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ABSTRACT: Background: Osteosarcoma is the most common primary bone tumor in children. While the humerus is the third most common anatomic location, it is the most common site for fractures. Our objective is to characterize magnetic resonance imaging (MRI) features of humerus osteosarcoma in children and with respect to risk of sustaining a pathologic fracture. Methods: Children with histologically confirmed humerus osteosarcoma, who underwent preoperative MRI (2008-2023) were included. Two radiologists retrospectively reviewed all MRIs to determine medullary (skip lesions and trans-epiphyseal tumor), joint, and extraosseous (muscle, neurovasculature, and lymphadenopathy) disease. Tumor volumes were measured at diagnosis and after neoadjuvant chemotherapy, and findings between those with and without fractures were compared. Results: This study included 25 children (10 boys, 15 girls; mean age: 12.9 ± 4.2 years), 9 (36%) with (6 at diagnosis, 3 during treatment) and 16 (64%) without fractures. Radiologists’ agreement on various MRI characteristics including bone, joint, muscle, and neurovascular involvement of humerus osteosarcoma ranged between 60 and 100%. The most common findings included trans-epiphyseal tumor (80%), involvement of the long head of the biceps tendon (76%), and axillary neurovasculature (72%). Although tumor volumes were smaller in patients with (104 cm3, interquartile range [IQR]: 68-116) than without fractures (136 cm3, IQR: 100-216), this difference did not reach significance (p = .07); no other findings differed between the groups (p > .05). At a median follow-up of 17 months (IQR: 7-55), 52% relapsed, but no significant association was found between relapse and fracture (p = .69). Conclusions: Over a third of the patients with humerus osteosarcoma had pathologic fractures in our study group, but these did not significantly associate with larger tumor size, specific MRI features, or increased risk for disease relapse. Key Concepts: (1) The most common MRI findings in children with humerus osteosarcoma were trans-epiphyseal disease, followed by extraosseous disease involving the long head of the biceps tendon and the axillary neurovasculature. (2) The lack of significant differences between fracture and nonfracture groups in terms of serum biomarkers, histologic subtype and treatment response, MRI findings and outcome suggest that these fractures may result from a combination of tumor-related and patient-specific factors, but do not significantly associate with increased risk for relapse. Level of Evidence: III, retrospective cohort study

The article discusses keratin-positive giant cell tumors of bone and soft tissue in children under 10 with HMGA2::NCOR2 fusion, focusing on three cases. The tumors are classified based on molecular alterations, with HMGA2::NCOR2 fusions distinguishing them from other giant cell-rich tumors. The youngest patient, a neonate with metastatic disease, showed a remarkable response to imatinib therapy. The study expands the understanding of these tumors and their response to targeted therapy, highlighting the importance of molecular characterization in diagnosis and treatment. [Extracted from the article]

Resumen: Introducción: Las fracturas de cóndilo humeral lateral (FCHL) representan del 12 al 17% de las fracturas de codo pediátrico. La asociación de esta fractura con luxación de codo es poco común, siendo escasa la bibliografía y generalmente limitada a reportes de casos. Nuestro objetivo fue revisar sistemáticamente la literatura sobre las fracturas del cóndilo lateral del húmero asociadas a luxación de codo en niños. Métodos: Se realizó una revisión sistemática mediante una búsqueda exhaustiva en las bases de datos PubMed y Embase de literatura revisada por pares entre 1960 y 2020. Dos revisores filtraron los resultados y buscaron artículos en inglés o español que reportan pacientes esqueléticamente inmaduros con fracturas del cóndilo lateral del húmero asociadas a luxación de codo. Los resultados analizados incluyeron características del paciente y de la lesión, estrategias de tratamiento, complicaciones y resultados finales. Resultados: La búsqueda inicial arrojó un total de 851 estudios. Después de la revisión, se incluyeron 16 estudios, con 67 pacientes disponibles para revisión. Las edades reportadas al momento de la lesión variaron entre 2 y 12 años. La lesión se presentó más comúnmente en varones con fracturas tipo Milch II, Jakob tipo 3. La dirección de la luxación fue posteromedial en la mayoría de los casos. La reducción abierta por abordaje lateral y la colocación de clavijas Kirschner fue el tratamiento más comúnmente realizado. El seguimiento reportado se presentó en un rango 3 a 156 meses. Catorce estudios informaron complicaciones en un tercio de los pacientes, que incluyen: limitación del rango de movimiento, cúbito varo, inestabilidad, prominencia del implante, retraso de la consolidación, seudoartrosis, consolidación viciosa, osificación heterotópica, lesión neurológica y fallo del implante. Trece estudios informaron resultados clínicos, que se calificaron como regulares o pobres en 2 de cada 10 pacientes. Conclusiones: La evidencia actual es nivel iv y sugiere que la tasa de complicaciones después del manejo quirúrgico de las fracturas de cóndilo lateral es elevada en el contexto de una luxación de codo, lo que se asocia además a un alto porcentaje de resultados subóptimos. Las complicaciones más frecuentes en esta serie fueron la rigidez articular y el cúbito varo. Abstract: Background: Lateral humeral condyle fractures are the second most common fracture around the elbow in children. However, the association of an elbow dislocation is a rare entity. Therefore, literature on young patients with this uncommon combination is sparse. We aimed to perform a systematic review of the literature searching for pediatric lateral condyle humerus fractures associated to elbow dislocation. Methods: A systematic review of the PubMed and Embase databases was conducted for peer-reviewed literature between 1960 and 2020. Two reviewers filtered the results, looking for articles in English and Spanish that reported fractures of the lateral condyle of the humerus associated to elbow dislocation in skeletally immature patients. Outcomes included patient and injury characteristics, treatment strategies, complications, and final outcomes including range of motion. Results: The initial search yielded a total of 851 studies. After initial screening, 16 studies were included, with 67 patients available for review. Age reported at the time of injury ranged from 2 to 12 years. The lesion occurred more commonly in males (60%) with Milch II, and Jakob type 3 fractures. The direction of the dislocation was posteromedial in most cases. Open reduction by lateral approach and Kirschner pin placement was the most performed treatment. The reported follow-up ranged from 3 to 156 months. Fourteen studies reported complications in 1/3 of the patients including: limited range of motion, cubitus varus, instability, hardware prominence, delayed union, nonunion, malunion, heterotopic ossification, neurological injury, and hardware failure. Thirteen studies reported clinical outcomes, which were rated as fair or poor in 2 out of 10 patients. Conclusions: Current evidence is level IV and suggests that the complication rate after surgical management of lateral condyle fractures is substantial in the context of an associated elbow dislocation, with an elevated percentage of suboptimal results. The most frequent complications in this series were elbow stiffness and cubitus varus.

Purpose: Distal radius fractures (DRFs) are common pediatric injuries typically treated with closed reduction and casting. A substantial number of these fractures fail nonsurgical management, occasionally requiring surgical intervention. Risk factors associated with an unsuccessful initial closed reduction (UIR) attempt or loss of reduction (LOR) after a successful closed reduction remain poorly characterized. Methods: This was a retrospective investigation of pediatric patients with displaced DRFs treated by closed reduction and casting at a single children’s hospital from 2013 to 2017. Patient factors (age, sex, and body mass index) and radiographic measurements (fracture type, fracture displacement, associated ulna fracture, and cast index) were evaluated to determine risk factors for UIR and LOR. Results: We identified 159 children (118 boys, mean age, 11 ± 3 years) with DRFs who underwent closed reduction and casting. An initial acceptable reduction was achieved in 81% of patients, and LOR occurred in 21.7%. Higher initial fracture translation in the sagittal or coronal plane and higher initial angulation in the coronal plane were associated with higher fluoroscopy times. Higher initial translation in the sagittal plane was independently associated with UIR. After closed reduction, residual translation in the sagittal plane and cast index were independent predictors for LOR. Fractures that were completely displaced in the sagittal plane were 6.2 times less likely to undergo an acceptable initial reduction, and fractures with any residual postreduction translation in the sagittal plane were 4.7 times more likely to demonstrate LOR. Conclusions: The most important factors predicting failure of nonsurgical management of pediatric DRFs are translation in the sagittal plane and cast index greater than 0.80. To optimize patient outcomes, these variables should be recognized by the treating provider and emphasized during simulation training of orthopedic and plastic surgery residents. Type of study/level of evidence: Prognostic III.

Background: Lateral humeral condyle fractures are the second most common fracture around the elbow in children. However, the association of an elbow dislocation is a rare entity. Therefore, literature on young patients with this uncommon combination is sparse. We aimed to perform a systematic review of the literature searching for paediatric lateral condyle humerus fractures associated to elbow dislocation. Methods: A systematic review of the PubMed and Embase databases was conducted for peer-reviewed literature between 1960 and 2020. Two reviewers filtered the results, looking for articles in English and Spanish that reported fractures of the lateral condyle of the humerus associated to elbow dislocation in skeletally immature patients. Outcomes included patient and injury characteristics, treatment strategies, complications, and final outcomes including range of motion. Results: The initial search yielded a total of 851 studies. After initial screening, 16 studies were included, with 67 patients available for review. Age reported at the time of injury ranged from 2 to 12 years. The lesion occurred more commonly in males (60%) with Milch II, and Jakob type 3 fractures. The direction of the dislocation was posteromedial in most cases. Open reduction by lateral approach and Kirschner pin placement was the most performed treatment. The reported follow-up ranged from 3 to 156 months. Fourteen studies reported complications in 1/3 of the patients including: limited range of motion, cubitus varus, instability, hardware prominence, delayed union, nonunion, malunion, heterotopic ossification, neurological injury, and hardware failure. Thirteen studies reported clinical outcomes, which were rated as fair or poor in 2 out of 10 patients. Conclusions: Current evidence is level IV and suggests that the complication rate after surgical management of lateral condyle fractures is substantial in the context of an associated elbow dislocation, with an elevated percentage of suboptimal results. The most frequent complications in this series were elbow stiffness and cubitus varus. Resumen: Introducción: Las fracturas de cóndilo humeral lateral representan del 12-17% de las fracturas de codo pediátrico. La asociación de esta fractura con luxación de codo es poco común, siendo escasa la bibliografía y generalmente limitada a reportes de casos. Nuestro objetivo fue revisar sistemáticamente la literatura sobre las fracturas del cóndilo lateral del húmero asociadas a luxación de codo en niños. Métodos: Se realizó una revisión sistemática mediante una búsqueda exhaustiva en las bases de datos PubMed y Embase de literatura revisada por pares entre 1960 y 2020. Dos revisores filtraron los resultados y buscaron artículos en inglés o español que reportan pacientes esqueléticamente inmaduros con fracturas del cóndilo lateral del húmero asociadas a luxación de codo. Los resultados analizados incluyeron características del paciente y de la lesión, estrategias de tratamiento, complicaciones y resultados finales. Resultados: La búsqueda inicial arrojó un total de 851 estudios. Después de la revisión, se incluyeron 16 estudios, con 67 pacientes disponibles para revisión. Las edades reportadas al momento de la lesión variaron entre 2 y 12 años. La lesión se presentó más comúnmente en varones con fracturas tipo Milch II, Jakob tipo 3. La dirección de la luxación fue posteromedial en la mayoría de los casos. La reducción abierta por abordaje lateral y la colocación de clavijas Kirschner fue el tratamiento más comúnmente realizado. El seguimiento reportado se presentó en un rango 3-156 meses. Catorce estudios informaron complicaciones en un tercio de los pacientes, que incluyen: limitación del rango de movimiento, cúbito varo, inestabilidad, prominencia del implante, retraso de la consolidación, seudoartrosis, consolidación viciosa, osificación heterotópica, lesión neurológica y fallo del implante. Trece estudios informaron resultados clínicos, que se calificaron como regulares o pobres en 2 de cada 10 pacientes. Conclusiones: La evidencia actual es nivel iv e indica que la tasa de complicaciones después del manejo quirúrgico de las fracturas de cóndilo lateral es elevada en el contexto de una luxación de codo, lo que se asocia además a un alto porcentaje de resultados subóptimos. Las complicaciones más frecuentes en esta serie fueron la rigidez articular y el cúbito varo.

ABSTRACT Interstitial mycosis fungoides (IMF) is a rare variant of mycosis fungoides, a cutaneous T-cell non-Hodgkin’s lymphoma. It is characterized by an interstitial dermal infiltrate of lymphocytes and histiocytes between collagen bundles. We report the case of a 54-year-old patient with pruritic hypochromic macules on the arms and forearms diagnosed with IMF. Special attention was given to the anatomopathological features that differentiate this entity from its differential diagnoses, such as inflammatory morphea, interstitial annular granuloma, and other variants of the mycosis fungoides itself. We also present a review of the literature on the classification of the IMF.

Antalgic gait is a common clinical presentation among pediatric patients and can have many different etiologies, with rare life-threatening etiologies including primary bone malignancies. Osteosarcoma is the most common primary malignancy of bone in pediatric and adolescent patients. The incidence rate of osteosarcoma has been reported as high as 5 to 7 per million among patients 19 years old or younger with males slightly more affected than females and African-Americans more than other racial groups. This report describes the case of a five-year-old African-American female who presented with an antalgic gait secondary to osteosarcoma in the left distal femur and follows her through treatment. In this case, the age is atypical as the peak incidence for osteosarcoma is around 16 years of age and is postulated to coincide with growth spurts. Osteosarcoma can have a range of presentations making it difficult to diagnose, which can cause delays in treatment and potential poor patient outcomes. Due to this, such a diagnosis must be included in the differential for patients presenting with antalgic gait. Because primary-care physicians and pediatricians may be the first medical providers to encounter patients with osteosarcoma, it is imperative that such clinicians are familiar with the signs and symptoms associated with osteosarcomas in order to reduce the risk of metastasis and disease progression and prevent treatment delays. Additionally, we believe these clinicians should have a low threshold to refer patients to orthopedists or oncologic specialists in the cases of persistent pain or inconsistencies with history, physical exam, and diagnostic studies. Finally, direct communication and discussion between radiologists and referring clinicians helps decrease delays in diagnosing of osteosarcoma and other life-threatening conditions.