Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Knee Dislocation (Genu Recurvatum)

Genesis 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 caused by uterine myomas or structural defects. It can also occur in various genetic connective tissue disorders, such as Ehlers-Danlos syndrome, megalencephaly-capillary malformation (MCAP) syndrome, atelosteogenesis types 1 and 3, Larsen syndrome, or (occasionally) arthrogryposis. Dislocation…

Developmental Dysplasia of the Hip (Congenital Dislocation of the Hip)

Genesis The definition of developmental dysplasia of the hip (DDH), formerly termed congenital dislocation of the hip (CDH), remains complex and controversial, making precise determination of incidence figures difficult. Figure 10-2 depicts some of the interacting factors that relate to the genesis of DDH. When hip dislocation develops as a consequence of genetic connective tissue dysplasia, it may not become evident until after birth. Under such…

Femoral Anteversion

Genesis Femoral rotation describes the normal twist present in the femur, and excessive femoral anteversion results from medial rotation of the femur after birth. Normal rotation in direction and magnitude is termed version , with normal values determined according to age. Abnormal rotation is termed torsion , and the rotation of a given bone is determined by the angle between the axis of the head and…

Tibial Torsion

Genesis Rotation refers to the twist of the tibia along its long axis. Normal rotation in direction and magnitude is termed version , and normal values are determined according to age. Abnormal rotation is termed torsion , and the degree of rotation is determined by the angle between the transmalleolar axis at the ankle and the bicondylar axis of the proximal tibia at the knee. Rotational…

Flexible Flatfoot

Genesis 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; hence it is strongly associated with genetic connective tissue disorders such as Marfan syndrome and Ehlers-Danlos syndrome. When flexible flatfeet are part of such a broader pattern of connective tissue dysplasia, there is usually hyperextension of fingers,…

Talipes Equinovarus (Clubfoot)

Genesis Talipes equinovarus (clubfoot) is often a serious foot defect, but predicting severity and response to treatment in the newborn has been notoriously difficult. Over the past 25 years, there has been a dramatic shift away from extensive surgical releases to manipulative methods with serial casting (primarily the Ponseti method), in which a series of manipulations and weekly casts is used to bring the foot into…

Metatarsus Adductus (Metatarsus Varus)

Genesis Compression of the forefoot with the legs flexed across the lower body in late gestation is a frequent cause of metatarsus adductus (also known as metatarsus varus ), which occurs in about 1.2 per 1000 live births and has an 80% predilection for males. Metatarsus adductus is associated with congenital hip dislocation in 5% to 10% of infants, further implicating fetal constraint as an important…

Calcaneovalgus (Pes Planus)

Genesis Sometimes called “flexible flatfoot,” calcaneovalgus 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 is usually the result of uterine constraint having forced the foot into a dorsiflexed position against the lower leg and is especially common after prolonged breech position with extended legs. Associated congenital hip…

Clinical Approach to Deformation Problems: Malformations, Deformations, Disruptions, and Dysplasias

Mechanical forces play an important role in both normal and abnormal morphogenesis. Anomalies that represent the normal response of a tissue to unusual mechanical forces are termed deformations , in contrast to malformations , which denote a primary problem in the morphogenesis of a tissue, and disruptions , which represent the breakdown of previously normal tissues. A fourth category of problems, termed dysplasias , results in…

Pregnancies in Challenging Locations

Learning objectives List key specialties to include in interdisciplinary planning of complex surgical cases. Describe clinical and sonographic findings of abdominal pregnancy. Describe sonographic findings of cesarean scar pregnancy. Develop interdisciplinary plan for management of complex surgical cases. There are times when a pregnancy implants in abnormal locations and develops to an advanced gestational age. Under certain circumstances, these pregnancies can result in delivery of a…

Trauma in Pregnancy

Learning objectives Describe the basic principles of trauma management in pregnancy. Demonstrate how to triage trauma patients to guide management. List signs of trauma-related placental abruption. Trauma in pregnancy is the main cause of maternal death due to nonobstetrical etiologies. Trauma-associated placental abruption is a major contributor to perinatal death. Common Causes of Trauma in Pregnancy Domestic violence Motor vehicle crashes Falls Homicide Suicide Obstetrical Complications…

Autonomic Dysreflexia

Learning Objectives Describe the pathophysiology of autonomic dysreflexia. Recognize signs and symptoms of autonomic dysreflexia. Describe prevention and treatment of autonomic dysreflexia in labor. Pathophysiology Occurs in 85% of women with spinal cord injury at level of T6 or above When the woman experiences a painful stimulus below the level of the spinal injury (such as from contractions or even a full bladder), she may not…

Myasthenia Gravis

Learning Objectives Describe the pathophysiology of myasthenia gravis. Identify pregnancy-related risks of myasthenia gravis. Describe management of a myasthenic crisis. Pathophysiology Autoimmune disease resulting from antibodies against the acetylcholine receptor or muscle-specific kinase When antibodies bind to acetylcholine receptor, it blocks muscle contraction and results in weakness of skeletal muscles Antibodies frequently result from the presence of a thymoma Signs and Symptoms Fatigable, painless muscle weakness…

Amniotic Fluid Embolism

Learning Objectives Describe the pathophysiology of amniotic fluid embolism. List risk factors for amniotic fluid embolism. Identify clinical presentation of amniotic fluid embolism. Describe a management strategy for amniotic fluid embolism. Amniotic fluid embolism is a fortunately rare obstetric emergency. However, if mothers are to survive this catastrophic event, clinicians must recognize it quickly and manage it very aggressively. Pathophysiology Amniotic fluid embolism occurs when there…

Pheochromocytoma in Pregnancy

Learning Objectives Describe the clinical presentation of pheochromocytoma in pregnancy. Discuss appropriate management of pheochromocytoma in pregnancy. Pheochromocytoma is a catecholamine-secreting tumor that arises from chromaffin cells of the adrenal medulla or the sympathetic ganglia. Clinical Presentation Symptoms ( Fig. 24.1 ): Severe hypertension—often difficult to control. Patient may have paradoxical supine hypertension with normal blood pressure in the sitting or erect position. This is because the gravid uterus can compress the…