The arrival of a new bundle of joy is the most important event for everyone in the family. But if the child is born with some deformity the entire family gets disturbed. Parents may go into tremendous depression because they don’t know how to face the situation & what will be the prognosis. Here comes the role of the pediatric orthopedic surgeon who can help them not only to allay anxiety but also to counsel them about further treatment depending on the status of deformity.
Pediatric orthopedics in the last 10-12 years has come up by leaps & bounds as far as managing congenital pediatric orthopedic deformities is concerned. Majority of the deformities if tackled at the appropriate time give amazing functional & cosmetic outcomes. The purpose of this article is to make everyone sensitize & aware about the same.
Let’s have a look at few common deformities diagnosed at birth.
Congenital TalipesEquinovarus (CTEV/Club foot)
- The most common deformity 1 in 1000 live births
- Idiopathic 90% , Neurological, syndromic cause 10%
- M>F , Bilateral > Unilateral
Treatment Protocol- Ponseti Treatment
- Weekly scientific manipulation & casting to gradually abduct the forefoot to 70 deg (average casts 3-5) followed by TA tenotomy.
- Maintainance in DB splint for first 3 months 23hrs a day. Thereafter bracing at nap time during day &night time till 2-4 years of age group.
- If one doesn’t follow the brace protocol recurrence rate can be more than 35%
Congenital Vertical Talus (CVT)
- The talus is vertically oriented and other foot bones get shifted on top of it. The bottom of the foot is stiff and has no arch — in fact, it usually curves out — and is often described as “rocker bottom.”
- The exact cause of vertical talus in not known.
- Associated with a neuromuscular disease, arthrogryposis, spina bifida, neurofibromatosis, and numerous syndromes.
- Management by reverse Ponseti Treatment- Serial manipulations to reduce the forefoot over talus ,Talonavicular open reduction & pinning followed by use of AFOs till about 2-3 years.
Congenital radial club hand
- The radius may be malformed or missing
- The affected arm is shorter, with curving of the forearm and stiffness of the elbow and fingers.
- Thumb is either very small or missing.
- Associated with congenital cardiac abnormalities (30%)
- Treatment involves gradual stretching of the contracted soft tissues of hand to centralize the wrist at around 1 year of age followed by pollicization procedure ie rotating index figure by 180 deg to convert into a thumb
Syndactyly
- one of the most common congenital hand problems 1in 2,500-3,000 newborns; M>F, Bilateral in 50%cases
- most often occurs between the middle and ring fingers.
- Can be part of Apert syndrome, Holt-Oram syndrome or Poland syndrome
- Usually treated surgically 6 months -1 year age
Its very important to intervene at the appropriate times to maximize the results.
