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OF THE SKELETON Although many skeletal abnormalities are identified ante - natally or at birth, others become apparent with growth. Skeletal disorders are often linked to focal or generalised soft-tissue abnormalities; the presence of a skin dimple or a ‘featur...

Osteochondritis dissecans Osteochondritis dissecans (OCD) a ff ects the lateral aspect of the medial femoral condyle of the distal femur (but also the talus and the humerus). An osteochondral fragment becomes partially or completely separated from the joint su...

Osteomyelitis As with septic arthritis, bone infection is usually caused by haematogenous spread. Infection starts in the metaphyses of long bones, where the slow flow through the looped vessels combined with microtrauma encourages seeding of infection during a...

Other foot and ankle conditions Most postural deformities such as metatarsus adductus and calcaneovalgus feet improve spontaneously . Congenital vertical talus (CVT) is rare and fre - quently associated with neuromuscular conditions such as ‘rocker-bottom’ foo...

PAIN Congenital deformities Congenital vertebral deformities are failures either of formation (a hemivertebra) or of segmentation (unilateral or bilateral fusions or bars). The clinical result is usually a scoliosis ( Figure 44.34 ). Treatment should be based...

Polio . Despite an e ff ective polio vaccine, this disease still occurs. About 1–2% of patients develop neurological problems when - the virus a ff ects the anterior horn cells. Muscle weakness is proportionate to the number of motor units destroyed. Patients ...

Postural abnormalities Many babies are subjected to moulding pressures in utero . At birth they exhibit ‘postural abnormalities’, such as torticollis, calcaneovalgus feet and plagiocephaly , which improve with time and/or stretching exercises. 2 sd 2 sd Postur...

Radial club hand This longitudinal failure of formation is commonly associ - ated with other malformations, for example as part of the V ACTERL (abnormal vertebrae, anus, cardiovascular system, trachea, oesophagus, renal system and limb buds) syndr ome. The ...

Radioulnar synostosis Failure of proximal separation of the embryonic radius and ulna means that the forearm has no ability to pronate/supi nate. The hand, on the end of the forearm, is therefore in a fixed position along the arc from full pronation–neutral–...

Scoliosis The term ‘scoliosis’ describes spinal deformity in three planes: lateral curvature is the most obvious deformity while the rota tional component is most apparent in forward flexion when the rib asymmetry creates a ‘rib hump’ ( Figure 44.35 ). The caus...

Septic arthritis Joint infection is usually secondary to haematogenous spread but direct inoculation can occur, for example during a neonatal venepuncture. Diagnosis can be di ffi cult in the very young and in those presenting with overwhelming sepsis. Neonates,...

Slip of the capital (upper) femoral epiphysis (SCFE/SUFE) The physis connects the proximal femoral epiphysis (the femoral head) to the metaphysis (femoral neck). In certain physiological or pathological conditions a ‘stress fracture’ through the physis allows ...

Slip of the capital (upper) femoral epiphysis (SCFE/SUFE) The physis connects the proximal femoral epiphysis (the femoral head) to the metaphysis (femoral neck). In certain physiological or pathological conditions a ‘stress fracture’ through the physis allows ...

Spina bifida The extent of the disability varies with the level of the lesion: upper motor neurone involvement will produce spasticity while the more classic lower motor neurone lesion produces a flaccid paralysis. Muscle imbalance leads to secondary joint a ff...

Spondylolisthesis Spondylolysis defines a defect in the pars interarticularis of the vertebra. There are six types including congenital and trau matic. Spondylolisthesis occurs when the upper vertebra slips forward on the lower; it is graded according to the p...

disease) Osteogenesis imperfecta (OI) represents a spectrum of condi tions linked by a qualitative and/or quantitative abnormality of collagen production. Most identified mutations a ff ect the collagen genes. The bone may break easily but it heals promptly an...

Acquired Campbell de Morgan spots These are arteriovenous fistulae at the dermal capillary level in - sun-exposed skin of older patients ( Figure 45.45 ). Spider naevi These are angiomata that appear (and may disappear) sponta neously at puberty or in two-thir...

Anomalies of skin metabolism Skin has the potential for a blood supply 20–100 times greater than its metabolic and thermoregulatory requirements. This apparent excess enables restitution of mechanical integrity after the myriad of trivial injuries (scratchin...