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[Osteonecrosis or spontaneous fractures following renal transplantation. Comparison of radiological changes (author's transl)].

31 renal transplant recipients with post-transplant development of osteonecrosis or spontaneous fractures were evaluated with regard to age, duration of dialysis before transplantation. Determination of metacarpal bone mass at the time of transplantation and registration of bone resorption and soft tissue calcification at the time of transplantation and at the time of onset of osteonecrosis and spontaneous fractures were made. Apart from the increased mean age in patients with spontaneous fractures no difference was seen between the groups. Osteonecrosis and spontaneous fractures occurred in areas of trabecular bone. It seems most likely that after renal transplantation the patients show bone complications of different localization.

Bone Resorption↗

Spontaneous fracture of hypertrophied genial tubercles.

A case of spontaneous fracture of hypertrophied genial tubercles is reported. This is an uncommon event with only six previously reported cases. This entity is usually associated with severe edentulous bone resorption, a condition related to the pathogenesis of this fracture. Clinical complaints include painful swelling of the floor of the mouth and impaired tongue function. If left untreated, mucosal inflammatory changes may appear and a biopsy should be performed. Total recovery is obtained after removal of the fractured fragments.

Aged↗

Spontaneous fractures of the olecranon process in rheumatoid arthritis.

Spontaneous fractures through the olecranon process occurred in 3 patients with long-standing rheumatoid arthritis. In each case the elbow was severely damaged, particularly in the midportion of the trochlear notch, which was thinned either by erosion or cyst formation. The thin trichlear notch is the weak pivot point of a lever (the olecranon process) which pivots on the distal humerus. Excess stress on the lever, by the action of the triceps on the olecranon process, will produce a fracture at the weakest point: the midtrochlear notch.

Aged↗

Spontaneous fracture of the odontoid process in rheumatoid arthritis.

Six cases of spontaneous fracture of the odontoid process in rheumatoid arthritis are presented. Fifty-one patients with atlantoaxial subluxation in rheumatoid arthritis underwent surgery between 1981 and 1990. This included six patients (in 10%) who had subluxation accompanied by fracture of the odontoid without apparent trauma. The mean patient age was 58 years and all had a long history of rheumatoid arthritis. No trauma was considered to be the cause of the fracture. This is a fracture caused by erosion and osteoporosis of the odontoid process due to rheumatoid synovitis, aging and steroid therapy. In addition, another cause is a dynamic load produced from the instability accompanying atlantoaxial subluxation working on the odontoid in cervical extension. It is important remember that the odontoid process is susceptible to spontaneous fracture.

Aged↗