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INTRODUCTION: Maltreatment adversely affects children's health and development. Knowledge of child maltreatment in early childhood is limited. We studied the demographic factors and health issues in children aged 0-3 years who were hospitalised for maltreatment. METHODS: In this retrospective cohort study, health and demographic information was extracted from the electronic medical records of children hospitalised in KK Women's and Children's Hospital between January 2018 and June 2019. High-risk groups were children with developmental delay (DD), missed vaccination (MV), low outpatient attendance, high dependency unit (HDU) or intensive care unit (ICU) admission and Child Protection Service (CPS) referral. Chi-square or Fisher's exact test was used for categorical variables. Mann-Whitney U test was used for skewed quantitative variables. RESULTS: Among the 101 children included in the study, the most common type of abuse and alleged perpetrator were physical abuse and parents, respectively. In addition, 35.6% of the children had pre-existing health conditions before hospitalisation, 58.4% had new health conditions diagnosed during hospitalisation requiring follow-up and 26.7% had maltreatment-related injuries. One-fifth of the children had DDs and another one-fifth had MVs. About 20% of them had defaulted all outpatient appointments. High-risk children mostly lived in rented housing. Their mothers mostly had primary education or lower. Most children admitted to ICU or HDU were <6 months old (8/12 [66.7%] vs. 6-24 months 3/12 [25%] vs. 24-47 months 1/12 [8.3%], P = 0.001). A higher number of children with DD were referred to CPS (63.2%, P = 0.049) than to other agencies. CONCLUSION: Maltreated children have significant health needs that are not fully met through routine surveillance practices. They are at risk of defaulting their hospital appointment. It is imperative that families at risk of child maltreatment are identified early and their needs holistically evaluated, with care coordinated within the hospital-community support system.
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BACKGROUND: Lateral column lengthening procedures have been extensively reported either as primary procedures or adjuncts to combined soft tissue procedures and osteotomies for the correction of the pes planovalgus deformity. There is also considerable debate as to the ideal procedure that is not followed by recurrence and obviates the need for revision surgeries and minimizes complications. We describe a technique and present the clinical results of lateral column lengthening that provides a powerful correction to restore normal foot alignment. METHODS: We retrospectively reviewed 26 feet in 21 patients with a mean age of 35.4 years (range, 12-75) over an average follow-up period of 71 months (range, 12-147) who underwent reconstructive surgery for flexible pes planovalgus foot. The reconstructive procedures included a central calcaneal osteotomy in all patients, a medial column stabilization procedure, flexor digitorium transfer (FDL), and a gastrocnemius or Achilles tendon lengthening. Clinical evaluation was carried out with the AOFAS ankle-hindfoot scores. Standard weight-bearing anterior posterior (AP) and lateral radiographs before surgery and at follow-up were analyzed for radiographic parameters of correction. RESULTS: The median AOFAS score increased from 50 to 90. Two patients reported dissatisfaction with the result. There were no nonunions nor complications related to hardware. Radiographic improvement of the talonavicular coverage angle was a 74% change from baseline value. All radiographic parameters improved (P < .001) except the lateral talocalcaneal angle (P = .48). No secondary subsidence of the arch was observed within the follow-up time. CONCLUSION: Correction of flexible pes planovalgus deformity with a central calcaneal osteotomy was an effective, reproducible method to restore normal foot alignment and good function. LEVEL OF EVIDENCE: Level IV, retrospective case series.