Abstract
Purpose: To evaluate the real effectiveness of orthopaedic prenatal diagnosis.
Introduction: Sonographic early detection of fetal club foot, spine abnormalities like “spina bifida” or spondylocostal ‘” dysostosis, limb discrepancy have been often reported in prenatal orthopaedic diagnosis. But in all these cases the role of the orthopaedic surgeon is secondary: In the case reported the joined evaluation of obstetrician and orthopaedic surgeon was able to anticipate delivery, avoid a severe and constrictive amniotic band on the lover limb which might cause an amputation of the ankle and foot.
Material and methods: At 25th week of pregnancy a morphologic sonographic examination was carried out in a Caucasian healthy woman. It demonstrated an healthy male fetus presenting a constrictive amniotic band on the distal right leg causing a mild oedema of the foot. Four weeks later the oedema of ankle and feet was dramatically increased and on the distal tibia an initial notch on the cortex was observed. The risk of self-amputation in utero was high, so a decision to bring forward delivery was made by a obstetrician, and paediatrician orthopaedic surgeon. In the last two weeks of uterine life the fetus was treated to obtain a satisfactory lung maturity and at 32nd week a caesarean delivery was carried out. The baby, normal, (agar score 7–9, 2750 kg.) presented a tremendous oedema of the dorsal foot causing a complete disappearance of normal shape. The skin constriction was detected on the distal leg deeply extended to the bone. An X -ray early performed showed a lesion of the anterior margin of the tibia. A Sonographic Doppler of the distal leg was able to demonstrate vascular normality so at the age of two days the baby was admitted to the plastic and reconstructive surgery for the release of the amniotic band and for reductive surgery of foot’s redundant tissue. The follow-up was good with a temporary oedema post-surgery. In 60 days the appearance of the foot was satisfactory normal.
Discussion: The ultrasonographic prenatal diagnosis of an amniotic band in the reported case probably has been able to avoid an amputation of the distal lower limb. The aim of this communication is to stress the role of the prenatal diagnosis in paediatric orthopaedic to emphasize the importance of early detection of congenital skeletal abnormalities. Severe and stiff club-foot, congenital “genu recurvatum” and amniotic band as. well, ought to be treated as soon as possible. Therefore, when diagnosed in selected pregnancies, if the fetus is healthy and the lung maturity is obtained with corticosteroIds and sulfactante factor sommmlstratlon, we advise a premature delivery never before 32nd week of intrauterine life. At this stage the deformities are less stiff and every treatment (manipulation, bandage, casting) offers better results and less risk.
Local Host: British Society for Children’s Orthopaedic Surgery. Conference Theme: Congenital Deficiencies of the Lower Limb. These abstracts were prepared by A.Catterall.
