Biomedical subjects
Publications and source records attributed to W H Sutro.
The status of the third femoral condyle, which can be seen in routine radiographs of the knee area, may be a useful adjunct for a clinical interpretation of the stresses incurred by patients with certain types of disabilities. Its status may prove to be a better indicator of the stresses in the components of the knee than the status of the articular surfaces of the femoral condyles.
We have as yet no method of treating osteoporosis because we have no clue to its etiology. A study of the evolution of a hen's egg may help us gain insight into the relationship of estrogen to bone formation in mammals.
The authors discuss the relationship between naturally loose or taut ligaments and flat or spastic feet.
A patient who suffered a fracture of the body of the 10th dorsal vertebra as a result of an automobile accident was examined seven years later. He complained of local pain over the gibbus site. All movements in the back and the joints of the extremities were within normal limits. Radiographs disclosed a healed compressed fracture of the body of the 10th thoracic vertebra with bony bridges contiguous with the 9th and 11th thoracic vertebrae. An unusual finding was the presence of a uniform sclerosis of a single rib at the level of the fracture site. Other bones of the rib cage, as well as the lumbar and pelvic bones, were normal. The basis for the abnormal density of the affected rib may be due to abnormal stress factors (Wolff's law).
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We have observed that "spool-shaped" proximal pedal phalanges sometimes are found in single or multiple toes, often affecting both feet. These changes may be present in normal as well as abnormal feet. The etiology is unknown. Such changes do not occur in the hands.
Cubitus valgus is a well-known complication of fracture of the bones of the elbow in childhood, but it is an uncommon deformity in adults. Three adult patients are presented, in each of whom cubitus valgus developed as a complication of a fracture and resection of the radial head. The importance of reestablishing the integrity of the ligaments of the elbow following severe injuries to the elbow is stressed.
Under physical stress, partial or complete tears of the muscle fibers of the medial head of the gastrocnemius may occur. Radiographs made by soft-tissue technique can be especially helpful in diagnosing partial ruptures, which are sometimes difficult to detect. Intermittent claudication can be caused by an abnormal position of the medial head of the gastrocnemius, resulting in compression of the popliteal vessels. Angiography or computerized tomography will usually disclose the site of local pressure. Surgical intervention may be necessary to eliminate the compression.
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A patient with ossification of the ligaments of the entire vertebral column has shoulder difficulties due to ossification of the right costoclavicular ligament. The speculation is that the sclerotic changes in the clavicle were caused by the same inflammatory process that has involved the ligaments of the vertebral column and of the sacroiliac joints. In some cases reported in the literature, although not in ours, vascular structures in the costoclavicular space were involved, resulting in venous obstruction or phlebitis. The patient's therapy currently consists of rehabilitation exercises. Nonsteroidal antiinflammatory medication was prescribed in the past without any marked benefit.
The authors present a radiographic illusion of the pubic bone and discuss an associated study of the iliopectineal eminence. They suggest that the changes in the configuration of the eminence may be the basis for "idiopathic groin pains."
The unusual end results of fractures of the extremities in several patients with neurological problems are presented. The authors suggest a theoretical explanation for the soft tissue changes and excess callus formation that occurred, as well as a possible method of curtailing or preventing paraarticular ossification in soft parts.
Abnormal articular surfaces of the tibiofibular joint may result in painful knees. Aberrations in the tibiofibular joint may be secondary to old fractures of the bones of the ankle or the bones of the ipsilateral leg. Similarly, neuromuscular disease with growth abnormalities or primary osteoarthritis of the tibiofemoral joint may initiate secondarily abnormalities in the joint in question. There is a definite close relationship between mobility of the bones of the ankle and the status of the upper tibiofibular joint. For that reason, this articulation should be included in the routine examination of the knee joint.
The joints of the ribs are true articulations and may be involved by local or general affections of the skeleton. Scoliosis, kyphosis, infections, arthritis (local or general types) may result in fibrosis, abnormal configuration, or ankylosis of the joints in question. In certain types of fractures of the dorsal vertebrae, disruption of the contiguous rib articulations may result in fibrosis or bony depositions and secondarily aid in local stabilization of the fracture. Narrowing of the intercostal spaces, as noted in kyphosis, scoliosis, and arthritis of the dorsal region, does not seem to be routinely associated with clinical findings of intercostal neuralgia.
Forestier's disease is generally characterized by the presence of heavy osteophytes in the vertebral column, sometimes associated with bony deposits in the ligaments and tendons at the sites of attachment to the bones of the extremities. The authors describe a variation of this syndrome-a patient with symmetrical bony deposits in the ligaments and tendons at the sites of attachment to the bones of the extremities, but with subminimal osteophytes in the vertebral column.