Multiple congenital deformity of the limbs – a better functional recovery with early physiotherapy

Abstract

Congenital deformities continue to be one of the main causes of deformities and stigmatization in children. We report a case of a 3-day-old baby, referred C O fever. Neonatal history not available, except that it was a twin delivery, other baby died at birth. Her weight at birth is 1.4 kg with temperature on admission 38.50 °C. Unilateral club foot (left foot), hyperdorsiflexion and eversion of the right foot with a reverse longitudinal and transverse curve of the foot. Right hand - about 1400 elbow flexion, 900 wrist flexion, 150 MCP extension, and 800 PIP flexion. Left hand - about 1100 elbow flexion, 800 wrist flexion, Nil MCP, Nil PIP. Passive ROM of right hand - about 450 elbow flexion, 300 wrist flexion, 450 MCP flexion, 200 PIP flexion. Left hand - 300 elbow flexion, 150 wrist flexion, Nil MCP, Nil PIP. Primitive reflexes - poor. The impression after necessary findings was + early neonatal infection in premature associated with multiple congenital limb deformity. The baby was unable to extend elbow and dorsiflex wrist of both hands, flex MCP and extend PIP of right hand. Physiotherapy was incorporated on day 12 of hospitalization. We started with PROM of all joints of the limbs moving them through the available range. Later, gentle passive stretch of elbow and wrist flexors of both hands, MCP extensors and PIP flexors of right hand to get full passive range. Finally, splints were designed to correct these deformities in the functional range gained - worn for 30 min, then 2 h, then 6 h, then by night, then 24 h. The lower limbs are being corrected by the Ponseti method. Baby continues normal follow-up by the pediatrician. After two months of therapy, babies have good extension of elbows and wrist of both hands, flex MCP and extend PIP or right hand. The sad mother is already excited at the results we have so far. Some African cultures stigmatize children born with deformity. The good result of this unique case will prove to many that no blames should be attributed to the child, mother or family as a result of deformity that can be properly managed by early physiotherapy intervention. Early physiotherapy intervention will become the solution to congenital deformities preventing handicap.