RESUMO
OBJECTIVE: To determine if children who present with an elbow flexion contracture (EFC) from brachial plexus birth injury (BPBI) are more likely to develop shoulder contracture and undergo surgical treatment. STUDY DESIGN: Retrospective review of children <2 years of age with BPBI who presented to a single children's hospital from 1993 to 2020. Age, elbow and shoulder range of motion (ROM), imaging measurements, and surgical treatment and outcome were analyzed. Patients with an EFC of ≥10° were included in the study sample. Data from 2445 clinical evaluations (1190 patients) were assessed. The final study cohort included 72 EFC cases matched with 230 non-EFC controls. Three patients lacked sufficient follow-up data. RESULTS: There were 299 included patients who showed no differences between study and control groups with respect to age, sex, race, ethnicity, or functional score. Patients with EFC had 12° less shoulder range of motion (95% CI, 5°-20°; P < .001) and had 2.5 times the odds of shoulder contracture (OR, 2.5; 95% CI, 1.3-4.7; P = .006). For each additional 5° of EFC, the odds of shoulder contracture increased by 50% (OR, 1.5; 95% CI, 1.2-1.8; P < .001) and odds of shoulder procedure increased by 62% (OR, 1.62; 95% CI, 1.04-2.53; P = .03). Sensitivity of EFC for predicting shoulder contracture was 49% and specificity was 82%. CONCLUSIONS: In patients with BPBI <2 years of age, presence of EFC can be used as a screening tool in identifying shoulder contractures that may otherwise be difficult to assess. Prompt referral should be arranged for evaluation at a BPBI specialty clinic, because delayed presentation risks worsening shoulder contracture and potentially more complicated surgery.
Assuntos
Traumatismos do Nascimento , Neuropatias do Plexo Braquial , Plexo Braquial , Contratura , Criança , Lactente , Humanos , Cotovelo , Ombro , Neuropatias do Plexo Braquial/complicações , Neuropatias do Plexo Braquial/diagnóstico , Contratura/diagnóstico , Contratura/etiologia , Plexo Braquial/lesões , Plexo Braquial/cirurgia , Amplitude de Movimento Articular , Traumatismos do Nascimento/complicações , Traumatismos do Nascimento/diagnóstico , Resultado do TratamentoRESUMO
The brachial plexus is a series of nerves formed by roots of cervical segments 5 to 8 (C5-C8) as well as the first thoracic nerve (T1). It functions to provide sensation and motor innervation to the skin and muscles of the chest and upper limb. It does so through different segments: roots, trunks, divisions, and cords. Injuries to the brachial plexus occur relatively frequently and are due mainly to traumatic accidents that lead to traction or compression of the nerve roots. When considering the etiology and treatment of such injuries, it is important to make a distinction between adult versus obstetric brachial plexus injury. Although several surgical treatment options are described and used for patients with brachial plexus injury, no perfect remedy currently exists. Prevention and safety should be the focus. At the same time, high-quality studies and new technology and techniques are needed to determine more effective treatments for this group.
Assuntos
Traumatismos do Nascimento/diagnóstico , Traumatismos do Nascimento/cirurgia , Plexo Braquial/lesões , Transferência de Nervo/métodos , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tronco , Resultado do TratamentoAssuntos
Traumatismos do Nascimento , Traumatismos Oculares , Complicações do Trabalho de Parto/cirurgia , Forceps Obstétrico/efeitos adversos , Procedimentos Cirúrgicos Oftalmológicos/métodos , Descolamento Retiniano , Transtornos da Visão/etiologia , Traumatismos do Nascimento/diagnóstico , Traumatismos do Nascimento/etiologia , Traumatismos do Nascimento/cirurgia , Técnicas de Diagnóstico Oftalmológico , Traumatismos Oculares/diagnóstico , Traumatismos Oculares/etiologia , Traumatismos Oculares/cirurgia , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: The occurrence of 4 bone fractures associated with birth by Caesarean section (CS) prompted us to examine the incidence and predisposing factors of bone injuries sustained during birth. CASE REPORT AND METHOD: The 4 cases with fractures were evaluated retrospectively and discussed in combination with a short review of the literature. CONCLUSIONS: With the increasing number of Caesarean sections the incidence of birth trauma has decreased. Nevertheless, when performing a CS there is still a risk of serious trauma to the neonate, including bone fractures. A Caesarean section for breech presentation constitutes a predisposition for femoral fractures. When diagnosed early and treated properly, the prognosis for these fractures is good without sequelae and one can expect a satisfactory clinical outcome for the child. We suggest that the possibility of this complication be mentioned when counselling the mother and getting informed consent.
Assuntos
Traumatismos do Nascimento/diagnóstico , Traumatismos do Nascimento/etiologia , Cesárea/efeitos adversos , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/etiologia , Traumatismos do Nascimento/prevenção & controle , Feminino , Fraturas Ósseas/prevenção & controle , Humanos , Recém-Nascido , MasculinoRESUMO
Traumatic separation of the distal humeral epiphysis during delivery is an uncommon injury in neonates and usually mimics elbow dislocation. Emergency medicine physicians and orthopedic surgeons must have a high index of suspicion for distal humeral epiphysis separation when evaluating elbow trauma in neonates. Magnetic resonance imaging (MRI) scan is an important diagnostic tool for this purpose. We report a case in which fracture-separation of the distal humeral epiphysis in a newborn was diagnosed with the help of ultrasonography and MRI scan, which provided a clear delineation of the injury.
Assuntos
Traumatismos do Nascimento/diagnóstico por imagem , Lesões no Cotovelo , Epífises/lesões , Fraturas do Úmero/diagnóstico por imagem , Luxações Articulares/diagnóstico por imagem , Traumatismos do Nascimento/diagnóstico , Traumatismos do Nascimento/cirurgia , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Epífises/diagnóstico por imagem , Epífises/cirurgia , Humanos , Fraturas do Úmero/diagnóstico , Fraturas do Úmero/etiologia , Fraturas do Úmero/cirurgia , Recém-Nascido , Luxações Articulares/diagnóstico , Luxações Articulares/etiologia , Luxações Articulares/cirurgia , Imageamento por Ressonância Magnética , Masculino , Resultado do Tratamento , UltrassonografiaRESUMO
A 5-year-old child presented to us with weakness of the left upper limb since birth. With the given history of obstetric trauma and limb examination, a diagnosis of birth brachial plexus palsy was made. Brachial plexus exploration along with microsurgery was performed at the same time which included extrinsic neurolysis of the roots and trunks and nerve transfer for better shoulder external rotation and elbow flexion. Both the movements were severely restricted previously due to co-contractures with the shoulder internal rotators and triceps. The problem of birth brachial plexus palsy is proving to be a global health burden both in developed countries and in developing countries such as India. The lack of awareness among the general public and primary healthcare providers and inadequate orthopaedic and neurosurgeons trained to treat the condition have worsened the prognosis. This case lays stress on the delayed complications in birth brachial palsy and its effective management.
Assuntos
Traumatismos do Nascimento/cirurgia , Neuropatias do Plexo Braquial/cirurgia , Plexo Braquial/cirurgia , Procedimentos Neurocirúrgicos/métodos , Paralisia/cirurgia , Traumatismos do Nascimento/diagnóstico , Neuropatias do Plexo Braquial/diagnóstico , Pré-Escolar , Humanos , Índia , Masculino , Paralisia/diagnóstico , Amplitude de Movimento ArticularRESUMO
Fetal heart rate patterns play a significant role in the modern day obstetric care. They also play a significant role in medicolegal allegations of negligence when the fetus suffers injury. Proper interpretation of the fetal monitor tracing is only one factor in the evaluation of the reasonableness of obstetric care. Appropriate care and optimal defense both derive from reasonable interpretation of pertinent clinical data, including the monitor strip, along with timely pursuit of a thoughtful, properly annotated, plan of care.
Assuntos
Monitorização Fetal/métodos , Frequência Cardíaca Fetal , Trabalho de Parto , Imperícia/legislação & jurisprudência , Obstetrícia/legislação & jurisprudência , Traumatismos do Nascimento/diagnóstico , Traumatismos do Nascimento/prevenção & controle , Protocolos Clínicos , Eletrônica Médica , Feminino , Hipóxia Fetal/diagnóstico , Hipóxia Fetal/prevenção & controle , Humanos , GravidezRESUMO
Despite better prevention programs and emergency medical care, trauma continues to be the leading cause of death in children. Children present very special anatomic, physiologic, and psychological problems to the emergency room physician, and the spectrum of injury in these young patients may be significantly different from that seen in adult trauma victims. These factors make immediate diagnosis and early appropriate therapy for these young patients imperative to a successful outcome. A few unique forms of injury have been reviewed in this article and their diagnosis and management discussed.
Assuntos
Ferimentos e Lesões , Traumatismos Abdominais/diagnóstico , Traumatismos do Nascimento/diagnóstico , Criança , Maus-Tratos Infantis , Pré-Escolar , Cuidados Críticos , Humanos , Lactente , Recém-Nascido , Estados Unidos , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/mortalidade , Ferimentos não Penetrantes/diagnósticoAssuntos
Parto Obstétrico , Monitorização Fetal , Imperícia , Erros Médicos/prevenção & controle , Traumatismos do Nascimento/diagnóstico , Traumatismos do Nascimento/prevenção & controle , Cardiotocografia/normas , Parto Obstétrico/métodos , Parto Obstétrico/normas , Feminino , Hipóxia Fetal/diagnóstico , Hipóxia Fetal/prevenção & controle , Monitorização Fetal/efeitos adversos , Monitorização Fetal/normas , Fidelidade a Diretrizes/normas , Humanos , Gravidez , SegurançaAssuntos
Encefalopatias/diagnóstico , Traumatismos do Nascimento/diagnóstico , Encéfalo/anormalidades , Encefalopatias/classificação , Encefalopatias/etiologia , Encefalopatias/patologia , Lesões Encefálicas/diagnóstico , Sistema Nervoso Central/patologia , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Recém-Nascido , Deficiência Intelectual/diagnóstico , Anamnese , Erros Inatos do Metabolismo/diagnóstico , GravidezRESUMO
An intracranial haemorrhage was diagnosed by computerised tomography in 35 term neonates. Subarachnoid haemorrhage was found in 23, intracerebral haemorrhage in 9 and subdural haematoma in 3 patients. Perinatal risk factors indicating trauma or hypoxic events were evaluated in more than 50%. Clinical symptoms were independent of the site of the bleeding. An additional hypoxic-ischaemic brain injury seemed to be the cause of the observed clinical symptoms in many cases. The outcome was significantly better in patients with subarachnoid haemorrhage than in intracerebral haemorrhage or subdural haematoma. Respiratory arrest, increased muscle tone and seizures were frequently associated with an unfavourable outcome.
Assuntos
Hemorragia Cerebral/diagnóstico , Doenças do Recém-Nascido/diagnóstico , Tomografia Computadorizada por Raios X , Asfixia Neonatal/complicações , Traumatismos do Nascimento/diagnóstico , Diagnóstico Diferencial , Hematoma Subdural/diagnóstico , Humanos , Recém-Nascido , Avaliação de Processos e Resultados em Cuidados de Saúde , Hemorragia Subaracnóidea/diagnósticoRESUMO
In this paper, census data were used to assess the effectiveness in birth delivery of obstetricians and general practitioners.though the data reported require some qualification and additional research, preliminary results indicate that general practitioners report approximately three times more birth injuries and/or malformations (than do obstetricians) at birth. Both groups (obstetricians and general practitioners) report approximately the same number of complications in pregnancy and delivery. It was tentatively concluded that the similarity in diagnosed complications was probably due to diagnostic error. This error, in combination with sample differences and differing delivery techniques, resulted in the consequent differences in rates of birth injury and malformation.