MSK Birth Injuries Dr. Ayman Awlia 2023.pdf

Orthopedic Birth Injuries
Muscoloskeletal Injuries

1. Birth Injuries
Dr. Ayman Awlia, MBBS, FRCSC
Assistant Professor of Orthopedic Surgery
University of Jeddah

2. •An impairment of the infants
body function or structure due to
adverse influences that occur at
birth
•Injuries to the infant may result
from mechanical forces (i.e.,
compression, traction) during the
birth process
Birth Injuries

3. •0.7% (Seven of every 1,000) births
result in birth injuries.
• Birth injuries account for fewer than
2% of neonatal deaths
Birth Injuries

4. •Primiparity
•Prolonged or unusually rapid labor
•Oligohydramnios
•Malpresentation of the fetus (breech)
•Cephalopelvic disproportion

Factors predisposing to injury
include the following

5. •Use of forceps or vaccum
extraction
•Very low birth weight or extreme
prematurity
•Fetal macrosomia birth weight over
about 4,000 grams
•Fetal macrocephali (Large head)
•Fetus anomalies
Factors predisposing to injury
include the following

6. •Soft tissue injuries
•Head and neck injuries
•Facial injuries
•Cranial nerve injuries
•Spinal cord injuries
•Peripheral Nerve injury
•Fractures - Torticollis
•Intra-abdominal injury
CLASSIFICATION OF BIRTH
INJURIES

7. PERIPHERAL NERVE INJURIES

8. Brachial plexus injury
•Erb-Duchenne palsy
(C5-C6) common
• Klumpke palsy
(C 7-8, T1) rare
Horner syndrome (T1
Sympathatic)
• Total plexus palsy
(Kerer’s paralysis) worst

9. Brachial plexus injury

10. Risk factors
Macrosomia
Shoulder dystocia
Instrumented deliveries
Malpresentation
Brachial plexus injury

11. Brachial plexus injury
•Erb-Duchenne palsy (C5-C6)
•The most common
•Lack of shoulder motion.
•The involved extremity lies adducted, prone,
and internally rotated.
•Moro, biceps, and radial reflexes are absent
on the affected side.
•Grasp reflex is usually present.
•Erb’s palsy may be associated with injury to
the phrenic nerve, innervated with
fibers from C3–C5

12. - The left arm is not flexed and hangs
limply. Adduction and internal rotation
of the arm with pronation of the
forearm.
•Biceps reflex is absent
•Moro reflex is absent
•Grasp reflex is present
•The involved arm is held in the ‘‘waiter’s
tip’’ position, with adduction and internal
rotation of the shoulder, extension of the
elbow, pronation of the forearm, and
flexion of the wrist and fingers.
- The baby demonstrates the findings of a
left-sided ERB PARALYSIS.

13. Brachial plexus injury
•Klumpke paralysis (C8-T1)
Rare
Weakness of the intrinsic muscles of the
hand; and long flexors of the wrist and
fingers (clawing not writing)
Grasp reflex is absent
Biceps reflex is present
•If cervical sympathetic fibers of the Th 1
are involved, Horner syndrome is
present (ptosis, miosis, and anhydrosis).
•Hematomas of the sternocleidomastoid
muscle, and fractures of the clavicle and
humerus.

14. • The total plexus palsy (Kerer’s
paralysis)
is the most disturbing
✓weakness
✓muscle hypotonia
✓Worst prognosis
Brachial plexus injury

15. •Physical examination.
•Radiographs of the shoulder and upper arm
•Initial treatment is conservative.
•The arm is immobilized during the first week
•Physical therapy with passive range-of-motion exercises at the
shoulder, elbow and wrist should begin after the first week.
•Infants without recovery of biceps muslce by 3 to 6
months of age may be considered for surgical
exploration and nerve grafting.
Brachial plexus injury
Diagnosis & Management

16. -Clavicular fractures
-Fractures of long bones
-Sternocleido-mastoid injury
MUSCULOSKELETAL
INJURIES

17. The clavicle & long bone
fracture
Clavicle
-most frequently bone fractured in the
neonate
-The infant may present with
pseudoparalysis.
-Examination may reveal crepitus,
palpable bony irregularity, and
sternocleidomastoid muscle spasm.
-"Arm Sling Immoblization”: should be
used for 7- 10 days.

18. Sternocleido-mastoid injury
Congenital muscular torticollis
•tearing of the muscle fibers
or fascial sheath with
hematoma formation and
subsequent fibrosis.
•The head is tilted toward the
side of the lesion and rotated to
the contralateral side,
•chin is slightly elevated.
•If a mass is present, it is firm,
spindle-shaped, immobile, and
located in the midportion of the
sternocleidomastoid muscle,
without accompanying
discoloration or inflammation.

19. Sternocleido-mastoid injury
Congenital muscular torticollis
•DIAGNOSIS
•physical examination
•Radiographs should be
obtained to rule out
abnormalities of the
cervical spine.
•Ultrasonography may be
useful both diagnostically
and prognostically.
•TREATMENT
•active and passive
stretching
•Surgery: if failed
response to at least 1 year of
stretching