KEY POINTS Lung hypoplasia implies an abnormal reduction in the weight and/or volume of the lung without the absence of any of its lobes. Decreased lung weight and volume can result from fewer bronchial branches, reduced numbers of alveoli, decreased alveolar size, or any combination of these phenomena. Thoracic insufficiency syndrome is the inability of the thorax to support normal respiration or lung growth, and this…

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KEY POINTS Eventration of the diaphragm is defined as abnormal elevation of the diaphragm, which can originate from a congenital defect or be acquired. Acquired eventration caused by injury to the phrenic nerve with resultant paralysis and elevation of the entire diaphragm can be secondary to an injury sustained during cardiothoracic surgery, or due to birth trauma. Brachial plexus palsy is the most common comorbidity with…

KEY POINTS The frequency of brachial plexus palsy has been decreasing with improved obstetric management. Lesions that affect the upper segments (C5–C7) result in Erb palsy, whereas lesions that affect the lower spinal segments (C7–T1) result in Klumpke palsy. Traction to the plexus, especially the upper plexus, occurs during delivery when the angle between the neck and shoulder is suddenly and forcibly increased, with the arms…

KEY POINTS Traumatic facial nerve palsy has been associated with birth weight greater than 3500 g, forceps-assisted deliveries, and prematurity. When facial nerve paralysis is of developmental origin, it may be part of a broader pattern of altered morphogenesis. Facial paralysis with associated distal limb deficiency has been seen after early chorion villus sampling, failed dilation and curettage, maternal use of either thalidomide or misoprostol after…

KEY POINTS Dislocation of the radial head is the most common congenital anomaly of the elbow. The direction of bowing of the ulna depends on the type of dislocation of the radial head, and if an abnormal position is initiated by one of the bones of the forearm, the other bone will bend accordingly as it grows. Most patients are asymptomatic and treated with observation and…

KEY POINTS Hyperextension of the leg with dislocation at the knee may result from the legs being in an extended posture with breech presentation, oligohydramnios, or other unusual late gestational constraint, and it can also occur in various genetic connective tissue disorders. If the tibia is displaced anterior to the long axis of the femur, the knee is considered dislocated , but if longitudinal contact is…

KEY POINTS Certain risk factors warrant close surveillance for congenital hip dislocation: positive family history, breech presentation, firstborn children, female gender, accompanying postural deformations, and certain postnatal positioning. All gradations of dislocation, from a partially stretched, dislocatable hip to a fully dislocated hip, occur with an overall frequency of about 1%–3%. In newborns, positive Ortolani and Barlow tests continue to be effective clinical screening tests for…

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KEY POINTS Excessive femoral anteversion results from medial rotation of the femur after birth. Surgery consisting of femoral derotation osteotomy is usually only contemplated in children older than 8 years with insufficient spontaneous correction, particularly children with diplegic cerebral palsy. Excessive femoral anteversion usually presents as a cause of in-toeing at 3 to 4 years of age, increases in magnitude through 5 to 6 years of…

KEY POINTS Rotational abnormalities of the lower extremities (in-toeing and out-toeing) are common in young children, and abnormal rotation is termed torsion . In-toeing is caused by one of three types of deformities: metatarsus adductus (during the first year), internal tibial torsion (in toddlers), and increased femoral anteversion (in early childhood). Tibial torsion is especially likely with fetal constraint of the legs in a folded and…

KEY POINTS Flexible flatfoot is common in children and influenced by age, weight, and gender. This deformity usually becomes evident with weight bearing and is often caused by ligamentous laxity and strongly associated with genetic connective tissue disorders. Treatment of flexible flatfeet is controversial as to whether corrective shoes or orthotics provide demonstrable benefit. Rigid pediatric pes planovalgus can be caused by congenital vertical talus, tarsal…

KEY POINTS Constraint of the feet while the legs are in a flexed and folded position can result in medial overlapping of the toes, especially the fifth, fourth, and third toes. Congenital curly toes are relatively common, asymptomatic soft tissue abnormalities of the lateral toes. GENESIS Constraint of the feet while the legs are in a flexed and folded position can result in medial overlapping of…

KEY POINTS Over the past 25 years there has been a dramatic shift away from extensive surgical releases to manipulative methods with serial casting. The term idiopathic talipes equinovarus is used to describe the most common type of isolated clubfoot that is not part of a syndrome. Structural talipes equinovarus can be either isolated or syndromic (termed complex when there are associated malformations). The forefoot is…

KEY POINTS Metatarsus adductus is the most common pediatric foot deformation related to intrauterine constraint. The feet turn inward, but the ankle and heel are generally in normal position with a flexible heel cord. In mild and flexible cases, manipulative stretching of the tight medial soft tissues and avoidance of sleeping postures that tend to augment the deformity may be all that are required. When metatarsus…

KEY POINTS Calcaneovalgus deformation is usually the result of extrinsic deformation. The foot is usually quite flexible and should return to normal without intervention. If not resolved after several months, consider the use of external splints. GENESIS Calcaneovalgus deformation has a reported frequency of 1.1 per 1000 live births, although some authors indicate that more than 30% of newborns have calcaneovalgus deformity of both feet. It…

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KEY POINTS This text is primarily concerned with extrinsic deformations produced by unusual or excessive constraint of an otherwise normal fetus. Individual deformations in this book are presented in an atlas format along with deformation sequences. Deformations are structural defects that represent a normal response of a tissue to an external mechanical force. Deformations are usually attributed to intrauterine molding and termed positional defects . The…