Knee Dislocation in the Delivery Room
T
he on-call neonatologist was called to the delivery room to attend a full term baby girl with an unusual position of her right lower limb. The baby was born by normal cephalic delivery in good condition. Antenatal scans were normal and the pregnancy was uneventful. The physical examination showed that her right leg was hyperextended to 30 (Figure). The active movement of the leg was conserved and the knee could be passively reduced to a maximum flexion of 90 . The radiograph taken immediately after confirmed the knee reduction and did not show any skeletal abnormality. Further assessment revealed a bilateral dislocatable hip, confirmed with ultrasound, but the rest of her systemic examination was normal.
Taking into account the reducibility of the hip and the knee, a conservative management with serial castings and a Pavlik harness was chosen. Congenital dislocation of the knee is a rare congenital anomaly that is characterized by the hyperextension of the knee with forward displacement of the proximal tibia on the femoral condyles.1 When diagnosed, it is important to rule out any associated orthopedic abnormalities such as developmental dysplasia of the hip and clubfoot. It can also be found in association with Larsen syndrome and arthrogryposis. Etiologic factors can be described as being extrinsic, due to abnormal intrauterine pressures and leading to intrauterine malposition; or intrinsic, due to genetic abnormalities and neuromuscular imbalance. Conservative management with serial castings and/or Pavlik harness is the treatment of choice,2,3 but in case of failure, open surgery is needed. The prognosis depends on the range of movement at the joint and the presence or not of an associated syndrome. The long-term outlook is generally good with conservative management. n Marıa Jose de Castro L opez, MD Department of Pediatrics
Alicia Iglesias Deus, MD Adriana Rodriguez Vidal, MD Olalla L opez Suarez, MD Alejandro Perez Mu~ nuzuri, MD, PhD Maria Luz Couce Pico, MD, PhD Maternity and Neonatal Unit Department of Pediatrics Hospital Clınico Universitario de Santiago de Compostela Santiago de Compostela, Galicia, Spain
References
Figure. Congenital dislocation of the knee, right side.
1. Ko JY, Shih CH, Wenger DR. Congenital dislocation of the knee. J Pediatr Orthop 1999;19:252-9. 2. Abdelaziz TH, Samir S. Congenital dislocation of the knee: a protocol for management based on degree of knee flexion. J Child Orthop 2011;5:143-9. 3. Shah NR, Limpaphayom N, Dobbs MB. A minimally invasive treatment protocol for the congenital dislocation of the knee. J Pediatr Orthop 2009;29:720-5.
J Pediatr 2014;-:-. 0022-3476/$ - see front matter. Copyright ª 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpeds.2014.05.035
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T
he on-call neonatologist was called to the delivery room to attend a full term baby girl with an unusual position of her right lower limb. The baby was born by normal cephalic delivery in good condition. Antenatal scans were normal and the pregnancy was uneventful. The physical examination showed that her right leg was hyperextended to 30 (Figure). The active movement of the leg was conserved and the knee could be passively reduced to a maximum flexion of 90 . The radiograph taken immediately after confirmed the knee reduction and did not show any skeletal abnormality. Further assessment revealed a bilateral dislocatable hip, confirmed with ultrasound, but the rest of her systemic examination was normal.
Taking into account the reducibility of the hip and the knee, a conservative management with serial castings and a Pavlik harness was chosen. Congenital dislocation of the knee is a rare congenital anomaly that is characterized by the hyperextension of the knee with forward displacement of the proximal tibia on the femoral condyles.1 When diagnosed, it is important to rule out any associated orthopedic abnormalities such as developmental dysplasia of the hip and clubfoot. It can also be found in association with Larsen syndrome and arthrogryposis. Etiologic factors can be described as being extrinsic, due to abnormal intrauterine pressures and leading to intrauterine malposition; or intrinsic, due to genetic abnormalities and neuromuscular imbalance. Conservative management with serial castings and/or Pavlik harness is the treatment of choice,2,3 but in case of failure, open surgery is needed. The prognosis depends on the range of movement at the joint and the presence or not of an associated syndrome. The long-term outlook is generally good with conservative management. n Marıa Jose de Castro L opez, MD Department of Pediatrics
Alicia Iglesias Deus, MD Adriana Rodriguez Vidal, MD Olalla L opez Suarez, MD Alejandro Perez Mu~ nuzuri, MD, PhD Maria Luz Couce Pico, MD, PhD Maternity and Neonatal Unit Department of Pediatrics Hospital Clınico Universitario de Santiago de Compostela Santiago de Compostela, Galicia, Spain
References
Figure. Congenital dislocation of the knee, right side.
1. Ko JY, Shih CH, Wenger DR. Congenital dislocation of the knee. J Pediatr Orthop 1999;19:252-9. 2. Abdelaziz TH, Samir S. Congenital dislocation of the knee: a protocol for management based on degree of knee flexion. J Child Orthop 2011;5:143-9. 3. Shah NR, Limpaphayom N, Dobbs MB. A minimally invasive treatment protocol for the congenital dislocation of the knee. J Pediatr Orthop 2009;29:720-5.
J Pediatr 2014;-:-. 0022-3476/$ - see front matter. Copyright ª 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpeds.2014.05.035
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