GROWTH AND EARLY DEVELOPMENT OF THE MUSCULOSKELETAL SYSTEM “NEONATOLOGY ORTHOPAEDICS”

Alvin H. Crawford, M.D., F.A.C.S.

MUSCULOSKELETAL NEONATOLOGY 1. Malformation * localized area of morphogenesis – cleft lip 2. Deformation *alteration of structure kyphoscoliotic tibia 3. Disruptive defects *structural defect of normal part B.E. amputation PRENATAL Defect in formation single/multiple

POSTNATAL

u Normal structure  Genetics/CNS  Environmental, trauma, infection, hypoxia, metabolic  Unknown DEFORMATION u Extrinsic – constraining forces • Uterine – additional fetus • Bicornuate • Fibroids u Tight muscles – Primip u Bony lumbar spine u Small pelvis u Fetal posture u Position of comfort – (postnatally) NEONATE EXTREMITIES

u Deformation u Disruptive defects u Position  Fixed  mobile u Malformation VARIABLES

u Size Paternal age ??? u Parity Multiple births u Hydramnios Breech u Rupture Uterine abnormalities URGENT PROBLEMS u Infection (femoral, umbilical hernia, septic arthritis, osteomyelitis, complication u Gangrene (IV’s cut down) u Avascular bands u Skin closure (myelos) CONGENITAL PROBLEMS OF SOFT TISSUE u Arthrogryposis u Congenital contractural arachnodactyly u Marfans syndrome u Ehlers Danlos syndrome u Hemihypertrophy u Popliteal pterygium syndrome u Muscle diseases u Malignant neoplasms DEFORMITIES OF UPPER EXTREMITY u Shoulder u Classification of congenital malformations u Elbow and forearm u Hand and finger deformities u Thumb DEFORMITIES OF THE HIP AND PROXIMAL FEMUR

u PFFD u Developmental dislocation of the hip u Extrophy of the bladder u Coxa vara u Congenital anomalies of the femur DEFORMITIES OF LOWER EXTREMITIES u Long dislocation or subluxation of the knee u Congenital dislocation of the patella u Congenital synostosis of the knee u Rotational deformities of the lower u Angular deformities of the tibia u Congenital deformities DEFORMITIES OF HIP AND THE PROXIMAL FEMUR

u Congenital dislocation of the hip u Extrophy of the bladder u Coxa vara u Congenital anomalies of the femur DEFORMITIES OF THE FOOT AND TOES

u Clubfoot u Varus foot (metatarsus adductus) u Valgus foot u Toe deformities CONGENITAL DEFORMITIES OF SPINE

u Cervical spine u Scoliosis and kyphosis u Diastematomyelia u Myelodysplasia u Lumbosacral agenesis DYSPLASIA OF BONE u Skeletal dysplasia u Lethal types of dwarfism u Osteogenesis imperfecta PATTERNS

Oligohydramnios Polyhydramnios

u Renal agenesis u Amniotic leaks DYSPLASIA OF THE BONE

u Skeletal dysplasia u Lethal types of dwarfism u Osteogenesis imperfecta Orthopaedic Neonatology Posna NP/PA Symposium References

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