Shriners Children's is a network of non-profit medical facilities across North America. Children with orthopaedic conditions, burns, spinal cord injuries, and cleft lip and palate are eligible for care and receive all services in a family-centered environment, regardless of the patients' ability to pay. Care for children is usually provided until age 18, although in some cases, it may be extended to age 21.Headquartered in Tampa, Florida, the hospitals are owned and operated by Shriners International, formerly known as the Ancient Arabic Order of the Nobles of the Mystic Shrine, a Freemasonry-related organization whose members are known as Shriners. Patients are not required to have any familial affiliation with the Shriners order nor Freemasonry. The current[when?] advertising campaign for the healthcare system features the tagline, "Love to the Rescue.
Purpose Accurate classification of brachial plexus birth injury (BPBI) is critical for predicting outcomes and guiding early intervention. In 1987, Narakas introduced the first widely adopted system. Over time, misquotations and reinterpretations have obscured the work, conflating group definitions, exaggerating recovery rates, and misrepresenting prognosis. Methods This manuscript revisits Narakas’ original classification, traces misquotations, and clarifies their impact on management. We aim to provide the original publication as a reliable reference for contemporary care of BPBI. Results Group 1 involves Sunderland grade 1−2 injuries to C5 and/or C6, with 93% achieving full spontaneous recovery. Group 2 includes Sunderland grade 2−3 injuries to C5−6 and grade 1−2 to C7. Groups 1 and 2 present similarly, with slightly weaker elbow extension in group 2. The key differentiator is slower recovery of the upper trunk, not C7 involvement. Only 22% fully recovered. Group 3 involves Sunderland grades 4−5 for C5−C6, grade 3 for C7, and grades 1−2 for C8−T1. Five percent achieved a full recovery, and 15% had a satisfactory outcome. Group 4 involves Sunderland grade 5 injuries to C5−C7 with avulsion of C8. No patients achieved full or good shoulder recovery, 35% had fair elbow recovery, and hand/wrist recovery was poor. Conclusions BPBI is complex, with extensive sequelae if mismanaged. Narakas’ work provides critical guidance for prognosis and treatment. Misquotations have propagated inaccurate expectations and hindered care. Reprinting and disseminating the original classification and associated group outcomes clarifies prognosis, informs clinical decisions, and supports improved care. Our table and commentary provide an accessible reference to optimize BPBI care. Level of evidence IV.
Bone is a highly vascularized tissue, which is required for the metabolically demanding process of remodeling. Blood vessels are important in fluid movement occurring during bone mechanoadaptation. We hypothesized that in-vivo mouse tibial loading, which does not involve muscle contraction and exercise-associated cardiovascular effects, would lead to acute and chronic changes in femoral, saphenous, and popliteal artery structure and function, as well as bone vascular porosity coincident with adaptive bone (re)modeling. Sixteen, 26-wk-old female C57BL/6 J mice received two weeks of once, daily in vivo cyclic loading to the left tibia, resulting in increased cortical bone formation with minimal changes to trabecular bone. In vivo microCT-based timelapse morphometry revealed that most formation occurred on the endocortical surface. Ultrasonography showed changes to blood velocity after each loading episode (days 1, 3, 7, and 9) in saphenous and popliteal arteries, with the femoral artery adapting later. Chronic changes to blood velocity (Δ from baseline) were seen only in the femoral and popliteal vessels closely associated with the loaded tibia. Microfil contrast agent perfused into the vasculature showed minimal loading-induced changes in overall limb vascularity and confirmed targeted popliteal adaptation. Synchrotron tomography revealed greater cortical bone vascular canal porosity in the metaphysis, but not mid-diaphysis of loaded versus non-loaded tibiae. We measured an increased osteocyte lacunar number density surrounding blood vessels in loaded limbs, with no increase found in the canalicular density. Overall, loading led to both temporal and spatially dependent adaptation in the vasculature in the hindlimb and the bone tissue at the level of the primary limb arteries, intracortical bone blood vessels, as well as the osteocyte lacunocanalicular network architecture surrounding the blood vessels. These results highlight the critical role of local vascular dynamics in orchestrating bone adaptation, with implications for developing precision therapies that modulate the vasculature to enhance skeletal resilience.
Abstract Introduction Hand and finger burns are common in children and often lead to deformity and functional limitations. Despite the importance of hand function during development, few outcome tools are designed or validated for the pediatric burn population. HANDFULS is a new performance-based measure that evaluates in-hand manipulation and palmar workspace volume (PWV), two frequent impairments after burn injury. The aims of this study were to use HANDFULS to: 1) establish functional recovery trajectories for children during two years of recovery, and 2) compare hand burn outcomes to the performance of age-matched non-injured peers. Methods We conducted a prospective longitudinal cohort of 119 children (165 burned hands), assessing hand function at 2, 6, 12, and 24 months post-burn. Mixed-effects models with random intercepts for hand clustering evaluated change over time while controlling for confounders. PWV and HANDFULS scores were compared with non-injured peers and analyzed by surgical status. Reliability was examined using intraclass correlation coefficients. Results Participants averaged 8.5 years of age with mean TBSA 12.7%. Surgery was performed on 41% of hands, most commonly involved split-thickness skin grafting (30.3%). Table 1. PWV improved by 1.5 marbles (p=.005) and HANDFULS scores by 1.2 sec/marble (p=.002) over two years, with greatest gains observed between 2–6 months. Surgical patients had lower PWV at 2 months(–2.22, p=.001) and 6 months (1.28, p=.036) but there was no difference in HANDFULS scores, indicating preserved dexterity despite reduced PWV. Compared to non-injured peers, 45.2% (PWV) and 31.8% (HANDFULS) of children with hand burns were within normal limits at 2 months, which increased to 77.6% and 78.1%, respectively by 24 months. Figure. Conclusions HANDFULS is a simple, feasible and burn-specific hand outcome measure that demonstrated validity, reliability, and responsiveness. This longitudinal study with a robust sample of pediatric burn survivors demonstrated that the tool can objectively track hand recovery after burns and skin grafting and benchmark outcomes to noninjured peers. Its specificity to burn-specific hand problems allows it to better support clinical decision-making, guide rehabilitation, and improve long-term care after burn injury. Applicability of Research to Practice HANDFULS fills a critical gap in pediatric burn assessment and can support tailored interventions. Funding for the study Institutional Grant 72 001.
Evidence on developmental milestones in children with arthrogryposis multiplex congenita (AMC) under the age of five is scarce. This multisite cross-sectional study described developmental status and examined factors associated with milestone attainment in 143 children aged 0-66 months from a pediatric AMC Registry. Development was assessed using the Ages and Stages Questionnaire, Third Edition (ASQ-3), across Communication, Gross Motor, Fine Motor, Problem-Solving, and Personal-Social domains. Independent variables included demographic, perinatal, clinical, and parental factors. Gross Motor function was the most limited domain, with more than 90% scoring close to/below the ASQ-3 domain-specific cutoff (≥ 2 SD below normative mean). Personal-Social scores were unexpectedly low, and Fine Motor limitations were also frequent, with 53.1% scoring close to/below the cutoff. Communication and Problem-Solving were relative strengths. Longer neonatal intensive-care unit stays were linked to poorer Communication and Fine Motor scores, and higher birth weight was associated with better Problem-Solving performance. Specific joint contractures, particularly those affecting the neck, shoulder, elbow, and knee, were associated with lower performance across domains, while higher parental education was related to better Personal-Social outcomes. Developmental attainment in AMC is shaped by interactions among musculoskeletal, perinatal, and family factors, underscoring the importance of early, coordinated orthopedic, developmental and family-centered interventions.
