The arthropathy of hemochromatosis

Five cases of hemochromatosis arthropathy are presented and the distinctive radiological features of the disease are described. Although the condition is typically degenerative, showing subchondral cyst formation, sclerosis, and thinning of cartilage, its distribution is characteristic. Selective degenerative changes of the second and third metacarpophalangeal joints are striking, particularly in the hands, while abnormalities in the intercarpal joints are variable and the interphalangeal joints are spared. Chondrocalcinosis involving both fibrous and hyaline cartilage is frequently seen as well, particularly in the large joints. The calcification is due to deposition of calcium pyrophosphate crystals, perhaps resulting from iron inhibition of pyrophosphatase.

Inhibition of secondary osteophyte formation in rheumatoid arthritis

Using radiographically demonstrated joint narrowing as an index of joint damage, a reduced incidence of osteophyte size and number as a measure of osteoarthritic change in the PIP and knee joints of patients with RA as compared to DJD has been demonstrated. The possible pathogenetic factors discussed include reduced joint use in RA, increased resilience of juxta-articular bone associated with osteoporosis in RA and the possibility that products of inflammation in the RA joint act locally or via juxta-articular vascular mechanisms to inhibit the secondary changes of DJD. Further study of the possible pathogenic mechanisms including the roles of joint stress, juxta-articular osteoporosis, and possible effects of the inflammatory reaction of the rheumatoid joint on intra-articular structures and juxta-articular vascular phenomena are needed.

[Use of roentgen-television film for the analysis of physical exercises]

Biochemical investigation of movements of man is based on precise registration of movements of body links in space and time. The popular method of filming is almost unsuitable for studying exact movements in small joints, rotation movements and movements performed simultaneously in several joints. The use of rentgen-television filming of movement in the joints broadens the possibilities of biomechanical investigations of movements of man.

The radiology of gout. Review article

The radiological features of gout are presented on the basis of a consecutive series of 64 in-patients and a review of the literature. Gout is a painful and potentially crippling disorder. Since fewer patients are referred with a classical acute attack due to the advent of more effective drug therapy, the radiologist may be presented with unusual or atypical cases. It is confirmed that there are no specific radiological features of gout. Provided a high index of suspicion be mai-tained, particularly in those groups of patients in whom secondary gout is common, a combination of signs may allow the diagnosis to be correctly inferred, leading to biochemical confirmation.

Metacarpophalangeal joint implants. III. Roentgenographic study of the in vivo function

With tomographic examination of the metacarpophalangeal joint in the straight lateral projection with maximum active extension and flexion, performed after the implantation of 42 Swanson and 41 Niebauer finger joint implants, it was possible to study the in vivo function of these implants. A method was devised to determine the position of the proximal phalanx in relation to the metacarpal bone in the plane of flexion. This was correlated to the ideal position of the proximal phalanx as determined for each of the implants in experimental studies and defined only by the implant axis of rotation. A displacement of the phalanx in the proximal and volar direction was found. Usually, this was more pronounced with fracture of the implant, and could be about 7-8 mm in each direction. The hinge of the Niebauer implant was found to bend significantly less than expected, indicating movements taking place in other parts of the implant. The two blocks of the midsection were found to move in relation to the adjacent bones. Indicating an insufficient intramedullary fixation of the stems, these findings explained why cortical erosions appeared at the sites where the stems were in close contact with the bone: dorsally in the metacarpal bone and volarly in the proximal phalanx.

Metacarpophalangeal joint implants. I. Roentgenographic study on the silastic finger joint implant, swanson design

A roentgenographic study was carried out on 104 Silastic Finger Joint Implants, Swanson design. Sixty-two of the implants were examined in the anterio-posterior-projection (AP) from 4 months to 5 1/2 years postoperatively, a total of 116 examinations. Forty-two implants were examined in the AP-projection and in the lateral projection by tomography in maximum active extension and flexion from 9 days to 42 months postoperatively, a total of 110 examinations. Stem fractures were found in 11/104 implants: two of these preceded by a laceration of the implant surface visualized by tomography. Fragmentation of the midsection was found in 14/104 implants. Cortical erosion was seen radially in the phalanx and the metacarpal bone in some joints showing ulnar deviation, predominantly MCP joints II and III. On the tomograms a cortical erosion dorsally in the metacarpal bone could be demonstrated. Particularly around the distal stem was found an intramedullary bone lamella, varying in distance from the stem as well as in density and regularity. Bone resorption was found at the site where the midsection bore on the metacarpal bone and the proximal phalanx, resulting in a migration of the implant in a proximal and/or distal direction. The migration of the implant was evaluated on the tomograms with maximum active extension and classified into 4 Grades. Concomitant with the migration in the proximal direction a bony spur developed volarly at the resected end of the metacarpal bone, also seen in the AP-projection. The degree of maximum joint flexion was measured on the tomograms by drawing a line along the dorsal contour of each bone. In some cases flexion was found to decrease as a consequence of implant migration in the distal direction or the development of a bony spur. In several cases the range of flexion was maintained by gliding of the stems, particularly the distal one.

[Radiographic study of the hand in 50 cases of primary articular chondrocalcinosis. Comparison with a control series of 100 subjects]

The authors analysed radiograms of the hands of 50 patients suffering from primary articular chondrocalcinosis (ACC) and compared them with those of 100 control subjects of similar sex and age. There were 40 women and 10 men, with an average age of 69.6 years (plus or minus 9.82). A chalky incrustation of the semilunar pyramidal interspace was observed in 40 percent of cases. The frequency of this incrustation was next in order of importance to incrustation of the triangular ligament which occurred in 52 percent of cases. The difference from the controls was highly significant (p less than 0.001). Voluminous geodes affecting one or more of the bone of the wrist were present in 20 percent of the patients with ACC and in 5 percent of the controls. The difference was significant (p less than 0.01). Chalky deposits were found in the soft tissues immediately next to a metacarpo-phalangeal articulation in 22 percent of the ACC patients but not in any of the controls. The difference was highly significant (p less than 0.001). These chalky deposits next to metacarpo-phalangeal articulations were always associated with chalky incrustation of the radio-carpal joint. As regards the radiological lesions, considered as being typical images of arthrosis and affecting the trapezo-metacarpal, metacarpo-phalangeal, and interphalangeal articulations, the chondrocalcinosis patients appeared to be more frequently affected than the controls, but the difference was not significant. On the other hand, a type of arthropathy occurs in ACC patients which also resembles an arthrosis radiologically but which was 5 times more frequent in them than in the controls and which in this series occurred without nearby trapezo-metacarpal arthropathy only in ACC patients (16 percent as against 0 percent in the controls: p less than 0.001); this was scapho-trapezial arthropathy. The finding of this kind of radiological lesion, particularly when it is not associated with lesions in the trapezo-metacarpal articulations should indicate the possibility of a diagnosis of ACC and should lead to radiological investigation of other sites.

Metacarpophalangeal joint implants. II. Roentgenographic study of the Niebauer--Cutter Metacarpophalangeal Joint Prosthesis

A roentgenographic study was carried out on 41 Niebauer -- Cutter Metacarpophalangeal Joint Prosthesis from 1 to 36 months postoperatively, a total of 105 examinations. The examinations were performed in the AP-projection and in the lateral projection by tomography in maximum active extension and flexion. The tomographic examinations revealed implant damage of three kinds: cracking within the midsection; fragmentation of the midsection; fracture of the hinge. Cracking within the midsection was found in 8 implants between 6 and 12 months postoperatively and in 1 implant later than 12 months. Later examinations revealed fragmentation of the midsection in 2 implants previously showing cracks. Hinge fracture was observed in 22 implants. Implant damage was found in a total frequency of 26/41. Bone reaction was found on the tomograms in all the operated joints, and could not be evaluated on the AP-projections. A bony spur was found to develop on the metacarpal bone volarly at the site of the osteotomy in 35 joints. In 2 of these the bony spur reached the base of the proximal phalanx, causing anchylosis. Bone resorption was found in 23 joints, constantly dorsally in the metacarpal bone and volarly in the proximal phalanx. The mechanism of the implant damage is discussed with respect to the shearing forces in the joint and the two materials of differing elasticity constituting the implant. The bone reaction is discussed with respect to the intended fixation of the intramedullary stems.

Roentgenographic examination of the metacarpophalangeal joint

Roentgenographic examination of the metacarpophalangeal joints of the index, long, ring and the little fingers is carried out routinely in antero-posterior (AP) and oblique lateral projections, while pictures in the straight lateral projection of each joint are hard to evaluate because of overprojection of the other metacarpal bones and proximal phalanges. A technique was devised to examine each joint separately in the straingt lateral projection by means of tomography. This is presented together with the technique for examination of the joint in the AP-projection. The tomograms in the lateral projection were found to be more valuable when carried out in active maximal extension as well as flexion. The great advantage of this method, particularly in examinations for scientific evaluation, has been demonstrated in repeated postoperative studies of 98 metacarpophalangeal joints.

[Some rare cases of dislocation and combined fracture and dislocation of the thumb]

Some rare cases of dislocation and combined fracture and dislocation of the thumb are presented. Some brief remarks concerning their importance with respect to normal hand function are followed by an explanation of the relevant anatomical and radiological pictures and a description of the surgical and conservative treatment employed in each case.

Influence of trauma on the development of chronic inflammatory polyarthritis

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