South Dakota Perinatal Association Newborn Orthopedics Stephen Eckrich, MD South Dakota Perinatal Association September 9, 2016

Newborn Orthopedics Physical Exam The Flail Extremity Foot Conditions Dislocations and Contractures

Examination History Gestational age Prenatal history Birth history

Examination History Physical Exam Gestational age Prenatal history Birth history Physical Exam Skin Range of Motion Reflexes Grasp Moro Stepping

The Flail Extremity Fracture Infection Brachial Plexus Palsy

The Flail Extremity Fracture

The Flail Extremity

The Flail Extremity Infection Usually in joint Staph aureus, gram negatives +/- fever +/- elevated white count +/- elevated ESR and CRP +/- positive blood cultures

The Flail Extremity Infection Can lead to joint subluxation or dislocation Can develop into osteomyelitis Can lead to rapid articular cartilage destruction

The Flail Extremity Brachial Plexus Palsy

The Flail Extremity Brachial Plexus Palsy

The Flail Extremity Brachial Plexus Palsy

The Flail Extremity Brachial Plexus Palsy Risk factors: Maternal diabetes High birth weight Prolonged labor Shoulder dystocia Clavicle, humerus fractures Torticollis Most (90%) recover spontaneously. Biceps function key predictor

Foot Conditions Metatarsus adductus Clubfoot Calcaneovalgus foot

Foot Conditions Metatarsus adductus Common (1:100) births Probably related to intra-uterine positioning Most resolve spontaneously

Foot Conditions

Foot Conditions Clubfoot 1-2 in 1000 births Wide range of severity Most are idiopathic

Foot Conditions Clubfoot Treatment by Ponseti method very effective 1-2 in 1000 births Wide range of severity Most are idiopathic Treatment by Ponseti method very effective

Foot Conditions

Foot Conditions

Foot Conditions

Foot Conditions Calcaneovalgus foot Common (1:1000) births Probably related to intra-uterine positioning Most resolve spontaneously

Dislocations and Contractures Developmental Dysplasia of the Hip Congenital Muscular Torticollis

Developmental Dysplasia of the Hip Risk Factors Breech position Female First Born Family History Exam No crying! Demonstrable subluxation or dislocation Thigh fold asymmetry unreliable Click vs. Clunk

Developmental Dysplasia of the Hip Imaging Plain X-rays not indicated Ultrasound study of choice, but… High false positive rate Useful until ossific nuclei form Treatment Wait and re-examine in two weeks for subluxatable hip Pavlik harness for dislocated or persistent subluxation >90% success rate

Dislocations and Contractures Developmental Dysplasia of the Hip

Developmental Dysplasia of the Hip Pavlik Harness

Dislocations and Contractures Congenital Muscular Torticollis

Congenital Muscular Torticollis Contracture of sternocleidomastoid muscle due to? Associated with DDH, metatarsus adductus Treatment: Stretching started prior to 6 months

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