Background: Upper extremity length and circumference abnormalities are present in a number of conditions in the pediatric population. In most cases, upper limb hypoplasia and hypertrophy are diagnosed when one limb appears substantially different from the other during physical examination. However, occasionally when this discrepancy exists, it can be difficult to determine which limb is the abnormal one. The purpose of this study was to establish normal values for upper extremity length, circumference, and rate of growth in children aged 0 to 17 years. Methods: In all, 377 participants had 4 measurements taken of each upper extremity: upper arm length, upper arm circumference, forearm length, and forearm circumference. Statistical analysis was performed to identify differences and rates of growth. Results: Mean values for arm and forearm length and circumference for each age, 0 to 17 years, were established. The determination of a child’s expected arm length is dependent on his or her height, age, and sex, while the calculation of a child’s expected forearm length depends on his or her weight, age, and sex. Male and female arms and forearms have similar growth rates of lengths and circumferences. No significant differences were found between right and left extremities for each of the 4 measurements taken. Conclusions: Contralateral limbs can be used for comparison of length and circumference of the arm and forearm in cases of unilateral upper extremity abnormality. The establishment of normal values for upper extremity length, circumference, and growth rate will be a useful diagnostic tool for upper extremity hypoplasia and hypertrophy.

Failed total knee arthroplasties with large bone defects are increasing rapidly because of the growing population of young, active patients undergoing primary total knee arthroplasty. There are limited options when tibial metaphyseal bone loss is so extensive that a tibial component with augments and thickest available polyethylene cannot fill flexion and extension gaps once the femoral component is appropriately positioned. Previously, allograft or megaprostheses would be required. However, allografts require contouring and fixation and may not incorporate into surrounding bone. Most endoprostheses do not osseointegrate and are associated with high risk of failure. To our knowledge, we are the first to describe stacked porous titanium cones for reconstruction of massive tibial metaphyseal defects, a straightforward technique with standard revision implants highly likely to osseointegrate.

Osteonecrosis of the femoral head is a progressive and potentially debilitating disorder that is responsive to core decompression, especially in early-stage disease. This is typically accomplished through use of an 8 to 10mm trephine or multiple, small-diameter percutaneous drilling. Use of the large diameter trephine is associated with risk of fracture and may not allow healing across large gaps. Here, we present a technique for core decompression using percutaneous drilling that allows bone marrow aspiration concentrate to be introduced. We used the aspirate needle to decompress the femoral head osteonecrotic lesion, followed by the administration of bone marrow aspirate concentrate. This is a straightforward procedure that can be used with low risk for patient morbidity.

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