The document discusses various orthopedic problems in newborns, covering conditions such as birth-related fractures, infections, brachial plexus palsy, congenital dislocation of the hip, and clubfoot. It outlines risk factors, clinical features, diagnosis methods, and management strategies for each condition. Emphasis is placed on early detection and appropriate treatment to ensure favorable outcomes for affected infants.

1. ORTHOPEDIC PROBLEMS IN
NEWBORN
Dr.A.Mohan Krishna
Consultant Orthopedic surgeon
Apollo Hospitals

2. Dr. A.MOHAN KRISHNA
M.S.ORTHO, MCh ORTH(U.K)
Consultant Orthopaedic surgeon ,
Trauma, Arthroscopy,
Arthroplasty Surgeon
Apollo hospitals, Hyderabad
9247258989
9441184590
www.drmohankrishna.com

3. FLAIL EXTREMITY
Orthopedic consultation in
NICU after delivery:
Failure to move the limb or
limbs
- Fractures
- Infection
- Brachial plexus palsy in
upper limb
- Pseudoparalysis : fracture or
infection

4. FRACTURES
Birth related fractures:
Risk factors:
- Breech position
- Forceps delivery
- Vaginal delivery
- Macrosomia
Postdelivery:
- Child abuse
- Osteogenesis imperfecta
- Neonatal rickets
Common fractures:
- Clavicle
- Femur
- Humerus

5. FRACTURES
Diagnosis:
- Flail extremity after delivery
- Deformity in case of long bone fractures
- Irritable during feeds
Radiographs: by the time radiographs are
ordered callus formation is seen in neonates
Management:
Fractures heal rapidly in neonates and
outcome is good if proper splinting is done
- Neonatal fractures require
immobilization for 2 weeks
- Femur fractures : pavilik harness, or
spica cast
- Humerus fractures : sling or splint
immobilization

6. HEALING IN FRACTURE FEMUR

7. INFECTION
Most commonly involves joints
Causes:
- Immunocompromised
- Premature delivery
- Multiple IV lines or central lines
Diagnosis:
- Clinically flail limb
- Irritable child
- Signs of inflammation around
joint

8. INFECTION
Investigations:
Blood tests:
- Leukopenia (<5000cells/ml)
(Normal:WBC : 9000 to 30000)
- ESR/CRP supportive
Blood culture
Aspirate culture
X-rays: widened joint space
USG
Organisms:
- Staph.aureus
- Group B Streptococci
- Recent trend towards Gram-ve
infections

9. INFECTION
Investigations:
X-rays :
- Septic arthritis: widened joint space, destruction of epiphysis in long
standing cases
- Osteomyelitis: destruction, seqestrum formation in long standing cases
Ultrasound :
- Detect fluid collection and also aids in aspiration

10. BRACHIAL PLEXUS PALSY
Cause for flail limb
- Incidence 0.13 to 3.6 per 1000
live births
Causes / Risk factors:
- Forceps delivery
- Shoulder dystocia
- Fracture clavicle, Humerus
- Prolonged vaginal delivery
- High birth weight

11. BRACHIAL PLEXUS PALSY
Diagnosis: Clinical
- Flail upper limb
Upper brachial plexus palsy:
(C5-C6) Erb’s palsy : Waiter’s tip
deformity
Internal rotation of shoulder
Extension of elbow
Forearm pronation and wrist
flexion
Total plexus palsy:
- Completely flaccid limb
- Horner’s syndrome-
Ptosis,Miosis,enopthalmos
- Ipsilateral diaphragmatic palsy
Investigations:
- X-rays to rule out fractures
- MRI to asses the level of injury

12. CONGENITAL DISLOCATION OF HIP
DEVELOPMENTAL DYSPLASIA OF HIP
Frank dislocation 1 in 1000 births
Subluxation with dysplasia of
acetabulum : 10 in 1000
Risk factors:
- Breech presentation
- Oligohydramnios
- Neuromuscular problems
- Female
- 1st child
Clinical examination:
- Limited abduction of hip
- Asymmetric knee heights
(Galeazzi sign)
- Barlow’s and Ortolani tests

13. CONGENITAL DISLOCATION OF HIP
DEVELOPMENTAL DYSPLASIA OF HIP
Barlow’s testOrtolani test

15. X-RAY- IN CDH/DDH

16. High resolution Ultrasound
(HRUS):
- Preferred modality in newborn:
- Help to identify mild subluxation
and acetabular dysplasia.
- Progression of treatment

17. Ultrasound
Femoral head
Abductors
Ilium
HRUS (ULTRASOUND)

18. Treatment:
- Pavlik harness
- Adductor tenotomy
- Hip Spica
- Open reduction and hip
Spica
- Corrective osteotomies in
later child hood
CONGENITAL DISLOCATION OF HIP
DEVELOPMENTAL DYSPLASIA OF HIP

19. TREATMENT ALGORITHM OF CDH/DDH

20. CONGENITAL KNEE DISLOCATION
Knee is hyperextended at birth
Causes:
- Contracture of quadriceps.
- Associated deformities- club foot,
arthrogryposis,myelodysplasia
Diagnosis:
Clinical:
- Knee is hyperextended
- Childs foot can touch the face.
- In complete dislocations knee
cannot be flexed
Investigations:
- X-rays: position of tibia in relation
to femur and grading of dislocation

21. CONGENITAL KNEE DISLOCATION
Management:
Non-operative treatment: gentle
reduction and serial casting in
progressive flexion
-Concomitant DDH Knee
dislocation should be reduced first
and child later put on Pavlik
harness.
Surgery:
- Not responding to conservative
management
- 6 months of age
- Open reduction and quadriceps
lengthening

22. CTEV (CLUB FOOT)
CONGENITAL TALIPEE EQUINO VARUS
1 to 2 in 1000 births
Deformities: Cavus,
Forefoot Adductus,Hindfoot Varus
Equinus
Etiology:
- Intrauterine Mechanical factors
- Germ plasm defect
- Neuromuscular
- Fibrosis of Medial soft-tissue
structures
Types:
Postural
Congenital
Syndromic or rigid

23. CTEV (CLUB FOOT)
CONGENITAL TALIPEE EQUINO VARUS
Investigations:
X-rays –Foot and ankle : Any bony
deformities Medico-legal
Hips and spine – to rule out spinal
malformations and DDH
Treatment:
- Ponseti method of serial POP
castings in out-patient setting
(Every 15 days)
- Percutaneous Achillis tendon
lengthening
- Foot abduction braces

24. Surgery:
Posteromedial soft tissue release at 9
months of age
CTEV (CLUB FOOT)
CONGENITAL TALIPEE EQUINO VARUS

25. CALCANEOVALGUS FOOT
Hind foot externally rotates and dorsiflexes.
Clinically: dorsum of foot comes in contact
with anterior tibia.
Treatment:
Gentle stretching of foot into plantar flexion
and inversion can be helpful.
Most deformities resolve by age of 3 to 6
months.

26. METATARSUS ADDUCTUS
- Medial deviation Metatarsotarsal joint
- Mild degree: resolve with growth
- Severe degree: Serial plasters in
corrected position.

27. CONGENITAL MUSCULAR TORTICOLLIS
Deformity of neck caused by contracture of sternocleidomastoid
Cause: Intrauterine compartment syndrome causing fibrosis of
sternocleidomastoid.
Risk factors: Breech position
Associated with DDH, metatarsus adductus
Clinical features:
- Head tilted towards involved muscle.
- Chin pointing towards opposite shoulder.
- Palpable mass in sternocleidomastoid muscle.

28. CONGENITAL MUSCULAR TORTICOLLIS
Investigations:
- X-rays: rule out klippel feil
syndrome, cervical spine
problems
Treatment:
- Gentle stretching initially up to 6
months.
- Surgery: 5 years of age- release
of Sternocleidomastoid muscle

29. POLYDACTYLY

30. SYNDACTYLY