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 Asher MA. Screening for congenital dislocation of the hip, scoliosis, and other abnormalities affecting the musculoskeletal system. Pediatr Clin North Am 1986;33:1335. Froster UG, Baird PA. Congenital defects of lower limbs and associated malformations: A population based study. Am J Med Genet 1993;45:60. Hedequist D, Emans J. Congenital scoliosis: a review and update. J Pediatr Orthop 2007 Jan-Feb; 27(1):106-16. Pappas AM. Congenital abnormalities of the femur and related lower extremity malformations: classification and treatment. J Pediatr Orthop Feb 1983;3(1):45-60. Parikh SN, Crawford AH, Do TT, Roy DR. Popliteal pterygium syndrome: implications for orthopaedic management. J Pediatr Orthop B 2004 May;13(3):197-201. Ponseti IV. Treatment of congenital club foot. J Bone Joint Surg Am 1992 Mar;74(3):448-54. Sarwark JF, MacEwen GD, Scott CI. Current Concepts review. Amyoplasia (a common form of arthrogryposis). J Bone Joint Surg Am 1990;72:465. Swanson AB. A classification for congenital limb malformations. J Hand Surg Am 1976;1:8. Tredwell SJ. Neonatal screening for hip joint instability: its clinical and economic relevance. Clin Orthop 1992;281:63. Wall EJ. Practical primary pediatric orthopedics. Nurs Clin North Am 2000 Mar;35(1):95-113. .