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At least 523 records · Page 29Linked to original sources

Multiple osteochondroses of bilateral knee joints: a case report.

Knee injuries in young athletes include not only the typical adult bone injuries, ligament and cartilage, but also the growth plate lesions. Osteochondroses are idiopathic, self-limited disturbance of enchondral ossification in which a rapid growth spurt is present. The patella could be affected by two different kinds of osteochondroses: Kohler syndrome and Sinding-Larsen-Johansson. Here we are reporting the first case of simultaneous location of osteochondroses of the two ossification centers of both patella. A 9-year-old boy, competitive skater, presented a history of anterior knee pain involving both knees. Standard X-rays, axial patellar view, MRI and arthro-MR were performed. In order to follow the natural history of the pathology and the evolution of the healing, examinations at 2 years were repeated. We proposed the young skater a medical and a physiotherapeutic treatment based on unloading, isometric exercises, NSAID. As the symptoms improve a gradual return to competitive sports activity was allowed. The case mentioned above can be considered an atypical case because the patient suffered for a bilateral knee osteochondroses, involving simultaneously the primary ossification centre (Kohler syndrome) and the secondary ossification centre (Larsen syndrome) of the patella.

Arthroscopy↗

[Transplantation of a bone with muscle pedicle in a case of pathological fracture of the femur neck].

Authors performed an operation for danger of fracture in case of extensive cystic fibrous dysplasia, localized in the femoral neck. The cyst was filled after refreshing its walls, with cancellous bone. To increase ossification a cortico-spongious bone cube, gained from the trochanter major and with retained connection with the insertion of the anterior third of the medial gluteus muscle was inserted in the area filled. The transplanted bone was fixed with an autologous fibular graft. Half a year after the operation bony transformation and good functional result could be observed.

Adult↗

Cervical cord compression secondary to ossification of the posterior longitudinal ligament.

STUDY DESIGN: Resident's case problem. BACKGROUND: A 52-year-old Chinese male with a 10-year history of gradually worsening right hip stiffness, weakness, and pain was referred to physical therapy by his orthopedist, who made a diagnosis of developmental dysplasia of the right hip, with possible Legg-Calve-Perthes disease. The patient reported multiple falls over the last several years and a gradual onset of low back pain with an onset of "electricity" down both legs. The patient also reported mild numbness in both forearms and the right hand over the previous several months. This resident's case problem illustrates how a physical therapist recognized the presence of an atypical musculoskeletal pathology through the use of hypothesis-driven clinical reasoning and detailed physical examination. DIAGNOSIS: Examination of the patient's lumbar and cervical spine and hips revealed joint dysfunctions. Neurological testing revealed hyperreflexia. Special testing revealed lower extremity clonus with a positive Babinski sign with gait disturbances. The patient was referred back to his primary physician and then to a neurologist and neurosurgeon. An MRI revealed cervical myelopathy due to ossification of the posterior longitudinal ligament from C3/C4 to C5/C6. The patient then underwent a C3 through C7 laminectomy. DISCUSSION: It is always imperative that sound clinical reasoning be used when performing physical therapy evaluations, regardless of the referral status of the patient. Patients with nonmusculoskeletal pathology may seek physical therapy services and it is the physical therapist's responsibility to complete a thorough examination and refer to specialists when appropriate.

China↗

Soft tissue involvement, mediastinal pseudotumor, and venous thrombosis in pustulotic arthro-osteitis. A study of eight new cases.

A syndrome of hyperostosis of the thoracic wall, nonspecific signs of inflammatory disease, and palmar and plantar pustulosis is described in eight patients (Table 1). Seven had intersternocostoclavicular ossification, and one had chronic recurrent multifocal osteomyelitis. This complex of findings has been called "pustulotic arthro-osteitis". This report emphasizes the periosseous soft tissue inflammation and the unexplained subclavian and mediastinal vein thrombosis seen in two patients. Inflammatory periosseous and mediastinal lesions were seen on plain films in all eight patients and on computed tomographic (CT) scans in seven. Radiographs of the spine showed a spondyloarthropathy in three patients. This was characterized by ossification of the vertebral ligaments and sclerosis of the vertebral bodies. Awareness of the radiologic features of pustulotic arthro-osteitis is important because the clinical, biochemical and pathologic findings are often nonspecific and misleading.

Adult↗

Assessment of talus deformity by three-dimensional MRI in congenital clubfoot.

PURPOSE: To evaluate the morphological deformity of talus in congenital clubfoot by three-dimensional MRI. MATERIAL AND METHOD: Subjects were five patients (two male, three female, mean age 5 months) with unilateral congenital clubfoot. Magnetic resonance imaging was performed of both feet using 1.5 T magnet. Based on the resulting magnetic resonance imaging volume data, a three-dimensional surface bone model was reconstructed by the Marching Cubes method. The long axis of the reconstructed model was determined, and in relation to the standard planes including this axis, the degree of talar head and neck deviation, and the relative positioning of the talus and navicular in the talonavicular joint were compared between normal foot and clubfoot. RESULT: The talar head and neck angle in relation to the talus exhibited significant medial deviation in the clubfoot, but the degree of plantar deviation of the talar head and neck did not show significance. The navicular was located more medially in clubfoot than in normal foot. The volume of the total talar and of the ossific nucleus for the clubfoot was smaller than that for the normal foot. CONCLUSION: The assessment technique presented herein was shown to be useful in ascertaining the various pathological characteristics associated with clubfoot.

Ankle Joint↗

[Unusual radiological and clinical findings in a calcified chronic extradural haematoma (author's transl)].

In three of 32 patients with epidural haematomas calcifications and ossifications of the bleeding were found. Quickly developing (3 to 7 weeks) ossifications could be demonstrated by repeated X-rays and CT of the skull in partial drained or untreated haematomas. No ossification could be observed in the remaining 29 cases, in which the haematomas were completely removed. The growth of the ossification from the parietal to the visceral side within the capsules of the haematomas could be monitored in its progress by CT and was histologically verified. The underlying pathological mechanisms are discussed.

Adult↗

[Pain in the internal knee compartment].

The anatomical classification of the traumatic or non traumatic lesion gives a mnemotechnical list which assists in the etiological search for pain of the inner aspect of the knee: skin, sub cutaneous tissue, medial lateral ligament, meniscus, cartilage, sub chondral bone, cruciate ligaments. Each mean of imaging detect specific lesions according to its technical capabilities: standard X Ray film, arthrography, CT scanner, MRI, bone scintigraphy, and echography. In practice, strategy is adapted to the clinical presentation, traumatic or non traumatic. In emergency situations, one is looking for bone, ligamentous, and meniscus lesions. Without acute traumatism, one can discover ligamentous tear sequellae (Pelligrini Stieda's ossifications), transient osteoporosis (algodystrophy), degenerative lesions (arthrosis) of the inner compartment. Always remember "close to the knee", it is necessary to check for more serious infectious or tumoral pathology. If standard plain films remain the first means of examination, and are still useful, MRI is becoming increasingly necessary for a complete anatomical evaluation.

Diagnosis, Differential↗

Osteochondrosis of the tarsal cuneiforms.

The osteochondroses are a conglomerate of bony lesions that share similar clinical, radiographic, and pathologic features. While almost any bone may demonstrate the features of this disease process, involvement of the tarsal bone is very rare. Some type of disorder of enchondral ossification is thought to be the common etiologic link in the development and manifestation of tarsal cuneiform osteochondrosis. The course of the disease process is benign and self-limited. The treatment is symptomatic.

Child↗

Meyer's dysplasia epiphysealis.

Meyer's femoral cephalic dysplasia (FCD) is a rare affection that is often confused with Perthes' disease from which it differs in terms of both treatment and prognosis. A constant feature is the absence of the nucleus of ossification that does not occur until 15-18 months of age; at times there are multiple nuclei of ossification, so that the epiphysis has a "morulated" aspect. Fusion of the various centers of ossification occurs at about 5 years of age. The epiphysis does not collapse and it preserves its density and its structure. Differential diagnosis involves Perthes' disease and other pathologies such as multiple dysplasia epiphysealis, hypothyroidism, dyschondroplasia.

Child, Preschool↗

Sternocostal joints. Anatomic, radiographic and pathologic features in adult cadavers.

Using radiographic-pathologic correlation, we studied the sternocostal joints derived from 27 consecutive cadavers and one additional cadaver with rheumatoid arthritis. Radiographic findings that were tabulated included joint space narrowing, sternal or costal osteophytes, articular calcification, vacuum phenomena, and the degree of ossification of the costal cartilages. The first sternocostal joint could be classified as either a synchondrosis or synostosis in every instance; however, a joint cavity lateral to the first sternocostal joint represented a normal variation and was seen radiographically in 10 specimens. The second sternocostal joint was synovial in type and intimately related to the manubriosternal joint; cavitation within this joint was present bilaterally in 36% of our specimens. Degenerative changes in the sternocostal articulations were characterized much more frequently by sternal osteophytes than by costal osteophytes or joint space narrowing. Calcification compatible with chondrocalcinosis was observed in two cadavers. Radiographic and pathologic evidence of synovial inflammation was evident in the sternocostal joints of the rheumatoid specimen.

Aged↗

[Growth disorders of the acetabular roof after acetabuloplasty in congenital hip dysplasia].

PURPOSE: The aim of this long-term study was to evaluate whether the Lance acetabuloplasty for congenital dysplasia of the hip causes a growth disturbance of the acetabular roof during or after puberty. METHOD: 71 hips of 58 patients were followed clinically and radiologically over a maximum time of 16 years after the operative procedure of a Lance acetabuloplasty. The average age of the patients at the time of operation was 2.8 years (1-6 years). In order to assess the growth of the acetabulum in the early and long-term postoperative phase quantitative parameters (acetabular index of Hilgenreiner, CE angle of Wiberg, ACM angle of Idelberger) as well as qualitative parameters (disturbance of the ossification of the acetabulum and the femoral head) were determined in standardized X-rays of the pelvis, done routinely 6 months, 3 years, 5 years, 8 years and at an average of 11 years as the last follow-up examination after the operation. The assessment of these metrical parameters were carried out in accordance to the classification of the study-group "hip dysplasia" of the DGOT (normal--slight pathological--serious pathological) respecting the different age-groups and degrees of dysplasia. RESULTS: Although in the early postoperative phase the acetabular roof showed a positive development (65% of the CE angles could be considered normal 3 years after operation), the further growth of the acetabulum was disturbed in the period of puberty (8 years after operation only 33% of the CE angles could be considered normal, 51% were extremely pathological). And also in the last X-ray control after an average follow-up time of 11 years a significant retardation of the acetabular roof was seen in 51% of all cases. CONCLUSION: The Lance acetabuloplasty seems to damage the Ossa acetabuli, which are as centers of ossification the essential anatomic structures for the growth of the acetabular rim in adolescence. CLINICAL RELEVANCE: Other procedures such as the Salter osteotomy are to be preferred for the therapy of hip dysplasia.

Acetabulum↗

Coexistence of melorheostosis and DISH in a female skeleton from Magna Graecia (Sixth Century BC).

This paper reports on a case of massive hyperostotic alterations observed in the skeleton of an adult woman from the necropolis of Montescaglioso Belvedere (Basilicata, Southern Italy) attributed to the Enotrian culture and dated to the 6th century BC. Hyperostotic changes involve joints, the vertebral column, and the lower limbs. In particular, the large flowing ossification in both the thoracic (T6-T10) and lumbar (L2-L5) tracts, the sacralization of L5, accompanied by sacroiliac fusion on the left side, and the proliferative bone production on both the metaphyseal portion of the left tibia and the left third metatarsal are described. The vertebral antero-lateral ossification and the sacroiliac fusion support a diagnosis of diffuse idiopathic skeletal hyperostosis (DISH), while the flowing bone formation on the lower limbs supports a diagnosis of melorheostosis. The pathological conditions described here were already described in the literature, but this is the first reported case of the coexistence of DISH and the very rare melorheostosis. Furthermore, the skeleton from Montescaglioso Belvedere represents the first case of this disease described for ancient Europe, therefore adding a valuable contribution to the reconstruction of the antiquity and distribution of skeletal dysplasias.

Female↗

Granulomatous meningitis as a late complication of iodized oil myelography.

The present report is an autopsy case of an 83 year old man with severe kyphoscoliosis and granulomatous meningitis as a late complication of iodized oil myelography. He suffered from mild cognitive impairment and died of pneumonia. At autopsy, the brain showed yellow-brown granular material on its surface, mainly in the Sylvian fissure. Microscopically, granulation tissue was seen around areas of ossification encasing the foreign material. Iodized oil apparently changed into two types of foreign bodies: eosinophilic membranous lipodystrophy-like features and homogenous yellow crystals of various sizes. The pathology was identical to foreign-body granulomatous meningitis, caused by iodized oil myelography, and caused cognitive impairment in this patient.

Aged↗

Heterotopic ossification and pseudoarthrosis in the shoulder following encephalitis. A case report and review of the literature.

Heterotopic bone formation, or myositis ossificans, is common, particularly following trauma, total hip arthroplasty, spinal cord injury, severe head injury, and long-term coma. Although the mechanism is unknown, the pathogenesis is assumed to depend on transformation of mesenchymal cells to bone forming cells in response to a variety of stimuli. The clinical findings, laboratory data, roentgenograms, and radionuclide studies are standard aids in the diagnosis of heterotopic ossification. The treatment usually consists of range-of-motion exercise, nonsteroidal antiinflammatory drugs, X-ray therapy, disodium etidronate (EHDP), and excisional surgery. Reported here is a rare case of periarticular heterotopic ossification in the shoulder of a 38-year-old woman following head injury and 13 months in a coma. The unusual feature was the development of a pseudoarthrosis within the heterotopic bone. The patient's shoulder became markedly stiff with the development of a heterotopic pseudoarthrosis. Excision of the heterotopic bone and pseudoarthrosis was performed to improve the range of motion. Clinical roentgenographic, radionuclide, and pathologic observations are presented on the formation of a synovial joint within the heterotopic bone.

Adult↗

Relationship between muscular tone, movement and periarticular new bone formation in postcoma-unaware (PC-U) patients.

Forty-eight post-traumatic brain-injured patients in postcoma-unawareness (PC-U) state, are included in this study. All recovered consciousness at least 1 month after the accident. The muscular tone and movement of all limbs was examined. At least two X-rays of the big joints were taken. Periarticular new bone formation appeared in 26 patients. This heterotopic ossification occurs in severely injured patients, primarily in proximal joints of the upper and lower extremities. Their aetiology in brain injury is unknown. Risk factors include prolonged coma, tone and movements in the involved extremity, and associated fractures. We found that the appearance of periarticular new bone formation had a close correlation with pathological movement (paresis or plegia), a borderline correlation with hypertonus, and no correlation with hypotonus or with associated fractures.

Arthrography↗