Epidermoid inclusion cysts (EIC) of the bone are exceedingly rare. We present a case of an atypical EIC originating at the base of the distal phalanx of the index finger following a remote history of crush injury to the finger. The differential diagnosis of expansile, lytic lesions of the phalanges remains broad, and definitive diagnosis requires tissue histopathological analysis. At latest follow-up, the patient was pain-free and obtained an excellent clinical and radiographic outcome following intra-lesional curettage and bone grafting. Differentiation of EIC from other radiolucent digital lesions remains challenging, especially when classic radiographic findings are not seen. We review the clinical, radiographic, and pathologic diagnostic features of this lesion, as well as our current treatment algorithm.
Patients with severe cerebral palsy who underwent either a femoral head resection with traction or a McHale procedure (femoral head resection and valgus osteotomy) were studied retrospectively and then contacted by telephone to assess whether removing the femoral head or proximal femur as a salvage procedure improved sitting tolerance, relieved pain, or improved hygiene. Twenty-seven patients (36 involved hips) were available for a retrospective chart and x-ray review, and over half (56%) of these patients or caretakers were able to complete a telephone questionnaire. Of the study cohort, 16 patients underwent femoral head resection with traction and 11 patients had a McHale procedure. The average age at surgery was 19 years and average follow-up was 3.4 years. For those in the McHale group, the length of stay in the hospital was shorter, the postoperative superior migration of the femoral head was less pronounced, and the surgical and medical complications were lower. The telephone survey showed that both groups had increased sitting tolerance and decreased pain, and both showed overall satisfaction with the surgical outcome.
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