A. G. Jurik

Chronic Recurrent Multifocal Osteomyelitis: A Follow-up Study

Thirteen children/adolescents and two young adults with unifocal or multifocal nonpyogenic inflammatory bony lesions with a prolonged, fluctuating course are reported. The lesions were most often located at the metaphyseal region of tubular bones and the clavicle, but also at the spine, ischiopubic bone, and the sacroiliac joint. Progressive sclerosis and hyperostosis occurred mostly in the clavicle and occasionally in the tibia, femur, metatarsal, and ischiopubic bone, linking the changes to those described under the name Garre osteomyelitis. Seven patients had pustulosis palmoplantaris, and the skeletal disorder may be regarded a form of pustulotic arthroosteitis.

Anterior chest wall involvement in patients with pustulosis palmoplantaris

With the aim of determining the frequency and radiographic features of anterior chest wall involvement in patients with pustulosis palmoplantaris, a questionnaire was sent to 107 patients. Ninety-three patients returned the questionnaire, five of whom were excluded from further analysis due to the appearance of psoriatic lesions. Twenty-five (28%) of the remaining 88 patients reported pain and/or swelling of joints or bones in the anterior chest wall. All were examined radiographically, using tomography, and a group of 20 patients without anterior chest wall complaints were examined similarly. Sixteen of the patients with, but none of the patients without, complaints were found to have arthro-osteitis of the anterior chest wall, consisting of diffuse sclerosis of the manubrium sterni in one patient, localized sclerosis in seven patients, and sequelae of arthritis of the sternoclavicular, upper sternocostal and/or manubriosternal joint in eight patients.

Frequency of skeletal disease, arthro-osteitis, in patients with pustulosis palmoplantaris

Fourteen randomly selected patients with pustulosis palmoplantaris were examined to determine the frequency of skeletal involvement. Symptoms and both clinical and radiographic signs of skeletal disease occurred in five patients (36%). Four patients had erosive and/or sclerotic changes in the region of the sternoclavicular, the first sternocostal, and/or the manubriosternal joint, in two with additional ossification of the costoclavicular ligament. Two patients had spinal involvement, one paravertebral ossifications, and the other sequelae of anterior spondylodiskitis. Peripheral joint complaints without radiographically detectable erosions, but with periarticular new bone formation, occurred in three patients. The skeletal changes are probably not incidental and seems to constitute a seronegative spondyloarthropathy associated with pustulosis palmoplantaris.

Inflammatory hyperostosis and sclerosis of the clavicle

Six cases with chronic inflammatory hyperostotic and sclerotic changes of the clavicle are reported. No causative organisms could be detected. Four patients had involvement of other bones including the thoracic spine, the femur, the tibia and the sternal end of the other clavicle. These may be classified as having “chronic recurrent multifocal osteomyelitis” (CRMO). The remaining two patients with similar clavicular changes might have an, as yet, unifocal CRMO.

Prevention of thromboembolism in hip-fracture patients. Comparison of low-dose heparin and low-molecular-weight heparin combined with dihydroergotamine.

SummaryIn a prospective, double-blind, controlled study, we compared the antithrombotic efficacy of low-dose heparin with dihydroergotamine (A), low-molecular-weight heparin with dihydroergotamine (B), and placebo (C). Two hundred and thirteen patients surgically treated for fractures of the hip were randomly divided into three groups. One hundred and sixty-one patients were analyzed. All thrombi were verified by ascending phlebography. Nine patients died within 1 month after operation. A and B proved to be equally safe but failed to provide any protection against deep-vein thrombosis, although B showed a tendency to reduce the incidence. Mortality within 1 month of operation was unaffected by the type of prophylaxis.

A method for assessing the height of the patella

SummaryIn 150 normal subjects the distance (P) between the upper and lower limits of the articular surface of the patella, and the shortest distance (T) between this same lower limit and the tibial plateau, were measured in standard lateral views of the knee in about 30° of flexion. The limits of confidence of the T/P ratio are shown in the Table. The 5% upper limit of normality of this ratio is 1.11 (one-sided). This method of determining the position of the patella is accurate and more simple than those previously described.RésuméOn a mesuré chez 150 sujets normaux, sur des profils standard du genou à 30° de flexion environ, la distance (P) entre les limites supérieure et inférieure de la surface articulaire de la rotule et la plus courte distance (T) entre cette même limite inférieure et le plateau tibial. Les valeurs du rapport T/P sont notées sur la tableau. La valeur de ce rapport, 5% supérieure à la normale est de 1.11. Cette méthode de mesure de la situation de la rotule est précise et plus simple que celles qui ont été précédemment décrites.

The use of computed tomography with two- and three-dimensional reconstructions in the diagnosis of three- and four-part fractures of the proximal humerus

Spiral computed tomography (CT) with three-dimensional and multiplanar reconstructions was used to assist in the diagnosis of three- and four-part fractures of the proximal humerus in 10 patients. CT added important information to that obtained by conventional radiography in four patients. It verified impaction of the capital fragment in two patients. In a patient with a four-part fracture metaphyseal attachment to the head fragment was demonstrated and in a patient with a three-part anterior fracture dislocation an osseous Bankart lesion was shown. In all patients CT clearly visualized the degree of displacement of tuberosity fragments which can be valuable when planning open reduction and internal fixation.

Seronegative arthritides of the anterior chest wall: a follow-up study

Fourteen patients with arthritis of the anterior chest wall (ACW) as part of ankylosing spondylitis, reactive arthritis, and arthritis associated with psoriasis and/ or pustulosis palmoplantaris (PPP) were re-examined after periods of 5–15 years (mean 9 years) using tomography. The findings were compared with those of 24 similarly examined patients with predominant osseous sclerotic ACW lesions or monarthritis of the manubriosternal joint. Pronounced osseous hyperostosis in the region of the sternoclavicular joint accompanied by ossification of the costoclavicular ligament was found to occur only in patients with PPP lesions. Patients with ankylosing spondylitis and reactive arthritis developed slight or moderate hyperostosis only and no ligament ossification. Predominant osseous sclerotic sternal and clavicular lesions occurred in patients with PPP and in patients without skin disease or traits suggesting well-known arthritides, but not as part of ankylosing spondylitis and reactive arthritis. Arthritis of the manubriosternal joint and upper sternocostal joints developed in all forms of arthritis.

Chronic sclerosing osteomyelitis of the iliac bone. Etiological possibilities

An adolescent with chronic recurrent multifocal osteomyelitis located to both iliac bones and an adult with pustulotic arthro-osteitis, involving the left iliac bone, an invertebral space, and the sternoclavicular, first sternocostal, manubriosternal and single peripheral joints are described. Their iliac bone changes were identical, except for the occurrence of bilateral changes in the adolescent, and ankylosis of the sacroiliac joint in the adult. It is suggested that chronic recurrent multifocal osteomyelitis and pustulotic arthro-osteitis may be related diseases with age-dependent differences.

Sclerotic changes of the sternal end of the clavicle.

Five adult females with swelling, tenderness and similar sclerotic changes of the sternal end of the clavicle are presented. They were recognised during a 10-year period, suggesting that the condition is rare and may be misdiagnosed. In three patients strain of the sternoclavicular joint seemed to be an aetiological factor.