Dépistage des affections orthopédiques à la naissance

Abstract

Orthopaedic diseases are disorders currently encountered by paediatricians: the necessity of early diagnosis and rapid therapeutic management by an orthopaedist are well established now. Some of these orthopaedic disorders are evident at birth, but some others remain non-evident and even hidden, which underlines the importance of a screening by complete orthopaedic examination. However, only a single examination at birth may be insufficient, and the necessity of repeated clinical examinations during the whole first year of life and up to the age of walking should be emphasized. Progressively, the orthopaedic emergency in the newborn has become a current concept due to the associated risk of severe impairment or complete loss of a musculo-skeletal function. Two distinct situations are identified: 1) the presence of a limb disability attributable either to an obstetrical trauma (bony or nervous) when observed at birth, or to an osteoarticular infection when delayed, or to a iatrogenic palsy; 2) the finding of a congenital malformation which must be distinguished from a congenital deformity since both the prognosis and the treatment are completely different. Indeed, real malformations occur during the embryonic period due to an organogenetic disorder, and since their treatment is not urgent and only palliative, it is delayed most of the time. On the contrary, congenital deformities occur during the foetal life due to the alteration of the shape and structure of an organ free of any malformation. They are sometimes secondary to a congenital neuromuscular affection (myelomeningocele, arthrogryposis, myopathy…), but most of the time the intrauterine positional aetiological factor is preponderant (hip dislocation, genu recurvatum, foot deformation). They are extremely frequent and urgent treatment is mandatory since most of them are reversible by adequate therapy, either partially or totally.