Genu Recurvatum

Hand Deformity Newborn

Figure 5.2. A close-up of the postural deformities involving the feet.

Figure 5.1. The infant in the following five figures was referred to hospital with a diagnosis of multiple congenital malformations. It should be noted that these "malformations" represent examples of congenital postural deformities. Note the position of the hands, lower extremities and the feet occurring as a result of this infant's position in utero.

Figure 5.2. A close-up of the postural deformities involving the feet.

Figure 5.3. This figure demonstrates the congenital postural scoliosis and pseudo "wrist-drop."

Figure 5.4. This figure of the same infant shows a skin dimple over the left hip. Skin dimples are not uncommon in association with deformations (postural deformities or "position-of-comfort" deformities).

Hip Dimples

Figure 5.5. The infant has been placed into her in utero position. This demonstrates clearly how the above changes occurred as a result of the infant's "position-of-com-fort" in utero. If placed in a normal position, infants with deformations will be uncomfortable and will cry, but will quiet down rapidly when allowed to return to their "position-of-comfort."

Figure 5.6. Abdominal pregnancy is associated with multiple congenital postural deformities as there is no cushion of amniotic fluid.

Figure 5.5. The infant has been placed into her in utero position. This demonstrates clearly how the above changes occurred as a result of the infant's "position-of-com-fort" in utero. If placed in a normal position, infants with deformations will be uncomfortable and will cry, but will quiet down rapidly when allowed to return to their "position-of-comfort."

Facial Deformities Birth Genu Recurvatum

Figure 5.7. Asymmetry of the face and head in an infant at birth due to a deformation.

Figure 5.8. The same infant demonstrating that this occurred as a result of the right upper extremity lying in apposition to the face and head on the right side in utero.

Figure 5.7. Asymmetry of the face and head in an infant at birth due to a deformation.

Newborn Cranial Deformation

Figure 5.9. This normal infant presented at birth widi a depression over its left temporal area. This occurred as a result of an in utero positional deformity.

Infant And Fetal Deformities

Figure 5.10. In the same infant as shown in Figure 5.9 the left temporal depression was due to pressure of the baby's left foot on the fetal skull in utero.

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Figure 5.10. In the same infant as shown in Figure 5.9 the left temporal depression was due to pressure of the baby's left foot on the fetal skull in utero.

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Figure 5.11. This very common finding of folding of the ear lobe occurs as a result of a postural deformity.

Figure 5.12. In this infant the same type of postural deformity is noted demonstrating that this occurs as a result of the shoulder pressing up against the ear lobe in utero. In general, over 90% of congenital postural deformities correct spontaneously.

Figure 5.12. In this infant the same type of postural deformity is noted demonstrating that this occurs as a result of the shoulder pressing up against the ear lobe in utero. In general, over 90% of congenital postural deformities correct spontaneously.

Congenital Ear Deformities

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Ear Lobe Deformity

Figure 5.13. In rare cases marked pressure of the shoulder on the fetal head in utero can result in a depression over the temporal area. Note the ear is pushed forward.

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Figure 5.14. The same infant in its "position-of-comfort" shows that the shoulder caused the depression and abnormal appearance of the ear.

Figure 5.13. In rare cases marked pressure of the shoulder on the fetal head in utero can result in a depression over the temporal area. Note the ear is pushed forward.

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Newborn Ear Folded Over

Figure 5.15. This infant with asymmetry of the jaw at birth was noted to have some abrasions on the neck. Skin abrasions can occur in relation to a postural deformity.

Facial Deformities Newborns

Figure 5.16. ihe same infant showing its "position-of-comfort" in utero.

Figure 5.17. There is marked asymmetry of the face in this infant. When the face and head are straightened, the infant is very uncomfortable and cries.

Figure 5.16. ihe same infant showing its "position-of-comfort" in utero.

Figure 5.18. The same infant quiets down immediately when allowed to go into its "position-of-comfort" in utero. This also demonstrates the reason for the asymmetry of the face.

Figure 5.17. There is marked asymmetry of the face in this infant. When the face and head are straightened, the infant is very uncomfortable and cries.

Facial Asymmetry Babies

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Symetry Face
Figure 5.20. Asymmetry of the face occurring as a result of a "position-of-comfort" deformity.

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Deformities Utero

Figure 5.21. The same infant shows that the asymmetry is due to its left foot being placed up against the side of the face and jaw. Another example of "position-of-com-fort" deformity.

Figure 5.22. Malocclusion of the jaw may occur if there is a marked and prolonged positional deformity. Infants with malocclusion should be followed as the malocclusion may require treatment at a later date.

Facial Deformities Newborns

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Figure 5.23. There is asymmetry of the nostrils in this infant. Note the vertical left nostril and horizontal right nostril. This can occur as a result of a postural deformity or dislocation of the nasal cartilage.

Nose Deformity Pictures

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Figure 5.24. The same infant shows that the asymmetry was associated with a postural deformity due to pressure of the right hand on the nose in utero. This invariably corrects spontaneously.

Genu Recurvatum

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Talipes Valgus Babies

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Figure 5.25. In this infant note the asymmetry of the nostrils and ecchymosis due to a dislocation of the triangular cartilage of the nasal septum, which may occur during delivery, especially if the mother has a prominent sacral promontory. When the septum is manually moved toward the midline the asymmetry persists confirming the dislocation. These infants require an otolaryngology evaluation.

Figure 5.26. Note the subcostal depression on either side of the xiphoid in an infant who was a breech presentation.

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Figure 5.27. This figure shows die same infant with bodi knees fitting well into die depressions. This is a fairly common example of a "position-of-comfort" deformity.

Retractions Respiratory Distress
Figure 5.28. Another example of a positional deformity on both sides of the subcostal area resulting from position in utero in a breech presentation. This should not be confused with subcostal retraction in this premature infant who had respiratory distress.

Figure 5.29. In this infant the chest appears to be narrow compared with the rest of the body.

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Figure 5.30. The same infant shows the arms lying along side the chest wall compressing the thorax. This is a fairly common postural deformity and should not be confused with a narrow thorax observed in cases of dwarfism.

Figure 5.29. In this infant the chest appears to be narrow compared with the rest of the body.

Infant Dwarfism

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Breech Presentation

Figure 5.32. In breech presentation there may be a marked concavity of the inner aspect of the thigh. The lower extremities in a frank breech may lie up against the fetal abdomen causing a "position-of-comfort" deformity.

Figure 5.31. In this infant it appeared that there was a left wrist-drop and the diagnosis of radial palsy was considered. However, with stimulation the left hand moved normally and the postural deformity resolved completely in a few days.

Figure 5.32. In breech presentation there may be a marked concavity of the inner aspect of the thigh. The lower extremities in a frank breech may lie up against the fetal abdomen causing a "position-of-comfort" deformity.

Figure 5.33. The same infant showing its "position-of-comfort." A similar concavity of the inner aspect of the thighs may occur in infants who have lack of movement in utero.

Figure 5.34. Radiograph of an otherwise normal infant with the uncommon finding of bilateral bowing of the femora occurring as a result of a "position-of-comfort" deformity. Bowing of one or both tibiae in which they curve gently toward the midline may have the soles of the feet face each other. Femoral bowing is rare but is occasionally present in babies born after prolonged breech presentation. Congenital bowing of the forearm and humerus almost never occur. These tend to improve gradually as with all deformations.

Newborn With Genu Recurvatum

Figure 5.35. Posterior view of an infant showing congenital postural scoliosis which occurred as a result of position in utero.

Figure 5.36. The same infant demonstrating the postural scoliosis. Postural scoliosis in the newborn is rare. If a true congenital scoliosis is present it is usually associated with a structural anomaly of the vertebral column.

Figure 5.35. Posterior view of an infant showing congenital postural scoliosis which occurred as a result of position in utero.

Scoliosis Newborn

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Genu Recurvatum

Figure 5.37. This infant has a fairly common congenital postural deformity - genu recurvatum. This "position-of-comfort" deformity gives the impression that there is a dislocation at the knees. Note the hyper-extensibility at the knees and note that the creases on the thighs which are normally seen posteriorly are anteriorly placed.

Figure 5.38. The same infant with genu recurvatum in its "position-of-comfort." When it occurs, genu recurvatum ("back knee") is almost invariably associated with breech presentations and the incidence is much more common in females. The majority correct spontaneously; in severe cases posterior splinting may be necessary.

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Congenital Genu Recurvatum

Figure 5.39. Another example of genu recurvatum in an infant with a neural tube defect. Note the bilateral clubfeet that are also considered to be postural deformities. Genu recurvatum may occur in neurologic disorders and in syndromes with generalized joint laxity and hypermobility, such as Ehlers-Danlos syndrome.

Figure 5.39. Another example of genu recurvatum in an infant with a neural tube defect. Note the bilateral clubfeet that are also considered to be postural deformities. Genu recurvatum may occur in neurologic disorders and in syndromes with generalized joint laxity and hypermobility, such as Ehlers-Danlos syndrome.

Figure 5.40. This infant has a congenital dislocation of the right knee. This uncommon finding has the same appearance as genu recurvatum. Congenital dislocations of the knee rarely occur as an isolated condition but may be seen in Larsen's syndrome, a condition in which there are multiple joint dislocations. It may be confirmed by radiography and requires treatment.

Figure 5.41. Another view of the congenital dislocation of the right knee in the same infant.

Figure 5.40. This infant has a congenital dislocation of the right knee. This uncommon finding has the same appearance as genu recurvatum. Congenital dislocations of the knee rarely occur as an isolated condition but may be seen in Larsen's syndrome, a condition in which there are multiple joint dislocations. It may be confirmed by radiography and requires treatment.

Joint Laxity Newborn

Figure 5.41. Another view of the congenital dislocation of the right knee in the same infant.

Tatarsus Adductus

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Figure 5.42. Metatarsus adductus (metatarsus varus) is a common postural deformity which requires no treatment. The forefoot is turned medially so that the lateral border of the sole is quite convex. The heel is in a neutral position and the foot can be dorsiflexed normally. If intrauterine constraint has been prolonged a deep plantar crease will be seen on the medial side.

Intrauterin Deformation

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Talipes Dorsiflexed

Figure 5.43. The position of the feet in utero in the same infant as shown in Figure 5.42 demonstrates how the midfoot becomes adducted.

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Figure 5.43. The position of the feet in utero in the same infant as shown in Figure 5.42 demonstrates how the midfoot becomes adducted.

Figure 5.44. Talipes calcaneoval-gus is die most common of the congenital postural deformities. The foot is dorsiflexed on the fibular side of die ankle and everted with the sole facing anterolaterally. As implied by the name, the calcaneus also is deviated laterally. A deep skin crease is often present in the plane of abnormal flexion and the subcutaneous tissue is diminished over the anterolateral region of the foot.

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Infants And Calcaneo Valgus

Figure 5.45. In this infant with talipes calcaneovalgus, note the marked dorsiflexion of the foot which is lying against the anterior part of the leg. Talipes calcaneo-valgus may occur as a result of abnormal intrauterine posture or may be associated with lower motor neuron defects such as spina bifida. Spontaneous correction usually occurs. This anomaly is more common in babies born in the breech position, especially if the knees were flexed in utero.

Figure 5.45. In this infant with talipes calcaneovalgus, note the marked dorsiflexion of the foot which is lying against the anterior part of the leg. Talipes calcaneo-valgus may occur as a result of abnormal intrauterine posture or may be associated with lower motor neuron defects such as spina bifida. Spontaneous correction usually occurs. This anomaly is more common in babies born in the breech position, especially if the knees were flexed in utero.

Figure 5.46. The same infant showing the flattening of the dorsum of the foot and marked concavity of the lateral side of the ankle joint.

Figure 5.47. An infant with severe talipes calcaneovalgus with marked bowing of the tibia and fibula. Osseous changes such as these are uncommon. This infant required surgical correction.

Figure 5.48. Radiograph of the same infant showing the marked bowing of the distal ends of the tibia and fibula.

Figure 5.47. An infant with severe talipes calcaneovalgus with marked bowing of the tibia and fibula. Osseous changes such as these are uncommon. This infant required surgical correction.

Infants Born Without Tibia And Fibula

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Neurologic Clubfeet

Figure 5.49. Bilateral clubfoot (talipes equinovarus). Talipes equinovarus causes the foot to be sharply plantar flexed and inverted so that the sole is toward the median plane. Note the "tip toe" position with the soles of the feet nearly facing each other. The calcaneus is in varus position and some degree of metatarsus adductus is almost always present. The skin and subcutaneous tissue over the lateral part of the joint may be thin and dorsi-flexion is minimal or absent.

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Club Feet Newborn Causes

Figure 5.50. Bilateral clubfoot. The occurrence of club feet has been considered to be the result of a congenital malformation or a postural deformity. If the legs and feet are subjected to mechanical stress during the last weeks in utero, especially if the fetus is in the breech position, a clubfoot may develop. If the constraint has been relatively mild or brief, the deformity is usually flexible in that the foot can be manipulated into normal position. A fixed deformity implies either severe, prolonged immobilization with contractures of the ligaments and capsules of the joints or an intrinsic skeletal anomaly. This type is resistant to conservative treatment, and casting or surgery is the treatment of choice.

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Figure 5.51. The same infant with the feet in their "position-of-comfort." Note the dimples at the ankles suggesting that this occurred as a result of a postural deformity. Some authors have suggested that the presence of dimples at die ankles in an infant with clubbing of the feet indicates that it has occurred as a result of a postural deformity.

Figure 5.52. Congenital curly toes (overlapping toes) are a common finding in newborn infants. There is often a family history of the same finding in parents or siblings. Treatment is not necessary.

Figure 5.53. Another infant with congenital curly toes. The abnormality becomes less obvious as the infant grows.

Figure 5.54. Twins with asymmetrical heads occurring as a result of an in utero positional deformity. Both infants were vertex presentations. Note how the heads "fit" together.

Figure 5.54. Twins with asymmetrical heads occurring as a result of an in utero positional deformity. Both infants were vertex presentations. Note how the heads "fit" together.

Curly Toe Deformity

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Congenital Curly Toes
Figure 5.55. The same infants as shown in Figure 5.54 with their heads together (in utero position). As the infants grew the asymmetry improved.
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Responses

  • genet medhane
    How genun recurvatum is treated in newborns?
    2 years ago
  • JONNA
    Where do they cut with 5th metatarsal scarf osteotomy?
    11 months ago

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