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

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

3. Examination
History
Gestational age
Prenatal history
Birth history

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

5. The Flail Extremity
Fracture
Infection
Brachial Plexus Palsy

6. The Flail Extremity
Fracture

7. The Flail Extremity

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

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

10. The Flail Extremity
Brachial Plexus Palsy

11. The Flail Extremity
Brachial Plexus Palsy

12. The Flail Extremity
Brachial Plexus Palsy

13. 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

14. Foot Conditions
Metatarsus adductus
Clubfoot
Calcaneovalgus foot

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

16. Foot Conditions

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

18. 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

19. Foot Conditions

20. Foot Conditions

21. Foot Conditions

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

23. Dislocations and Contractures
Developmental Dysplasia of the Hip
Congenital Muscular Torticollis

24. 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

25. 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

26. Dislocations and Contractures
Developmental Dysplasia of the Hip

27. Developmental Dysplasia of the Hip
Pavlik Harness

28. Dislocations and Contractures
Congenital Muscular Torticollis

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

30. THANK YOU !