RT Journal
A1 Kulaylat NA, Narchi H, Tunnessen WW, Jr
T1 PIcture of the month
JF Archives of Pediatrics & Adolescent Medicine
JO Archives of Pediatrics & Adolescent Medicine
YR 2001
FD March 1
VO 155
IS 3
SP 407
OP 408
DO 10.1001/archpedi.155.3.407
UL http://dx.doi.org/10.1001/archpedi.155.3.407
AB 
A 4-MONTH-OLD infant with musculoskeletal anomalies had a history of poor feeding and hypotonia. He was born by breech delivery to a multigravida mother whose pregnancy was complicated by oligohydramnios and decreased fetal movements. At birth, the infant's hips were dislocated and a right femur fracture was detected. On physical examination, the infant had a round face with a midline, glabellar nevus flammeus and an upturned nose. A nasogastric tube was in place for feeding (Figure 1). The shoulders were sloped and internally rotated, and the left elbow was fixed in extension with flexion contractures of the wrist and hand in a "policeman tip" position (Figure 2). The lower extremities had decreased muscle mass with flexion contractures of both knees and talipes equinovarus deformities of the feet. Findings from laboratory studies were normal, including a serum creatine kinase, computed tomography of the brain, and electromyography. The karyotype was 46 XY.