management

Definition

Any act or failure to act that

- results in or potentially results in harm / death / physical / emotional / sexual abuse

- by a parent or caretaker who is responsible for the child

4 types

Neglect 

Physical (punch / kick / bite / burn / shake)

Sexual 

Emotional

Risk factors

Defect

Abnormality of type 1 collagen

- amino acid substitution of glycine with another amino acid

- prevents triple helix formation

Many many deformities described

- some 286 mutations of Type 1 collagen described

Sillence Classification

There are actually now 7 

Type I

- mild

- AD

- blue sclera

Definition

Proximal Focal Femoral Deficiency

- congenital malformation

- characterised by failure of normal development of the proximal femur

Epidemiology

Rare

- 1 in 50 000

Bilateral in 15% 

- usually more severe

Association

Fibular hemimelia in 2/3

ACL deficient

Associations

Larsen Syndrome 

- AD, very rare

- associated with ligamentous laxity and dislocations, amongst other things

X-ray

Hindfoot valgus

Talonavicular lateral subluxation

TMT adduction

Management

Difficult to treat

Technique

1.  Medial calcaneal sliding osteotomy

Definition

Condition present at birth

- ankle dorsiflexed & in valgus

- foot abducted

Epidemiology

1 in 1000 births

Aetiology

Probably result of intrauterine positioning

- packaging defect

Associations

Oligohydramnios

DDH

Definition

Deformity characterised by 

- dorsiflexion of calcaneus 

- plantarflexion of forefoot / plantaris / forefoot equinus

Both sides of foot have elevated arch

Aetiology

Weakness of triceps surae 

- polio - most common worldwide

- spina bifida

Benefit most from Treatment

Problems

1. Tight psoas / Adductors / Hamstrings / T Achilles

2. Increased Femoral Anteversion

3. External Tibial Torsion

4. Valgus Foot

Principles

Surgery once walking but before school (3-4)

SEML surgery

Gait analysis lab

Gait

True equinus

Apparent equinus (FFD knee and hip)

Jump

Crouch

Definition

Progressive varus deformity of knees

- secondary to abnormality of medial upper tibial physis

- localised varus & internal rotation deformity

Infantile form 

- onset 1-3 years / bilateral

Adolescent form 

Concept

Treat the wound, not the gun velocity

Management based on gun velocity old fashioned because

1.  Only 1/3 guns are known 

2.  High velocity guns can produce low energy transfer wounds

Wound Ballistics

Kinetic Energy = 1/2mv²

- important factor is tissue interaction

- energy transfer

Epidemiology

4th most common STS

- 10-35% of STS

Peak age 3rd-4th decade

- rare in children

Pathology

Cellular characteristics suggest tumour arises from primitive synovial cells

- rarely actually occurs within joint

Characteristic

Occasionally metastasis to lymph nodes (5-7%) 

- like Epitheloid Sarcoma