natural history

Metatarsus Adductus

Definition

 

Metatarsus varus

- adduction of the forefoot at the TMTJ

 

Intrauterine positional deformity / packaging defect

 

Epidemiology

 

1:1000

- M = F 

- bilateral in 50%

- 10% have CDH

 

Aetiology

 

Unclear

 

Theories

- intrauterine positioning defect

- prone nursing

 

Undifferentiated Pleomorphic Sarcoma

Definition

 

Malignant Fibrous Histiocytoma

 

Characterised by heterogenous population of pleomorphic spindle cells

- organised in a characteristic storiform or "starry night" pattern

 

Cell of origin unknown 

- primitive mesenchymal cell

- allowing both features of a macrophage (hence histiocyte)

- and collagen producing cell (hence fibroblast)

 

Epidemiology

 

Parosteal Osteosarcoma

Epidemiology

 

Uncommon

- 4% OS

 

Females more common 

- similar to GCT

 

NHx

 

Less aggressive locally

- less metastasis

- size / location & duration of symptoms don't correlate with outcome

 

Arise from cortex of bone / periosteum

- parosteal 

- periosteal

- high grade juxtacortical

 

Non-Ossifying Fibroma

AKA

 

Non Ossifying Fibroma

 

Definition

 

A hamartomatous defect in the metaphyseal cortex of skeletally-immature adolescents

 

Fibrous cortical defect 

- < 2cm in diameter

 

Non ossifying fibromas 

- > 2cm

 

Non Ossifying Fibroma

 

Aetiology

 

Fibrous Dysplasia

Definition

 

Developmental hamartoma in which areas of the skeleton fail to mature normally

- remain indefinitely as immature, poorly mineralized trabeculae

 

Pathology

 

Hamartoma of bone and fibrous tissue

 

McCune - Albright's Syndrome

 

Rare triad of

 

1.  Fibrous Dysplasia

 

Chondroblastoma

Definition

 

Rare cartilage tumour 

 

Epidemiology

 

1% of bone tumours / rare

- typically in adolescents

 

NHx

 

Usually benign

- but aggressive / frankly malignant behaviour reported

- locally aggressive

- can have pulmonary metastasis

 

Location

 

Acute lateral ankle sprain

Definition

 

Partial or complete rupture of one or parts of lateral ligaments of ankle

- common ankle sprain

 

Epidemiology

 

Lateral ligaments sprains are the most common ligamentous injuries of the human body

- account for approximately 15% of all athletic injuries

- it is estimated that there is one ankle inversion injury per day per 10,000 people

 

Most common young males

- average age 27

Lumbar Scheuermann

Definition

 

Different entity to thoracic Scheuermann's

- end plate abnormal but no kyphosis or wedging

 

Natural History

 

Self - limiting condition

 

Epidemiology

 

Young athlete / labourer

 

Symptoms

 

Adolescent who presents with low grade levels of low back pain

- more pain than thoracic

 

Signs

 

Scheuermann's kyphosis

Definition 

 

Structural kyphosis of thoracic or thoracolumbar spine

- characterised by vertebral wedging & subsequent growth disturbance of vertebral end plate

 

X-ray Diagnostic Criteria Sorensen 1964

 

1.  Kyphosis > 45°

 

2. > 5° wedging 3 or more adjacent apical vertebrae

 

Other features

- Schmorl nodes