NEONATAL METATARSUS ADDUCTUS, JOINT MOBILITY, AXIS AND ROTATION OF THE LOWER EXTREMITY IN TERM AND PRETERM BORN CHILDREN AT 5 YEARS OF AGE

Abstract

To compare the development of attitude and joint mobility of the lower extremity in 111 normal term born(TB) with that of 128 preterm born(PTB) children, orthopedic examinations were carried out at birth and the age of 5 years. 21/128 (16%) PTB children had cerebral palsy(CP) requiring physiotherapy for 6 to 24 months (m= 12.5, 1SD=5.1). At birth, the incidence of metatarsus adductus(MA) was identical in single born TB and PTB infants(12% vs 16%), but higher in twins compared to single born infants(41%vs 16%, p<.05). At 5 years, MA had resolved in all TB but only in 83% of the PTB children. In the PTB group, incomplete resolution of neonatal MA occurred in 5/7(71%) children with CP compared with 2/18 (11%) without CP [p<.05]. Passive joint mobility did not differ between the groups except abduction (56 vs 45°) and extension(22 vs 9°) of the hip which were both smaller in the PTB group [p<.01]. When PTB children with CP were excluded from analysis, abduction and extension of the hip were identical in TB and PTB children. Median gait angle, tibia torsion and genu valgum were comparable in both groups.In conclusion, neonatal MA is more frequent in twins because of intrauterine space constraint. At 5 years, incomplete resolution of MA and impaired hip mobility are more likely to be the expression of neurological impairment than of prematurity.