.13 to 3.6 per 1000
live births
Causes / Risk factors:
- Forceps delivery
- Shoulder dystocia
- Fracture clavicle, Humerus
- Prolonged vaginal delivery
- High birth weight

11. BRACHIAL PLEXUS PALSY
Diagnosis: Clinical
- Flail upper limb
Upper brachial plexus palsy:
(C5-C6) Erb’s palsy : Waiter’s tip
deformity
Internal rotation of shoulder
Extension of elbow
Forearm pronation and wrist
flexion
Total plexus palsy:
- Completely flaccid limb
- Horner’s syndrome-
Ptosis,Miosis,enopthalmos
- Ipsilateral diaphragmatic palsy
Investigations:
- X-rays to rule out fractures
- MRI to asses the level of injury

12. CONGENITAL DISLOCATION OF HIP
DEVELOPMENTAL DYSPLASIA OF HIP
Frank dislocation 1 in 1000 births
Subluxation with dysplasia of
acetabulum : 10 in 1000
Risk factors:
- Breech presentation
- Oligohydramnios
- Neuromuscular problems
- Female
- 1st child
Clinical examination:
- Limited abduction of hip
- Asymmetric knee heights
(Galeazzi sign)
- Barlow’s and Ortolani tests

13. CONGENITAL DISLOCATION OF HIP
DEVELOPMENTAL DYSPLASIA OF HIP
Barlow’s testOrtolani test

15. X-RAY- IN CDH/DDH

16. High resolution Ultrasound
(HRUS):
- Preferred modality in newborn:
- Help to identify mild subluxation
and acetabular dysplasia.
- Progression of treatment

17. Ultrasound
Femoral head
Abductors
Ilium
HRUS (ULTRASOUND)

18. Treatment:
- Pavlik harness
- Adductor tenotomy
- Hip Spica
- Open reduction and hip
Spica
- Corrective osteotomies in
later child hood
CONGENITAL DISLOCATION OF HIP
DEVELOPMENTAL DYSPLASIA OF HIP

19. TREATMENT ALGORITHM OF CDH/DDH

20. CONGENITAL KNEE DISLOCATION
Knee is hyperextended at birth
Causes:
- Contracture of quadriceps.
- Associated deformities- club foot,
arthrogryposis,myelodysplasia
Diagnosis:
Clinical:
- Knee is hyperextended
- Childs foot can touch the face.
- In complete dislocations knee
cannot be flexed
Investigations:
- X-rays: position of tibia in relation
to femur and grading of dislocation

21. CONGENITAL KNEE DISLOCATION
Management:
Non-operative treatment: gentle
reduction and serial casting in
progressive flexion
-Concomitant DDH Knee
dislocation should be reduced first
and child later put on Pavlik
harness.
Surgery:
- Not responding to conservative
management
- 6 months of age
- Open reduction and quadriceps
lengthening

22. CTEV (CLUB FOOT)
CONGENITAL TALIPEE EQUINO VARUS
1 to 2 in 1000 births
Deformities: Cavus,
Forefoot Adductus,Hindfoot Varus
Equinus
Etiology:
- Intrauterine Mechanical factors
- Germ plasm defect
- Neuromuscular
- Fibrosis of Medial soft-tissue
structures
Types:
Postural
Congenital
Syndromic or rigid

23. CTEV (CLUB FOOT)
CONGENITAL TALIPEE EQUINO VARUS
Investigations:
X-rays –Foot and ankle : Any bony
deformities Medico-legal
Hips and spine – to rule out spinal
malformations and DDH
Treatment:
- Ponseti method of serial POP
castings in out-patient setting
(Every 15 days)
- Percutaneous Achillis tendon
lengthening
- Foot abduction braces

24. Surgery:
Posteromedial soft tissue release at 9
months of age
CTEV (CLUB FOOT)
CONGENITAL TALIPEE EQUINO VARUS

25. CALCANEOVALGUS FOOT
Hind foot externally rotates and dorsiflexes.
Clinically: dorsum of foot comes in contact
with anterior tibia.
Treatment:
Gentle stretching of foot into plantar flexion
and inversion can be helpful.
Most deformities resolve by age of 3 to 6
months.

26. METATARSUS ADDUCTUS
- Medial deviation Metatarsotarsal joint
- Mild degree: resolve with growth
- Severe degree: Serial plasters in
corrected position.

27. CONGENITAL MUSCULAR TORTICOLLIS
Deformity of neck caused by contracture of sternocleidomastoid
Cause: Intrauterine compartment syndrome causing fibrosis of
sternocleidomastoid.
Risk factors: Breech position
Associated with DDH, metatarsus adductus
Clinical features:
- Head tilted towards involved muscle.
- Chin pointing towards opposite shoulder.
- Palpable mass in sternocleidomastoid muscle.

28. CONGENITAL MUSCULAR TORTICOLLIS
Investigations:
- X-rays: rule out klippel feil
syndrome, cervical spine
problems
Treatment:
- Gentle stretching initially up to 6
months.
- Surgery: 5 years of age- release
of Sternocleidomastoid muscle

29. POLYDACTYLY

30. SYNDACTYLY