Module 30, General Orthopaedist Level

This 29 week gestation male was born by vaginal delivery. These x-rays were made after it was noted that that the knees appeared to be hyper-extended. The right knee had -30 degrees extension to 20 degrees of flexion. The left knee had -20 degrees extension to 20 degrees of flexion. Ortolani exam revealed a positive sign in the left hip and a negative sign in the right.

Question 30A

The primary deformity to treat in this child is the hip.

Question 30B

A Pavlik harness would be an appropriate orthosis to use for this child.

Question 30C

Arthrogryposis is a possible diagnosis in this child.

Question 30D

You inform the parents that this child will likely have long term severe disability from his knee deformities.

Question 30E

The most appropriate treatment for the hips is to do a closed reduction and place the child in a spica cast.