Module 12, THE ALFRED I. DUPONT INSTITUTE

Module 12, General Orthopaedist Level

This is a newborn infant whose mother has insulin dependent diabetes. The infant is the product of an otherwise normal pregnancy and vaginal delivery. Marked atrophy of the buttocks showing gluteal dimples with a very short intergluteal fold and a horizontal anus were present. The lower limbs are in flexion, abduction, and external rotation contracture at the level of the hips, and a severe flexion contracture of the knees was also present giving infant the classic Buddha-like position.

Question 12A

The limbs in this child are very stiff and thin. He likely has a severe form of distal arthrogryposis.

Question 12B

In addition to x-rays of the lower extremities and lumbar spine you also order x-rays of the cervical spine.

Question 12C

As this child grows, he is likely to develop scoliosis.

Question 12D

Careful evaluation of the feet demonstrates the appearance of a planovalgus foot which is a common associated deformity. In the newborn nursery stretching and casting should immediately be started.

Question 12E

As this child grew x-rays clearly demonstrated a type IV sacral agenesis. At age 2 the child should be fit with AFOs to start walking.

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