Module 12, Pediatric Orthopaedist Level

This is a new born infant whose mother has insulin dependent diabetes. The infant is the product of another wise normal pregnancy and vaginal delivery. A short spine with marked atrophy of the buttocks showing gluteal dimples with a very short intergluteal fold and a horizontal anus were present. The lower limbs had 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

By the age of 8 months this child's right hip was noted to dislocated on ultrasound, the left hip was normal. An open reduction of the right hip is indicated.

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Question 12B

At age two this child has a 70 degree fixed knee flexion contracture and she is pulling up and starting to do some weight bearing on her feet. You apply stretching casts to reduce this knee flexion contracture.

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Question 12C

Through knee amputation and fitting with below knee prosthesis would be an acceptable treatment to over come severe knee flexion deformities.

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Question 12D

When there is total sacral agenesis the child should have a lumbar illial fusion to prevent abnormal abdominal pressure during sitting.

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Question 12E

Before any surgery is done in this child a careful cardiac examination must be ordered to make sure that there are no life threatening cardiac abnormalities.

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