Posted by: wockhardthospitals | July 20, 2009

Orthopedic Problems in Babies

There are quite a number of common orthopedic conditions seen in newborns. A pediatrician will be able to diagnose common birth deformities or conditions as soon as the child is born. If the deformity poses a bigger concern then the pediatrician can give a referral to an orthopedist / orthopedic surgeon for correction.


Certain orthopedic injuries or conditions in newborn babies will gradually heal by itself without much treatment. Such birth injuries are most commonly seen around the shoulder – shoulder nerve injuries and clavicle fractures are the most commonly seen problems. So also femur fractures. Fortunately, most of these injuries will heal with a simple splint or no treatment at all.


While orthopedic conditions as these are just normal variations of the human anatomy that don’t require treatment, others may persist, become more severe and may be linked to other conditions. Clubfoot deformity and Hip Dysplasia are the two more common orthopedic deformities in newborn babies that could require immediate surgical correction.


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Clubfoot is a birth defect that causes a newborn baby’s feet to point down and inward. This condition does not cause pain but it can cause long-term problems, affecting the child’s ability to walk in the future. Here the tendons on the inside and the back of the foot are too short. So the foot is pulled such that the toes point down and in, and it is held in this position by the shortened tendons. What causes this deformity is not clearly established yet, but fortunately this deformity can be cured in early childhood with appropriate treatment.


Soon after the child is born with clubfoot deformity, the orthopedic surgeon will manipulate the foot and cast it on a weekly basis. This manipulation and casting technique is called the Ponseti method of treatment, intended to stretch and rotate the foot into a proper position. With serial casting each week, the casts slowly correct the position of the clubfoot.


The Ponseti method is a non-surgical treatment procedure known to correct over 50 percent of new born children with clubfoot. For the rest however, a surgical procedure to release/ loosen / tighten the tendon may be required to allow the foot to assume the normal position. Once the casts are removed, the child will usually wear nighttime braces until the child is two years of age.


In about one half of cases, this manipulation is sufficient to correct the clubfoot deformity. In some cases, a surgical procedure may be necessary. Surgery is recommended in cases where the child has other developmental problems (such as arthrogryposis) or if the child begins treatment more than a few months after birth.


If the clubfoot deformity is not corrected, the child will develop an abnormal gait and may have serious skin problems along with walking disability. Since the child will be walking on the outside of the foot, a part of the foot not designed to walk upon, the skin can break down and the child may develop serious infections. The overall abnormal gait can lead to joint wear and chronic arthritic symptoms.


Another serious orthopedic deformity among new born children is Hip dysplasia, a problem of abnormal hip joint formation. It is known to occur in about 0.4 percent of all births, and is most common in first born girls. The location of the problem can be either the ball of the hip joint –femoral head, the socket of the hip joint –the acetabulum, or both.


Several factors are thought to contribute to the cause of hip dysplasia. Babies with a family history of hip dysplasia, babies born in breech position, babies who suffered inadequate supply of intrauterine fluid – Oligohydraminos, or babies born with other “packaging problems” arising in part from the in-utero position of the baby like torticollis (twisted neck due to abnormal positioning or during difficult delivery) or clubfoot are potential risk cases.


Hip dysplasia can be diagnosed with a “hip click,” a physical examination to assess special maneuvers of the hip joint. Certain maneuvers of the hip will cause a hip that is out of position to “click” as it moves in and out of the proper position. The baby’s hip ultrasound will ascertain the exact position of the hip joint. An x-ray is ruled out as does not show the bones in a young baby until at least 6 months of age. . Instead of the normal ball-in-socket joint, the ultrasound may show the ball outside of the socket, and a poorly formed (shallow) socket. The hip ultrasound can also be used to determine how well the treatment is working.


The treatment of hip dysplasia depends on the age of the child. The goal of treatment is to properly position the hip joint. Once an adequate reduction is obtained and held in place, the body is allowed to adapt to the new position. The younger the child, the better capacity to adapt the hip, and the better chance of full recovery.


The treatment for proper positioning of the hip joint is facilitated by using a special hip brace called Pavlik harness in children up to 6 months of age. Over time, the body adapts to the correct position, and the hip joint begins normal formation. About 90% of newborns with hip dysplasia treated in a Pavlic harness will recover fully. Since this method of treatment may not be successful in older babies, surgeons place the child in a special spica cast. The cast is similar to the Pavlik harness, but allows less movement. This is needed in older children to better maintain position of the hip joint.


Children older than one year old often need surgery to reduce the hip joint into proper position. The body can form scar tissue that prevents the hip from assuming its proper position, and surgery is needed to properly position the hip joint. Once this is done, the child will have a spica cast to hold the hip in the proper position.


Children who have persistent hip dysplasia have a chance of developing pain and early hip arthritis later in life. A possible Hip replacement surgery or a hip osteotomy is required to cut and realign the bones later in life. That’s why it is wise to begin treatment for hip dysplasia early in life. In a newborn infant with a good reduction, there is a very good chance of full recovery.


Then there are certain rare craniofacial or skull deformities in newborn babies like Craniosynostosis, the early closure of one or more sutures of the infant’s head. As an infant’s brain grows, open sutures allow the skull to expand and develop a relatively normal head shape. Premature closure of sutures forces the skull to expand in the direction of open sutures, resulting in abnormal head shape. Treatment includes surgery, sometimes, in association with cranial remolding helmet or band.

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