Module 5, General Orthopaedist Level

This girl was the product of 42 week gestation without complications. Her birth weight was 7 lbs (3.2 kg), length 18-1/2" (47 cm). At birth she was found to have bilateral clubfeet and, bilaterally dislocated hips. Casts were applied to the feet and hips for the first 13 months of age. The developmental milestones were delayed. She pulled up and walked without help at 20 months. By age 7 years this girl had 8 mm of C1 occiput mobility on flexion extension x-rays and 80 degree thoracolumbar scoliosis. She was able to walk although was slow. Neurological examination showed normal reflexes and no asymmetric weakness.

Question 5A

This combination of symptoms strongly suggests a syndrome which affects connective tissue.

Question 5B

The cervical spine instability needs to be monitored closely as long as there are no neurological symptoms and the diagnosis is unknown.

Question 5C

At age seven, this child will probably need a fusion of her thoracolumbar spine. Doing the fusion at this age would cause severe growth stunting and the parents should be told to plan that it will be done around age 10.

Question 5D

This is a type of scoliosis which is very responsive to orthotic management.

Question 5E

This girl should have a very careful evaluation of the shoulder because she likely also has dislocated shoulders.

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