Ann G. Bjorkengren

Destructive spondyloarthropathy in hemodialysis patients

A destructive spondyloarthropathy is reported in four patients undergoing maintenance hemodialysis for chronic renal disease. In a separate investigation a controlled, prospective radiographic study of the cervical spine revealed this spondyloarthropathy in 4 (15%) of 26 long-term dialysis patients. A single disc level was involved in three patients, and two disc levels were involved in one patient. This spondyloarthropathy correlated with the duration of dialysis but not with the radiographic evidence of renal osteodystrophy or severity of laboratory abnormalities associated with hyperparathyroidism. Three of these four patients also had discovertebral erosions or destruction involving the lumbar spine. Cervical spine flexion views revealed evidence of ligamentous laxity or instability in three (12%) dialysis patients, all with vertebral resorption and disc space narrowing. It is postulated that this instability may contribute to the development of cervical discovertebral lesions or be a secondary manifestation of disc destruction.

Isolated Dislocation of the Tarsal Navicular: A Case Report*

Isolated dislocation of the tarsal navicular is a rare injury that is not mentioned in standard orthopedic textbooks and described only once in the English literature. Because of the rarity of this condition, the best means of treatment has not been established. A patient with this unusual dislocation was recently diagnosed and treated. Open reduction was eventually required, which was followed by the development of ischemic necrosis of the navicular.

Case report 764

Fig. 2. Midline sagittal Tl-weighted magnetic resonance (MR) image of the left knee demonstrates the joint effusion (arrowheads), extraosseous soft-tissue component (black arrows), and extension of the epiphyseal lesion into the metaphysis (white arrows). The lesion and surrounding edema are of intermediate signal intensity. Intercalation of tumor through the superior tibial cortex can be seen Clinical information