Neonatal Orthopaedics N De Mazumder
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Second Edition
N De Mazumder MBBS MS Ex-Professor and Head Department of Orthopaedics Ramakrishna Mission Seva Pratishthan Vivekananda Institute of Medical Sciences Kolkata, West Bengal, India Visiting Surgeon Department of Orthopaedics Chittaranjan Sishu Sadan Kolkata, West Bengal, India Ex-President West Bengal Orthopaedic Association (A Chapter of Indian Orthopaedic Association) Kolkata, West Bengal, India Consultant Orthopaedic Surgeon Park Children's Centre Kolkata, West Bengal, India Foreword AK Das
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Neonatal Orthopaedics
First Edition: 2003
Second Edition:2013
Printed at
There has been a phenomenal breakthrough in the diagnosis and management of orthopaedic maladies in the last 50 years. This is partly because of introduction of newer alloys and different plastics in the construction of implants and orthosis, production of newer antibiotics, better understanding of biomechanics of bones and joints in the health and disease, and introduction of more efficient imaging techniques. Newer technology has advanced our horizon of knowledge, particularly, the advancement of information technology. Better methods of management of trauma with image intensifiers and better implants for fracture fixation, availability of various joint implants, advances in management of spinal injuries and deformities have vastly increased our capability to treat complicated abnormalities with much better functional results. Arthoscopic techniques have vastly improved the diagnosis of joint injuries and diseases with a minimum damage to joint structures and much early restoration of normal function.
As a result of these advances, it has become increasingly difficult for any individual surgeon to become expert in all the different techniques of surgery. Consequently, a number of subspecialties have emerged, e.g. Joint Replacement Surgery, Spinal Surgery, Arthroscopic Surgery, Paediatric Orthopaedics, Trauma Surgery and so on.
One of the subspecialties, which is getting popular, is paediatric orthopaedics. This deals with the diagnosis and management of diseases and injuries of bones, joints, muscles and nerves in children whose disease manifestations and management are quite different from adults. Neonatal orthopaedics is an offshoot of this specialty, which deals with the orthopaedic problems in neonates. Congenital deformities and abnormalities of muscles, bones and joints need to be diagnosed immediately or soon after birth in order to start treatment as early as possible. These need special awareness and expertise. Infections of bones and joints in the neonates pose special problems in diagnosis and management. Early effective treatment restores a normal anatomy and functions. Immediate correction of congenital deformities gives better correction before the structures get more rigid. This is comparatively a newer branch of orthopaedics, which is drawing the attention of some paediatric orthopaedicians. In our country, though paediatric orthopaedics is an established specialty, not many surgeons are yet interested to devote their attention to neonatal orthopaedic problems.
It is very encouraging that an experienced orthopaedic surgeon like Dr N De Mazumder has become interested in this new subspecialty and has written a book on this subject highlighting the special problems in orthopaedic affections in neonates. He had been the Professor and Head of orthopaedic service of a large hospital, such as Ramakrishna Mission Seva Pratishthan, Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India, which has also a large Obstetric Department. Consequently, he had the opportunity to study neonates also. He has written very lucidly with excellent diagrams covering the different aspects of this new specialty. I am sure that the book will be of great interest to orthopaedic surgeons, paediatric orthopaedic specialists as well as paediatricians.
AK Das
Department of Orthopaedics
Nil Ratan Sircar Medical College and Hospital
Kolkata, West Bengal, India
Ex-Emeritus Professor
BC Roy Polio Clinic and Hospital for Crippled Children
Kolkata, West Bengal, India
West Bengal Orthopaedic Association (A Chapter of Indian Orthopaedic Association)fm6
Kolkata, West Bengal, India
Preface to the Second Edition
fm7Nine years from now, this book Neonatal Orthopaedics was published as a venture to bring in a new subject with descriptions of orthopaedic conditions in the neonatal period. Presently, the revised edition is being published. The first edition of this book published by M/s Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, India, has been reviewed by Indian Journal of Orthopaedics in the April 2003 issue of the journal; a few lines are being coined here from Dr Ashok Kumar's review. This book is timely and has fulfilled a need of having a single source of information on neonatal orthopaedic problems and will serve as an important reference for the practicing orthopaedicians as well as the paediatricians. There is a wealth of information contained in this book. Overall, this book makes an interesting reading and will be a valuable addition to any medical library and is strongly recommended for postgraduate students, orthopaedicians, neonatologists and paediatricians.
The research, in the field of neonatal orthopaedics, has yet to get a momentum as many of the neonatal orthopaedic conditions have not been explored even today. Newer antenatal and natal diagnostic facilities are evolving with time. An effort is made to describe the diagnostic points to achieve a neonatal diagnosis. As written in the preface of the first edition, the details of surgical technique of the operations necessary for the correction of the neonatal deformities were avoided as the operations described were mostly undertaken long after the neonatal period.
All the 45 chapters with addition of keywords with each chapter, have been reviewed thoroughly with some illustrations added to bring out an effect of clarity of the conditions described. I am indebted to Professor Niloy Kanti Das for providing me with some clinical photographs. As this book has fulfilled to some extent, the need of postgraduate students, I have purposely kept it in an abridged form without much elaboration. The book Essentials of Paediatric Orthopaedics edited by me and published by M/s Jaypee Brothers Medical Publishers in 2007 has covered the paediatric orthopaedic conditions in a greater detail with an eye to present the readers, a comprehensive discussion on the subject. In the two books Neonatal Orthopaedics and Essentials of Paediatric Orthopaedics, I have tried to bring in the management of paediatric orthopaedic disorders from their onset in utero to the fully grown condition. My sincere thanks go to the M/s Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, India.fm8
N De Mazumder
Preface to the First Edition
fm9The orthopaedic problems of the infants in their early days fascinate me for a long time. An involvement in orthopaedic practice, especially in paediatric orthopaedics, for more than three decades has led me to think about an early diagnosis of the orthopaedic conditions in the neonatal period, i.e. within 4 weeks of birth; which gives the opportunity for proper management of the condition and a better prognosis. The paediatric involvement stimulated me to study the orthopaedic conditions in the neonatal period in a greater detail.
Deviation from the normal growth of a baby in the mother's womb is considered as a defect or a disease. As the subject embryology deals with the anatomical study of the growth of the fetus, it needs proper study for an effective care of the newborn. Mention of embryology and growth of the fetal limbs is found in the Charaka Samhita—the famous ancient treatise in the Ayurveda. The care of the newborn is a well-known practice from the ancient times and has been outlined by Soranus (98-138 AD) of Ephesus. Weakness at birth was attributed to prematurity or an inheritance from infirm parents. A fetus, comfortable in the warm ambience of the mother's womb needs proper neonatal care of maintenance of body temperature and nutrition for the growth of the baby. The high rate of infant mortality in yesteryears was because of improper infant care after birth and from prematurity with its inevitability of suffering of the baby from a serious illness. The decline in the rate of infant mortality is an outcome of fervid elaboration of the subject neonatal medicine with an improvement in the care of the prematures and also of a normal baby.
The book deals with the orthopaedic conditions in the neonatal period. An effort is made to describe the diagnostic points to achieve a neonatal diagnosis. Many of the congenital orthopaedic conditions need their management to be started in the neonatal period to achieve better results. The misconception of starting the treatment of many congenital conditions after two or three years of age, when the limbs of the baby grow bigger, prevails today. It will not be an overstatement if I say, proper management of orthopaedic conditions in the neonatal period prevents secondary changes in the bones of the deformed parts. The management becomes easier with the use of splint or brace after birth, which is recommended in the book. The details of surgical technique of the operations necessary for the correction of the neonatal deformities are purposely avoided in this monograph, as they are mostly undertaken long after the neonatal period.
The book, with a new approach without much elaboration, may arouse interest of the general orthopaedic surgeons who treat children, neonatologists, paediatricians and the paediatric orthopaedic surgeons. I have tried to cover as many neonatal orthopaedic conditions as possible. I would like to apologize to the readers for any inadvertent omission.
I am grateful to Mr Shambhu N Pal, Librarian and Head, Sudhira Memorial Library, Chittaranjan National Cancer Institute, Kolkata, West Bengal, India, for his meticulous care and help extended during preparation for publication of the book. To M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, my sincere thanks go for publishing the book and to Dr Prasanta Pujari, Mrs Gouri Sen and Mr Biswanath Mukherjee, for the photographs of the book, I owe my special thanks. My sincere thanks are due to the Secretary, the Dean, my colleagues in the Department of Orthopaedics, to name specially Dr Tapas Chakraborty and Dr Chandrachur Bhattacharya, the Department of Paediatrics, the Department of Genetics, the Department of Radiology and other participating departments of the Ramakrishna fm10Mission Seva Pratishthan, Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India, where I carried out major part of this work during my tenure of service of long 35 years.
I sincerely acknowledge the active participation and help of the sisters, splint-makers and other staff of the Department of Orthopaedics for the successful completion of the work.
I am indebted to Professor AK Das, the pioneer in paediatric orthopaedics in Eastern India, who took particular care to go through the manuscript and enriched me with a Foreword.
I gratefully acknowledge the help of Dr Niloy Kanti Das, Orthopaedic Surgeon, attached to the Institute of Child Health, Kolkata, West Bengal, India, by providing illustrations of some of his patients (Figs 6.3, 10.1, 10.2, 10.3, 19.2, 21.1 and 21.2).
My thanks and gratitude are due to the parents of my large number of patients, whose helpful participation was key to the successful completion of this work. The line drawings of the pictures in the book have been done by me and the cover design by my beloved daughter, Jayasmita. To my wife, Swapna and to my son-in-law, Sandipan, I owe my special thanks for their various help during the preparation of this book.
N De Mazumder