Skeletal

• Causes of Skeletal Disorders in the Newborn

  • Genetic
  • Environmental
  • Maternal drug ingestion
  • Virus invasion
  • Amniotic band formation in utero
  • Unknown
• Syndactyly


  Condition where fingers or toes are fused together
• Pectus excavatum


  • An indentation of the lower portion of the sternum
  • Most common congenital deformity of the anterior chest
  • Occurs in about 1 out of 500 live births
  • Affects boys 4 times more often than girls

  
• Pectus carinatum


  • The sternum is displaced anteriorly
  • Can be surgically corrected
• Torticollis (Wry Neck)


  • A term derived from the terms tortus ("twisted") and collum ("neck")
  • Occurs when the sternocleidomastoid muscle is injured and bleeds during birth
  • Occur in newborns with wide shoulders when pressure is exerted on the head to deliver the shoulder either with a vaginal or cesarean birth
• Craniosynostosis


  • The premature closure of the sutures of the skull
  • More often in boys than in girls
  • Sagittal suture line is the one that closes prematurely - the child's head tends to grow anteriorly and posteriorly
  • Coronal suture line fuses early - the orbits of the eyes become misshapen and the increased intracranial pressure may lead to eye disorders such as exophthalmos, nystagmus, papilledema, strabismus, and atrophy of the optic nerve with consequent loss of vision
  • X-ray or ultrasound: reveals fused suture line
  • Sagittal: treatment involve only careful observation
  • Coronal: surgically opened to prevent brain compression and an abnormally shaped head by 9 to 12 months
• Achondroplasia (Chondrodystrophia)


  • Failure of bone growth inherited as a dominant trait
  • The forehead is prominent and the bridge of the nose becomes flattened
  • Trunks are of near-normal size, but a thoracic kyphosis (outward curve) and lumbar lordosis (inward curve) of the spine may develop
• Talipes Disorders


  • Ankle–foot disorders, popularly called clubfoot
  • Foot is twisted out of alignment; maybe misshapen
  • 1 in every 1000 children is affected; common in boys
  • Inherited as a polygenic pattern
  • Occurs as a unilateral problem

  
• Types of Talipes Disorders

  • Talipes equinovarus
  • Plantar flexion (an equinus or "horse foot" position)
  • Dorsiflexion - the heel is held lower than the forefoot or the anterior foot is flexed toward the anterior leg
  • Varus deviation - the foot turns in
  • Valgus deviation - the foot turns out

  
• Assessment of Talipes Disorders


  1. Straightening all newborn feet to the midline as part of the initial assessment to detect this disorder

  2. Refer to the pediatric physician and orthopedist specialist

  
• Therapeutic Management of Talipes Disorders

  1. Casts or braces to gradually mold the foot into good alignment (a Ponseti method); extends above the knee to ensure a firm correction

  2. Change diapers frequently

  3. Check the infant's toes for coldness or blueness

  
• Developmental Dysplasia of the Hip (DDH)

  • Referred to as congenital hip dysplasia
  • Improper formation and function of the hip joint
  • Common musculoskeletal condition found in newborns
  • Cause: unknown
  • May be from a polygenic inheritance pattern, uterine position that causes less-than-usual pressure of the femur head on the acetabulum
  • Occur with breech birth, a female infant, and a mother's first pregnancy
  • Additional risk factors: family history of DDH, oligohydramnios, large birth weight for gestational age, metatarsus adductus, and torticollis

  
• Assessment of Developmental Dysplasia of the Hip (DDH)

  1. All infants should be screened for DDH from birth and up until 3 months of age by performing the Ortolani & Barlow maneuver

  2. On inspection: affected leg may appear slightly shorter than the other, Skin folds-thighs & buttocks

  
• Ortolani Sign


  Procedure to assist in detecting developmental dysplasia of the hip

  
• Barlow Sign


  Procedure to assist in detecting developmental dysplasia of the hip

  
• Therapeutic Management of Developmental Dysplasia of the Hip (DDH)

  1. Infants less than 6 months of age - flexion-abduction splinting devices

  2. Correction: positioning the hip into a flexed, abducted (externally rotated) position

  3. Brace and splints, such as the von Rosen, Pavlik, Craig, or Frejka: unstable hip

  4. Pavlik harness: high success rate

  5. May have corrective and therapeutic hip surgery, which may involve having a pin inserted to stabilize the hip

  6. Spica Cast - frog-leg, A-line cast, or a spica cast - to maintain an externally rotated hip position; these casts are heavy and are so wide that dressing infants or sitting them in an infant car seat or using a bassinet can be difficult

  
• Developmental Dysplasia of the Hip (DDH)

  • All infants should be screened for from birth and up until 3 months of age
  • Performed by Ortolani & Barlow maneuver
• On inspection of affected leg

  • May appear slightly shorter than the other
  • Skin folds-thighs & buttocks
• Figure 27.4 shows a normal femur head and acetabulum, a subluxated hip, and a dislocated hip
• Figure 27.5 shows signs of developmental dysplasia of the hip, including asymmetry of skin folds and prominence of the trochanter
• Assessing Ortolani and Barlow signs


  1. Lay infant supine, flex knees to 90 degrees

  2. Place middle fingers over greater trochanter, thumb on internal side of thigh

  3. Abduct hips, apply upward pressure, listen for clicking sound (Ortolani sign)

  4. Apply backward pressure, adduct hips, note feeling of femoral head slipping (Barlow sign)
• Ortolani sign


  Clicking or clunking sound when displaced femoral head reenters the acetabulum
• Barlow sign


  Feeling of the femur head slipping out of the socket posterolaterally, indicative of hip instability
• Spica


  A type of cast
• Spica cast


  • Frog-leg, A-line cast, or a spica cast to maintain an externally rotated hip position
  • These casts are heavy and are so wide that dressing infants or sitting them in an infant car seat or using a bassinet can be difficult