OR12.1 | Congenital Malformation and Deformity Assessment — Summary & Reflection

KEY TAKEAWAYS

This module has presented a systematic approach to four key congenital musculoskeletal conditions relevant to the final-year student.

Scoliosis is defined as a lateral spinal curve ≥10° (Cobb angle). Adolescent idiopathic scoliosis is the most common form; congenital scoliosis arises from vertebral formation or segmentation failures and demands full-spine MRI. Management is stratified by curve magnitude and skeletal maturity: observe (<25°), brace (25–45°, immature), or surgically fuse (>45°).

Spina bifida ranges from spina bifida occulta (covered, neurologically intact) through meningocele (meninges only) to myelomeningocele (neural tissue herniated, with Arnold-Chiari II malformation and hydrocephalus in 70–90%). Management is multidisciplinary; folic acid supplementation prevents the majority of cases.

DDH affects female, breech, first-born, and left hips most commonly. Neonatal diagnosis via Ortolani (felt clunk of reduction) and Barlow (provocation of dislocation) tests is critical. Imaging: ultrasound <4–6 months, X-ray thereafter. Treatment: Pavlik harness (birth to 6 months) → closed reduction + spica (6–18 months) → open reduction ± osteotomy (>18 months).

Congenital muscular torticollis reflects SCM fibrosis; head tilts toward the affected side, chin rotates away. Early physiotherapy resolves >90%; surgery for resistant cases before 3 years.

CTEV (clubfoot) has four components — CAVE (Cavus, Adductus, Varus, Equinus). The Ponseti method corrects them sequentially (C first, E last with Achilles tenotomy), followed by 4–5 years of foot abduction bracing. Brace non-compliance is the leading cause of relapse.

REFLECT

Consider a 10-year-old girl who presents to your outpatient clinic with her parents, who have noticed her 'crooked posture' for the past year. On examination you find a 32° right thoracic scoliosis by Cobb angle on her standing X-ray, and she is pre-menarchal with a Risser sign of 1. Reflecting on what you have learned: What is the risk of curve progression in this patient? What treatment would you recommend, and what would you need to monitor? How would your management differ if she were post-menarchal with a Risser sign of 4? Now think about how you would communicate the diagnosis and the concept of brace treatment to a 10-year-old girl and her anxious parents — what aspects of the condition, the brace, and the prognosis would you prioritise in your explanation?