Congenital Anomalies of Upper and Lower Limbs

Congenital Anomalies of the Upper Limb and Lower Limbs

Hip

• Developmental dysplasia of the hip joint: a spectrum of pathology in the development of the immature hip joint, also known as congenital dislocation of the hip.
• Acetabular dysplasia: abnormal morphology and development of the acetabulum.
• Hip subluxation: partial contact between the femoral head and acetabulum.
• Hip dislocation: a hip with no contact between the articulating surfaces of the hip.
• Risk factors: intrauterine position (breech), oligohydraminos, hyperlaxity of ligaments (e.g. Ehler Danlos), underlying neuromuscular disorders, and left hip is affected more than the right.

Clinical Picture

• Neonate: asymptomatic, screened for by specific maneuvers (Barlow and Ortolani).
• The Barlow test: a "clunk" should be felt as the hip subluxates out of the acetabulum.
• The Ortolani test: a "clunk" is felt when the hip is reduced.
• Infant: shortening of the thigh, Galeazzi sign, and Klisic test.
• Walking child: limping, waddling gait, and leg-length discrepancy.

Investigation

• Hip U/S: best for high-risk infants, children with suspected hip instability, and monitoring after closed reduction.
• Hip X-ray: 4-6 months of age (once the proximal femoral epiphysis ossifies).
• CT and MRI: also used for investigation.

Complications

• Avascular necrosis of the femoral epiphysis.
• Redislocation.
• Hip joint stiffness.
• Postoperative complications: including wound infections.

Treatment

• Newborns and infants younger than 6 months: Pavlik harness.
• Older infants or children or failed previous maneuvers after 6 months of age: closed or open surgical reduction.

Knee

• Genu Valgum (Knock Knees): causes include hereditary (metaphyseal dysplasia), metabolic bone disease (vitamin D resistant rickets), genetic (Down syndrome), and idiopathic.
• Genu Varum (Bow Legged): causes include tibia vara, rickets, hypophosphatemic, nutritional, renal disease, skeletal dysplasias, and achondroplasia.

Arthrogryposis Multiplex

• Multiple joint contractures and fibrosis of skeletal muscle.
• Heterogeneous group of muscular, neurologic, and connective tissue anomalies.
• Presents with 2 or more joint contractures at birth and muscle weakness.

Upper Limb

Shoulder

• Brachial Plexus Birth Palsy.
• Congenital elevation of the scapula (mild, moderate, severe).

Hand

• Polydactyly: duplication of a digit, treated with ablation.
• Clinodactyly: angular deformity of the digit in the coronal plane, distal to the metacarpophalangeal joint.
• Camptodactyly: non-traumatic flexion contracture of the proximal interphalangeal joint, progressive.
• Nonsurgical treatment is the primary treatment for mild contractures of camptodactyly.

This quiz covers congenital anomalies of the upper and lower limbs, including developmental dysplasia of the hip joint and other conditions. It is suitable for students of paediatrics and orthopaedics. Associate Professor of Paediatrics, Dr. Shaimaa Sayed, provides an overview of these anomalies.