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A variant of diffuse idiopathic skeletal hyperostosis: a case report.

The case of an elderly man with a bamboo-like spine is presented. Because the patient's osteoporosis prevented proper evaluation of the sacroiliac and apophyseal joints on plain radiographs, the case originally was misdiagnosed in an outpatient clinic as ankylosing spondylitis. A further work-up showed the integrity of the apophyseal and sacroiliac joints, as well as cortical hyperostosis of the midcervical spine consistent with the diagnosis of diffuse idiopathic skeletal hyperostosis (DISH).

Aged↗

Ankylosing spondylitis presenting as spondylodiscitis.

Spondylopathy is a relatively common finding in advanced ankylosing spondylitis (AS). However non-infectious spondylodiscitis as an early manifestation of AS seems to be exceptional. In this article, we present such a case in an adolescent.

Adolescent↗

Spontaneous fusion of atlanto-axial dislocation in psoriatic spondylitis.

A 36-year-old man, suffering from psoriatic arthritis from the age of 17 years, was found to have developed atlanto-axial dislocation at the age of 30. Spontaneous fusion took place over the next two years. An explanation for this finding is based upon a review of the literature regarding the nature of spinal involvement in psoriatic arthritis.

Adult↗

A hospital-based survey of radiological sacroiliitis and HLA-B27 and Cw2 in Navajo and Hopi Indians.

The frequency of radiological sacroiliitis and its association with HLA-B27, Cw1, and Cw2 were determined in Navajo and Hopi Indians coming to a community hospital. In the Navajo, the phenotype frequency of HLA-B27 was 36% and the frequency of sacroiliitis, 11%. In contrast, among the Hopi, the phenotype frequency of HLA-B27 was 9% and the frequency of sacroiliitis, 4%. Of the Navajo men, who had sacroiliitis and were HLA typed, 83% were HLA-B27 positive. The increased frequency of radiological sacroiliitis and were HLA typed, 83% were HLA-B27 positive. The increased frequency of radiological sacroiliitis in the Navajo was felt to be related to the high frequency of HLA-B27 and Reiter's syndrome in this population. HLA-B27, HLA-Cw1, and HLA-Cw2 are known to be in linkage disequilibrium, and about one-half of the men with sacroiliitis from both tribes had concurrence of HLA-B27 and HLA-Cw2.

Arizona↗

High-energy pelvic ring disruptions.

High energy pelvic ring disruptions are associated with numerous primary organ system injuries. Early, accurate pelvic reduction and stable fixation optimize patient outcome. A variety of fixation techniques have been advocated. A multispecialty team approach is advantageous when managing these patients and their pelvic injuries.

Fractures, Bone↗

Utility of the inferior gluteal vessels in free flap coverage of sacral wounds.

An improved technique for gaining access to the inferior gluteal vessels is presented. This method allows rapid isolation of these vessels, preservation of greater pedicle length, and improved access for the performance of microsurgery. The innervation and function of the gluteus maximus is also preserved. We believe the use of this technique makes the inferior gluteal vessels the receptor vessels of choice for microsurgical procedures in the sacral area. An illustrative patient is presented in whom these vessels were used for a combined serratus anterior-latissimus dorsi free muscle flap for sacral wound coverage.

Aged↗

Percutaneous screw fixation of fractures of the iliac wing and fracture-dislocations of the sacro-iliac joint (OTA Types 61-B2.2 and 61-B2.3, or Young-Burgess "lateral compression type II" pelvic fractures).

A technique for closed reduction and percutaneous screw fixation of fractures of the iliac wing and fracture-dislocations of the sacro-iliac joint is presented. Twenty-seven pelvic fractures were treated with attempted closed reduction followed by percutaneous screw fixation. Closed reduction failed in two patients. In the other twenty-five, closed reduction to within one centimeter of residual displacement was obtained, and was followed by stabilization with percutaneously placed cannulated screws. Complications included dislodgment of a screw from the superior pubic ramus in one patient, and partial cut-out of a screw along the inner cortex of the iliac wing in another. Two patients were lost to follow-up before fracture union occurred. The remaining twenty-three patients were followed-up for an average of twenty-seven months (range, 18-48 months). All of the fractures healed in the twenty-three patients who were not lost to follow-up. All but two of the patients who were working before injury returned to work. All but one of the patients was satisfied with the outcome of their pelvic fracture treatment. Closed reduction and percutaneous screw fixation of fractures of the posterior portion of the iliac wing yields acceptable reductions, with minimal blood loss and limited damage to the surrounding soft tissues.

Adolescent↗

Ankylosing spondylitis and inflammatory bowel disease. II. Prevalence of peripheral arthritis, sacroiliitis, and ankylosing spondylitis in patients suffering from inflammatory bowel disease.

To establish the prevalence of peripheral arthritis, radiographic sacroiliitis, and ankylosing spondylitis in patients with inflammatory bowel disease, 58 consecutive patients suffering from ulcerative colitis (UC) and 51 with Crohn's disease (CD) underwent a detailed rheumatological examination. In addition, all patients were screened for the presence of the antigen HLA B27. Peripheral arthritis was found in 14 (8 UC, 6 CD) patients (12.8%); radiographic sacroiliitis was diagnosed in 11 (5 UC, 6 CD) (10.1%), of whom 10 were asymptomatic; and ankylosing spondylitis was diagnosed in 2 UC and 2 CD patients (3.7%). 18.9% of the UC and 3.9% of the CD patients were HLA B27 positive. One of the 11 patients with radiographic sacroiliitis and 2 of the 4 with ankylosing spondylitis had the HLA B27 antigen. Peripheral arthritis, radiographic sacroiliitis, and ankylosing spondylitis are apparently frequent manifestations in patients suffering from inflammatory bowel disease. Asymptomatic radiographic sacroiliitis in these patients appears to differ from idiopathic ankylosing spondylitis, both clinically and genetically. Evaluation of subjective rheumatological complaints, necessary for a confident diagnosis of ankylosing spondylitis, according to the New York criteria is difficult during a flare-up of the inflammatory bowel process, as was shown in 4 CD cases with marked limitation of lumbovertebral function and chest expansion, but no radiological abnormalities of the SI joints.

Adult↗