Tufted Angioma of the Index Finger Middle Phalanx.

A tufted angioma is a benign vascular tumor of the skin and subcutaneous tissue that classically presents as a violaceous nodule on the trunk or extremities in early childhood. Tufted angiomas of the finger are uncommon, and intraosseous involvement of these tumors is exceedingly rare. When present in the bone, these lesions may be difficult to distinguish from the more common pediatric condition of osteomyelitis or osteoid osteoma. We present the clinical, radiographic, and histopathologic findings for a unique case of a tufted angioma with intraosseous involvement in the middle phalanx treated by surgical excision and curettage with preservation of function.

Patient-Reported Outcomes after Syndactyly Reconstruction.

BACKGROUND: There is scant literature regarding patient-reported outcomes after reconstruction for congenital hand syndactyly. Understanding patient perceptions of the postoperative outcome may facilitate a more evidence-based discussion of expectations after reconstruction. METHODS: All patients undergoing congenital syndactyly reconstruction at Ann and Robert H. Lurie Children's Hospital of Chicago between January of 2007 and December of 2015 were identified. Patient-Reported Outcomes Measurement Information System questionnaires were completed by patients; parent-proxy questionnaires were completed for patients 10 years of age and younger and those unable to complete the questionnaire independently. A retrospective chart review was also performed to capture demographic and clinical information. RESULTS: The authors identified 124 patients meeting inclusion criteria; 51 completed the Patient-Reported Outcomes Measurement Information System surveys (response rate, 41.1 percent). The survey score for upper extremity function was 41.8 ± 11. Upper extremity function was further impaired in patients with a documented history of developmental delay (23.8 ± 6.2 versus 44.2 ± 10.2). Parents completing surveys on behalf of their children reported higher pain interference scores than self-responders. CONCLUSIONS: The Patient-Reported Outcomes Measurement Information System is a valuable tool for measuring patient-reported outcomes in patients with syndactyly. Patients who have undergone reconstruction for syndactyly experience minor impairments in upper extremity function, but other aspects of their health-related quality of life are comparable to those of the general population. Developmental delay may be associated with additional impairments in upper extremity function and should be discussed when considering surgical reconstruction.

Assessment of the Spastic Upper Limb with Computational Motion Analysis.

This article presents the current status of integrating 3-dimensional motion analysis and electromyography to assess upper extremity function clinically. The authors used their approach to establish a normative database for 5 Shriners Hospital Upper Extremity Evaluation tasks, which provides ranges of motion at the point of task achievement. Also, the inter-joint correlations are provided to understand the movement coordination required for each task. Distal upper extremity motion is strongly related to proximal function, supporting the idea that treatment of the proximal upper extremity deficits may be best preceded by treatment of the more distal upper extremity segments.

Which Proximal Humerus Fractures Should Be Pinned? Treatment in Skeletally Immature Patients.

Most proximal humerus fractures in skeletally immature individuals are treated nonoperatively with excellent functional results. Extensive remodeling of the proximal humerus and the wide arc of motion of the glenohumeral joint accommodate a large degree of fracture displacement and angulation. The treatment of severely displaced fractures and/or severely angulated fractures continues to be debated. Older patients and those with significantly displaced fractures may benefit from surgery because of their inability to remodel displacement and angulation during their limited remaining growth. The decision to treat a proximal humerus fracture in a skeletally immature patient operatively versus nonoperatively is dependent on the following 3 factors: displacement, bone age, and capacity to remodel. There is an increasing trend toward treating severely displaced and severely angulated fractures surgically, especially in older patients and adolescents. Smooth wires, percutaneous threaded wires, cannulated screws, and retrograde elastic stable intramedullary nailing are acceptable options for fixation.

Remodeling of birth fractures of the humeral diaphysis.

BACKGROUND: Birth fractures of the humeral diaphysis are encountered at most pediatric medical centers and pediatric orthopaedic practices. The treatment strategy of these fractures is uniformly nonoperative. However, we have not found sufficient studies in the literature demonstrating the extent to which remodeling is possible and therefore how much deformity is acceptable in the treatment of these fractures. METHODS: We reviewed the records of our institution's Orthopaedic Surgery Clinic and identified all children seen for birth fractures of the humerus from 2001 to 2005. The angulation and displacement at presentation and at follow-up were measured. RESULTS: All patients were treated nonoperatively, and most were managed by swaddling. In 9 patients with more than 4 months of radiographic follow-up, the mean initial angulation was 26 degrees in the coronal plane and 25 degrees in the sagittal plane. The mean angulation at final follow-up was 5 degrees in the coronal plane and 7 degrees in the sagittal plane. The maximum angulation at presentation was 66 degrees, which remodeled to 5 degrees at 7.3 months' follow-up. CONCLUSIONS: Our findings suggest that attempts to obtain an anatomical reduction or the use of more than the simplest immobilization methods are not necessary given the tremendous capacity for remodeling of these fractures in infants.

Central physeal arrests as a manifestation of hypervitaminosis A.

Vitamin A is necessary for synthesis of visual pigments and required in appropriate amounts for membrane stability. Acute hypervitamin A intoxication can lead to increased intracranial pressure, vomiting, and lethargy. Chronic excessive intake of vitamin A can lead to pruritus, muscle and bone tenderness, and failure to thrive. Reported effects of hypervitamin A intoxication on bone include osteoporosis, fracture, cortical thickening, and metaphyseal irregularity. We are reporting on a case of central physeal arrest in the distal femur, proximal tibia, and distal tibia after excessive intake of vitamin A.