Primer For Obstreticians

Something in paediatric orthopaedics to know about

Congenital anomalies-

  • Most of the congenital structural anomalies are usually detected on antenatal ultrasound

  • Unless multisystem involvement indicative of syndromic affection is seen, these musculoskeletal anomalies usually do not affect the life expectancy and quality of life can be improved by timely interventions.

  • These congenital anomalies range from positional maladjustments like calcaneovalgus foot deformity, hyperextension deformity of knee; which are self limiting and completely reversible by gentle physiotherapy, to deformities due to soft tissue contracture like congenital dislocation of knee, CTEV etc which require more intensive treatment like serials stretching plasters and surgery at appropriate age followed by physiotherapy to avoid recurrence.

  • The other spectrum of deformities usually involves bony structures occurring due to failure of formation or failure of differentiation, which require at times multiple surgeries and are associated with long term morbidity and disability.

  • Thankfully, these problems are far less common than the other two mentioned previously

  • What's important to remember inform to the new parents is that most of these congenital anomalies require staged treatment with decision making influenced by severity of affection and age of the baby.

  • These congenital anomalies don't require an urgent treatment and as said earlier requires staged treatment in the form of stretching, plasters and sos surgery.

Birth injuries-

  • With advancements in the quality of obstetric care, birth injuries are becoming less and less common.

  • The ones which we see on and off are-

1. Fracture of femur/ humerus- femoral fracture is more common than later and usually is seen as a sequel of difficult labour. Characteristically affecting the proximal third of femur, this fracture unites rapidly and without any long term problem. Femoral fractures during birth process usually don't require any aggressive intervention except for immobilisation. Till an expert opinion is sort, it is worthwhile to immobilise the upper limb in case of # humerus by strapping to the side of the chest and thigh in the case of fracture femur to the leg by flexing the knee.

2. Brachial plexus palsy- with the documented incidence of 0.25 % of all live births, the incidence is showing a decreasing trend due to change in management principles of breech presentations. But we do get occasional cases of Obstetric Brachial plexus Palsy due to forceful manipulations. Though the palsy recovers in 90 % of cases, it requires a mix of physiotherapy, splintage and close follow up. The remaining 10-15 % may require different surgeries depending on the lesion and time of presentation.

Cerebral Palsy-

  • Cerebral Palsy is defined as a permanent motor disorder due to a non-progressive defect or lesion of the brain in the early stages of development.

  • Cerebral palsy is the commonest cause of disability in childhood

  • Common causes include prematurity, low APGAR score, difficult labour and neonatal illnesses.

  • Presenting as delayed milestones, locomotor disabilities due to lack of balance, lack of muscle coordination, joint contractures and spasticity, treatment of cerebral palsy requires prolonged treatment in the form of physiotherapy, occupational therapy, splints, medications and surgeries spanning the entire growth period of a child.

  • Of the aforementioned causes, low APGAR score and difficult labour have been seen as factors which can be modified and therefore it is worth to intervene at an appropriate time

 

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