Orthopaedic approach to the congenital Zika syndrome
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ORIGINAL PAPER
Orthopaedic approach to the congenital Zika syndrome Marcos Almeida Matos 1 & Mônica Alexandra Sampaio Torres Nascimento 1 & Joely Wilder Merriman 1,2 Received: 25 September 2019 / Accepted: 4 March 2020 # SICOT aisbl 2020
Abstract Purpose The aim of this study is to present a case series of patients with congenital Zika syndrome (CZS), giving special attention to the more relevant aspects for the paediatric orthopaedic surgeon. Methods An analytical cross-sectional study was performed in a group of 47 patients affected by CZS with maternal Zika serology confirmation. Clinical features of the maternal Zika infection, prenatal and perinatal complications, and patient demographic data were recorded. In addition, clinical and radiographic evaluations of the lower limb (hip, knee, and foot) were performed. Results Maternal Zika infection occurred at an average of 12.5 (± 6.4) weeks of gestation. The rates of complications during pregnancy and delivery were 37% and 17.4%, respectively. At the time of the clinical evaluation, spasticity was appreciated in 77.3% of the cases, and arthrogryposis was present in 15.2%. Foot deformities were appreciated in 41.2% of the cases, hip alterations in aggregate in 29.8% (adduction contracture in 20.2%; displacement in 7.5%), and knee alterations in 12.8% (displacement in 6.4%). The deformities in arthrogrypotic patients were both more prevalent and severe. All arthrogrypotic patients were simultaneously spastic. Conclusions The current study demonstrates a high prevalence of musculoskeletal alterations in patients with CZS. Affected patients were able to be classified as belonging to one of three types at the time of evaluation: Type I patients presented with a low incidence of musculoskeletal complications; Type II demonstrated progressive deformities; Type III presented with simultaneously the most prevalent and severe deformities. This classification system could help guide medical and surgical management of CZS patients based on the frequency and severity of the deformities at the time of initial evaluation. Keywords Zika virus . Evaluation . Deformity . Limb
Introduction Congenital Zika syndrome (CZS) encompasses a large range of pathologic abnormalities observed in newborns who acquired Zika virus in utero [1–3]. Common pathologic alterations include (but are not limited to) severe microcephaly associated with fetal brain disruption sequence (FBDS), intracranial calcifications in the subcortical region, hypoplasia or absence of the corpus callosum, decreased myelination, cerebellar or cerebellar vermis hypoplasia, and thinning of the spinal cord with reduction in the ventral roots [4–7]. Several
* Marcos Almeida Matos [email protected] 1
Bahiana School of Medicine and Public Health, Rua Guilhard Muniz 175, Pituba, Salvador, Bahia 41810-110, Brazil
2
University of Rochester Medical Center, Rochester, NY, USA
of these findings result in chronic peripheral and central motor neuron pathology [5, 8]. Functionally, children born with CZS have been des
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