Acro-osteolysis.

Acro-osteolysis is an osteolysis of the distal phalanges of the hands and feet and can affect the terminal tuft or the shaft of the distal phalanx (transverse or band acro-osteolysis). It is often associated with distal digital ischemia, digital calcinosis, or severe sensory neuropathy. Acro-osteolysis has been associated with a heterogeneous group of disorders, including occupational activities, infections, rheumatic disorders (systemic sclerosis, psoriatic arthritis), endocrinopathies, genetic disorders, and lysosomal storage disorders. Plain radiography is the gold standard for the detection of acro-osteolysis.

Treatment of massive acetabular bone loss and pelvic discontinuity with a custom triflange component and ilio-sacral fixation based on preoperative CT templating. A report of 2 cases.

Revision rates for total hip arthroplasty are increasing and pelvic discontinuity is estimated to be present in 1% to 5% (Berry). Discontinuity is defined as a separation of the cephalad portion of the pelvis from the caudad portion (AAOS Type IV defects). This results from bone loss secondary to osteolysis, infection, fracture, or mechanical loosening. The goals of revision surgery in this setting are to obtain secure fixation of the acetabular component with or without union of the discontinuity. Many methods exist for treating this problem. Results with allograft and cage fixation have generally been poor (Berry, Hansen). More favourable outcomes have been reported using either a cup cage technique or custom triflange (Gross, Christie). The custom Triflange component is designed based on preoperative imaging with CT scan to manufacture a custom titanium implant to address the patient's specific bone loss pattern and obtain secure fixation in the ilium, pubis, and ischium. However, we have encountered cases of acetabular discontinuity with massive pelvic bone loss in which bone stock in the ilium was insufficient to provide support for proximal fixation of a conventional custom triflange component. Currently in the trauma patient population posterior pelvic ring disruptions are being treated with ilio-sacral screw fixation. The sacrum provides a source of secure bony fixation for these injuries. We report on 2 patients with pelvic discontinuity and massive bone loss using a technique to obtain proximal fixation of a custom triflange component into the sacrum.

Bone loss in limbs with decreased or absent sensation: ten year follow-up of the hands in leprosy.

Three hundred and sixty-seven patients with insensitive hands have been studied by correlating radiologic findings with occupational and medical history in order to better define causal factors in bone resorption. This study indicates that nonspecific infection and trauma are the reasons for bone resorption in 98% of cases. The role of intermittent pressure seems to be in soft tissue breakdown, which then allows bone to become infected. Bone resorption can be arrested at any stage of the disease by appropriate therapy of splinting and control of infection.

[Bone changes in Hansen's disease]. / Knochenveränderungen bei Morbus Hansen.

Bone lesion is a frequent organic manifestation in leprosy. Osseal destructions caused by granulomatous process induced by M. leprae are so-called specific lesions in contrast to non-specific lesions based on nerval or arterial diseases. The specific osseal alterations are characterized by cystic brightenings in roentgenograms while non-specific osseal changes show absorption to bone structure as akroosterolysis and osteoporosis. Typical radiologic findings in different stages of mutilation are demonstrated.

Skeletal deformities of the denervated hand in Hansen's disease.

Skeletal deformities of the denervated hand are subtle in their development and pose a more formidable problem than do primary deformities of Hansen's disease. Basic osseous changes consist of concentric, longitudinal, or the longitudinal varying methods of absorption. Knowledge of their pathogenesis provides the basis for their management. Prevention of deformity and conservative management of secondary complications are necessary to salvage as much of the hand as possible.