NEONATAL ORTHOPAEDICS NEONATAL ORTHOPAEDICS Second Edition N De Mazumder MBBS MS Ex-Professor and Head Department of Orthopaedics Ramakrishna Mission Seva Pratishthan Vivekananda Institute of Medical Sciences Kolkata, West Bengal, India Visiting Surgeon Department of Orthopaedics Chittaranjan Sishu Sadan Kolkata, West Bengal, India Ex-President West Bengal Orthopaedic Association (A Chapter of Indian Orthopaedic Association) Kolkata, West Bengal, India Consultant Orthopaedic Surgeon Park Children’s Centre Kolkata, West Bengal, India Foreword AK Das ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD. New Delhi • London • Philadelphia • Panama (021)66485438 66485457 www.ketabpezeshki.com ® Jaypee Brothers Medical Publishers (P) Ltd. Headquarters Jaypee Brothers Medical Publishers (P) Ltd. 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 Email: [email protected] Overseas Offices J.P. Medical Ltd. Jaypee-Highlights Medical Publishers Inc. Jaypee Brothers Medical Publishers Ltd. 83, Victoria Street, London City of Knowledge, Bld. 237, Clayton The Bourse SW1H 0HW (UK) Panama City, Panama 111, South Independence Mall East Phone: +44-2031708910 Phone: +507-301-0496 Suite 835, Philadelphia, PA 19106, USA Fax: +02-03-0086180 Fax: +507-301-0499 Phone: +267-519-9789 Email: [email protected] Email: [email protected] Email: [email protected] Jaypee Brothers Medical Publishers (P) Ltd. Jaypee Brothers Medical Publishers (P) Ltd. 17/1-B, Babar Road, Block-B, Shaymali Shorakhute, Kathmandu Mohammadpur, Dhaka-1207 Nepal Bangladesh Phone: +00977-9841528578 Mobile: +08801912003485 Email: [email protected] Email: [email protected] Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2013, Jaypee Brothers Medical Publishers All rights reserved. No part of this book may be reproduced in any form or by any means without the prior permission of the publisher. Inquiries for bulk sales may be solicited at: [email protected] This book has been published in good faith that the contents provided by the author contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the author specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the author. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device. Neonatal Orthopaedics First Edition: 2003 Second Edition: 2013 ISBN 978-93-5090-372-8 Printed at (021)66485438 66485457 www.ketabpezeshki.com Foreword There has been a phenomenal breakthrough in the diagnosis and management of orthopaedic maladies in the last 50 years. This is partly because of introduction of newer alloys and different plastics in the construction of implants and orthosis, production of newer antibiotics, better understanding of biomechanics of bones and joints in the health and disease, and introduction of more efficient imaging techniques. Newer technology has advanced our horizon of knowledge, particularly, the advancement of information technology. Better methods of management of trauma with image intensifiers and better implants for fracture fixation, availability of various joint implants, advances in management of spinal injuries and deformities have vastly increased our capability to treat complicated abnormalities with much better functional results. Arthoscopic techniques have vastly improved the diagnosis of joint injuries and diseases with a minimum damage to joint structures and much early restoration of normal function. As a result of these advances, it has become increasingly difficult for any individual surgeon to become expert in all the different techniques of surgery. Consequently, a number of subspecialties have emerged, e.g. Joint Replacement Surgery, Spinal Surgery, Arthroscopic Surgery, Paediatric Orthopaedics, Trauma Surgery and so on. One of the subspecialties, which is getting popular, is paediatric orthopaedics. This deals with the diagnosis and management of diseases and injuries of bones, joints, muscles and nerves in children whose disease manifestations and management are quite different from adults. Neonatal orthopaedics is an offshoot of this specialty, which deals with the orthopaedic problems in neonates. Congenital deformities and abnormalities of muscles, bones and joints need to be diagnosed immediately or soon after birth in order to start treatment as early as possible. These need special awareness and expertise. Infections of bones and joints in the neonates pose special problems in diagnosis and management. Early effective treatment restores a normal anatomy and functions. Immediate correction of congenital deformities gives better correction before the structures get more rigid. This is comparatively a newer branch of orthopaedics, which is drawing the attention of some paediatric orthopaedicians. In our country, though paediatric orthopaedics is an established specialty, not many surgeons are yet interested to devote their attention to neonatal orthopaedic problems. It is very encouraging that an experienced orthopaedic surgeon like Dr N De Mazumder has become interested in this new subspecialty and has written a book on this subject highlighting the special problems in orthopaedic affections in neonates. He had been the Professor and Head of orthopaedic service of a large hospital, such as Ramakrishna Mission Seva Pratishthan, Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India, which has also a large Obstetric Department. Consequently, he had the opportunity to study neonates also. He has written very lucidly with excellent diagrams covering the different aspects of this new specialty. I am sure that the book will be of great interest to orthopaedic surgeons, paediatric orthopaedic specialists as well as paediatricians. AK Das Ex-Professor Department of Orthopaedics Nil Ratan Sircar Medical College and Hospital Kolkata, West Bengal, India Ex-Emeritus Professor BC Roy Polio Clinic and Hospital for Crippled Children Kolkata, West Bengal, India Ex-President West Bengal Orthopaedic Association (A Chapter of Indian Orthopaedic Association) Kolkata, West Bengal, India (021)66485438 66485457 www.ketabpezeshki.com (021)66485438 66485457 www.ketabpezeshki.com Preface to the Second Edition Nine years from now, this book Neonatal Orthopaedics was published as a venture to bring in a new subject with descriptions of orthopaedic conditions in the neonatal period. Presently, the revised edition is being published. The first edition of this book published by M/s Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, India, has been reviewed by Indian Journal of Orthopaedics in the April 2003 issue of the journal; a few lines are being coined here from Dr Ashok Kumar’s review. This book is timely and has fulfilled a need of having a single source of information on neonatal orthopaedic problems and will serve as an important reference for the practicing orthopaedicians as well as the paediatricians. There is a wealth of information contained in this book. Overall, this book makes an interesting reading and will be a valuable addition to any medical library and is strongly recommended for postgraduate students, orthopaedicians, neonatologists and paediatricians. The research, in the field of neonatal orthopaedics, has yet to get a momentum as many of the neonatal orthopaedic conditions have not been explored even today. Newer antenatal and natal diagnostic facilities are evolving with time. An effort is made to describe the diagnostic points to achieve a neonatal diagnosis. As written in the preface of the first edition, the details of surgical technique of the operations necessary for the correction of the neonatal deformities were avoided as the operations described were mostly undertaken long after the neonatal period. All the 45 chapters with addition of keywords with each chapter, have been reviewed thoroughly with some illustrations added to bring out an effect of clarity of the conditions described. I am indebted to Professor Niloy Kanti Das for providing me with some clinical photographs. As this book has fulfilled to some extent, the need of postgraduate students, I have purposely kept it in an abridged form without much elaboration. The book Essentials of Paediatric Orthopaedics edited by me and published by M/s Jaypee Brothers Medical Publishers in 2007 has covered the paediatric orthopaedic conditions in a greater detail with an eye to present the readers, a comprehensive discussion on the subject. In the two books Neonatal Orthopaedics and Essentials of Paediatric Orthopaedics, I have tried to bring in the management of paediatric orthopaedic disorders from their onset in utero to the fully grown condition. My sincere thanks go to the M/s Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, India. N De Mazumder (021)66485438 66485457 www.ketabpezeshki.com (021)66485438 66485457 www.ketabpezeshki.com Preface to the First Edition The orthopaedic problems of the infants in their early days fascinate me for a long time. An involvement in orthopaedic practice, especially in paediatric orthopaedics, for more than three decades has led me to think about an early diagnosis of the orthopaedic conditions in the neonatal period, i.e. within 4 weeks of birth; which gives