Background
Definition 
Palmar Fibromatosis
Aetiology
AD with variable penetration
Pathogenesis
Murrell's Theory of Pathogenesis
1. Microvascular ischaemia
Palmar Fibromatosis
AD with variable penetration
Murrell's Theory of Pathogenesis
1. Microvascular ischaemia
Chronic, non metabolic bone disorder
Characterised by increased bone resorption, bone formation and remodelling
Rare < 40
1 – 3 % population over 60
M > F
Unknown
Paramyxovirus implicated
- measles
- RSV
- canine distemper virus
Electron Microscope
1/3 caucasian women > 64
Insufficient bone mass at time of skeletal maturity
- peak bone mass is achieved at age 25
Rapid loss of bone after menopause
Low body weight / weight loss / history of smoking / steroids
Type 1
- postmenopausal
- high turnover / osteoclast mediated
- F x 6
Adolescent apophyseal avulsion
- treat non operatively
- unless displaced > 2 cm
Adult
- soft tissue avulsion
Usually associated with sporting activities
- skiing
- water skiing
Violent contraction
- knee extended
- hip flexing
Usually young patients
- 15 - 40
15% compound
High velocity injury
- MBA
- MVA
- pedestrian v car
- fall from height
EMST principles
- need for transfusion not uncommon
Pathological bone formation in soft tissues
In elbow
- 3% of trauma
- 89% if head injury + trauma
Completely different
1. Myosisitis Ossificans Circumscripta
- post traumatic
- more common
- recognised as a consequence of neurological injury
Non-traumatic or traumatic condition of femoral head with bone death
20 - 50 yo (average 38)
- M: F 4:1
70-80% with AVN will progress within 1 year
Second most common hindfoot after calcaneal fractures
Aviators Astragalus
Fall from height
- hyper-dorsiflexion injury
- neck of talus strikes the anterior tibia
More than half surface covered by articular cartilage
- medial articular wall straight
- lateral articular wall curves posteriorly
Repetitive plantar flexion
- soccer players, ballet dancers
Os trigonum
FHL stenosing tenosynovitis
Soft tissue mass
Secondary centre of ossification of talus
- lateral to groove for FHL
- 2-7% of normal feet
- impinges against plafond with forced PF
Fibrous proliferative lesion in plantar fascia
Male, white, middle age
May arise in isolation
Association Dupuytren's Diathesis
- aka Lederhosen disease
Proliferative Fibroblastic lesion
- May resemble fibrosarcoma histologically