Para-articular Calcification Research Articles

AB0648 Clinical and Radiological Hand Involvement in Systemic Sclerosis (SSC) Comparison between Diffuse and Limited Cutaneous Ssc

ObjectivesTo determine the prevalence, clinical characteristics and radiographic findings of hand abnormalities in SSc patients in a cross sectional study, as well as to compare those differences among SSc subgroups.MethodsSSc...

Wear measurements of hip prostheses with UHMW polyethylene (RCH-1000) socket and chromium plated protasul-10 head (author's transl)

An estimation of wear was carried out on 100 of 340 UHMW polyethylene sockets (RCH 1000) that were implanted with Protasul-10 prostheses furnished with a chromium plated head. This was effected by measuring the position of the head relative to the socket as seen on radiographs during a follow-up period of 4 years. The method employed was verified in 3 cases (in which the socket had been removed) by measurements on silastic casts of the bearing surface. Practically no difference in the results was observed. The average wear rate amounted to 0.16 mm/year over an observation period of 4 years. Furthermore, it has been observed that para-articular calcification seems to be independent of the amount of abrasive debris present. It seems rather to depend on other factors, such as the size of the haematom, degree of muscle necrosis, etc.

Experiences with Wagner's cup prosthesis

Surface replacement is an alternative procedure especially in younger patients who absolutely need hip replacement. Accurate diagnosis is imperative and the range of indications is naturally small. A follow up study of 44 patients (range, 10 months to 4 years) showed 2 loosenings (5%); other severe complications were not seen. In 39 (89%) hips was no more pain after operation and there was a distinct improvement of motility in 39 (89%) cases. Avascular necrosis should not be treated by surface replacement. Primary inflammatory diseases (rheumatoid arthritis) seem to have a higher incidence of complications, especially when long time treated with large doses of steroids. Cortisone medication promotes avascular necrosis of the hip and lytic enzymes coming from the pannus might be another reason for loosening. According to our experience the position of the cup according to varus or valgus has no influence on the result of the operation. The Watson-Jones approach seems to be better than the approach recommended by Wagner, because paraarticular calcifications are seldom seen.

DETECTION OF LOOSE BODIES IN JOINTS

The ability of US to diagnose intra-articular loose bodies greatly depends on a high degree of suspicion of the examiner, related to the knowledge of radiographic and clinical findings. Nowadays, radiography is still the modality of choice when a loose body is suspected on clinical grounds. Plain films are panoramic and not expensive. If a calcified image consistent with a loose body is shown on radiographs, US can be performed to prove its intra-articular location and rule out para-articular calcification. The size, position (recess, bursa), and macroscopic composition (osseous, osteochondral) of loose bodies can be reliably evaluated. Additional findings, including mobility of loose bodies, presence of joint effusion, and synovial proliferation, can also be assessed with US. Detailed knowledge of the normal anatomy of joints and related structures is, of course, an essential requirement to investigate loose bodies. If the fragment is not found in the expected location, other joint recesses and bursae must be explored, because a fragment can change position with time. In addition, the US appearance of loose bodies has to be known by sonographers dealing with the musculoskeletal system because an intra-articular fragment can be found during routine examination of a joint performed before standard radiographs. There are a number of limitations on the clinical usefulness of US in this field. Although US is able to differentiate between single and multiple loose bodies, the exact number of the fragments cannot always be established. In osteochondral fractures, information on the posttraumatic damage to other intra-articular structures, such as ligaments or menisci, cannot be obtained by US. Furthermore, because US can evaluate only a portion of the articular surface, in most patients it is not able to demonstrate the site from which the fragments detach, as well as show their overall size and gross appearance. In conclusion, loose bodies are consistently depicted with US. A high degree of suspicion, knowledge of the radiographic studies, as well as a careful scanning technique, however, are essential to obtain a reliable diagnosis of loose bodies. US is able to support plain films to confirm the intra-articular location of a calcification around a joint. During routine joint examination, US can recognize loose bodies as incidental findings.

Fixation of the endoprosthesis stem with muracito cortical bone allograft

Endoprosthesis replacement of the femoral head for neck fractures in elderly and senile patients is the method of choice [1]. However, when using it, a number of significant factors should be taken into account. Bone tissue in this category of patients, as a rule, is porotic and characterized by increased fragility, the medullary canal is significantly expanded. Therefore, after the operation and subsequently, loosening of the endoprosthesis often occurs with all the ensuing consequences, such as pain, swelling of the limb, instability in the hip joint, inflammation, paraarticular calcifications. To ensure stable fixation of the endoprosthesis stem in the medullary canal of the femur, special cement, fragmented spongy auto- or allogeneic bone, hydroxyapatite glue, etc. are used [26]. However, these measures do not exclude the occurrence of a suppurative process, the development of micromobility, loosening and instability of the endoprosthesis.

Prevention of Osteitis Fibrosa, Aluminium Bone Disease and Soft-Tissue Calcification in Dialysis Patients: A Long-Term Comparison of Moderate Doses of Oral Calcium±Mg(OH)<sub>2</sub> vs Al(OH)<sub>3</sub>±1α OH Vitamin D3

Since 1980, moderately large doses of oral calcium (80 +/- 35 mmol/day as CaCO3 +/- calcium polystyrene sulphonate), in association if necessary with Mg(OH)2 (2.5 +/- 1 g/day), with a reduction in the dialysate Mg concentrations from 0.75 to 0.375 mmol/24 h, have replaced A1(OH)3 as phosphate binders in our centre. A1(OH)3 was previously given to our haemodialysis patients in association with small doses of Ca CO3 (less than or equal to 3 g/day) and if necessary with 1 alpha OH vitamin D3. To compare the long-term efficacy of this new approach with the former one in the prevention of renal osteodystrophy and soft-tissue calcification, 32 current patients were selected on the basis of at least 24 months of treatment in our centre and availability of a yearly bone survey (profile of lumbar spine and anteroposterior view of the pelvis, shoulders and hands). A group of 30 patients treated before 1980 were then selected on the same criteria and matched for age, sex, and duration on dialysis. Linear calcifications of the anterior and posterior walls of the aorta in front of L2, L3, L4 and on the lateral walls of the iliac and femoral arteries were measured and the para-articular calcifications and subperiosteal resorptions of the hands evaluated. The initial extent and the subsequent increase of the ocular and para-articular calcification were comparable in the two groups. Plasma alkaline phosphatase was stable in the normal range in both groups, as was plasma concentration of calcium. Plasma phosphate was slightly elevated (1.7 mmol/l) but stable and comparable in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Hereditary diffuse articular chondrocalcinosis. Dominant manifestation without close linkage with the HLA system in a large pedigree.

Thirty-nine members of one family, covering three generations, were HLA-typed. Twenty-five suffered from primary diffuse articular chondrocalcinosis, and all had the same dominantly transmitted autosomally controlled disease. This was characterized by acute articular attacks, which always started before the age of 35, and radiologically by typical cartilaginous and fibrocartilaginous deposits associated with para-articular calcifications. The lesions were both peripherally and axially generalized. None of the 28 HLA antigens tested seemed related to the disease, nor did the disease segregate with an HLA haplotype.

Para-articular ossification, a complication of anterior poliomyelitis; a case report.

The development of para-articular ossifications associated with anterior poliomyelitis is considered an unusual complication, although para-articular calcification and ossification are not infrequent sequelae of traumatic paraplegias or cord lesions with accompanying sensory deficits. Drehmann (1) in 1927 reported a case of para-articular calcification following acute anterior poliomyelitis in a boy two and a half years old. Three cases of myositis ossificans, all in adults, were published in 1951 by Costello and Brown (2). In 1952 Freiberg (3) reported an unusually extensive case of calcification and ossification of hips, shoulders, and metacarpophalangeal joints, and cited 2 other cases, in adults, with extensive calcifications in the hip regions. The authors recently observed an extensive ossification of the left hip in a patient in the convalescent stage of acute anterior poliomyelitis. This complication seems not to have been reported previously in the roentgen literature, except as noted by Caffey (4). B. R., a 12-year-old white girl, was admitted to South View Isolation Hospital on Sept. 10, 1955, with poliomyelitis, confirmed by laboratory findings. The immediate hospital course was one of progressive weakness of all extremities, most pronounced in the right arm and left leg. After an initial ten-day isolation period, the patient was transferred to St. Luke's Hospitals, where, in addition to the above findings, numbness of the left anterior thigh was noted. The prescribed post-polio treatments were given during the succeeding three months, but the response was not as anticipated, in that posture became progressively poorer as a result of contractures of the left hip. A careful review of the family and personal history revealed no evidence of local injury or disease of the left hip, or of previous significant illness. Preparatory to surgery for correction of contractures of the hip, roentgen studies were done on Jan. 6, 1956. These revealed an extensive para-articular ossification (Fig. 1). Laminagraphy of the involved area failed to reveal any evidence of fracture or intrinsic disease in the femur. Complete skeletal surveys showed no similar involvement elsewhere. Relevant laboratory findings were: serum total protein, 7.3 gm. per cent; serum phosphorus, 4.6 mg. per cent; serum calcium, 10.4 mg. per cent; alkaline phosphatase, 7.4 Bodansky units. Follow-up x-ray studies during the succeeding six months revealed findings consistent with bone of increasing maturity (Fig. 2). Surgical extirpation was considered advisable because of the extreme flexion contractures and fixation of the hip. Operation was performed on June 29, 1956, ten months after onset of the disease. The major muscle groups were identified and found not to be replaced by ossifying tissue.

PARA-ARTICULAR CALCIFICATION AND OSSIFICATION FOLLOWING ACUTE ANTERIOR POLIOMYELITIS IN AN ADULT

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CALCIUM DEPOSITS IN THE SHOULDER AND SUBACROMIAL BURSITIS

The title of this paper is purposely indefinite. It is intended to cover calcium deposits observed in the tendons of the four short rotator muscles of the shoulder and the inflammatory condition of the overlying serous bursa to which these deposits not infrequently give rise. That others have experienced difficulty in devising an appropriate label for this pathologic entity is well attested by the diversity of captions used by many who have written on the subject in the last two or three decades. It has been described as periarticular calcifications, 1 paraarticular calcifications, 2 or subdeltoid calcifications, 3 humeroscapular or scapulohumeral periarthritis, 4 para-arthritis, 5 Duplay's disease, 6 calcified bursitis, 7 calcic bursitis, 8 calcification of the subacromial bursa, 9 rheumatism or neuritis 10 and painful shoulder. 11 The fact remains that calcium deposits in the tendinous cuff which forms the capsule of the shoulder joint have for some

Pellegrini-Stieda's Disease

Introduction PELLEGRINI-STIEDA'S disease is a post-traumatic disorder of the knee in which roentgen opacities appear near the internal condyle of the femur, but do not, as a rule, become manifest until two to three weeks after injury to the knee (1). Because each of the terms calcification and ossification have been applied to such roentgen opacities, confusion has arisen pertaining to which represents the true pathologic condition of this disorder. The exactitude of Pellegrini-Stieda's disease, as a disease entity, has also suffered because of conflicting reports pertaining to the structures of the knee it affects, and because similar changes occur about other joints after trauma. Explanations will be proffered as to why para-articular calcification or ossification may occur after trauma, and a theory advanced pertaining to why certain joint structures seem more prone than others to become the seat of such pathologic processes. To indicate that Pellegrini-Stieda's disease is but a local manifestation of ...