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[Osteoarticular manifestations of palmoplantaris pustulosis. A prospective study of 15 cases].

Between 1986 and 1989, we conducted a clinical, biochemical, radiological and scintigraphic prospective study of 15 patients (8 men, 7 women) with histologically proven palmoplantar pustulosis. In 70 percent of the cases the time interval between the first cutaneous and the first osteoarticular signs was 2 years. Anterior thoracic clinical manifestations were frequent. The joints and the numbers of patients involved were: sternoclavicular (12), manubriosternal (6), sternocostal (5), intervertebral (11), sacroiliac (6) and peripheral (10). Two patients had osteitis. The clinical, radiological and scintigraphic findings, as well as the distribution of these arthropathies over the anterior thorax (i.e. over a sternocostoclavicular complex with numerous ligaments), suggest a preference for entheses. Despite the absence of link with the HLA B27 antigen, the frequent association with pelvic and spinal lesions indicate that the articular disease of palmoplantar pustulosis is a spondyloarthropathy.

Adolescent↗

Acute traumatic retrosternal dislocation of the clavicle.

A review of the literature on acute traumatic retrosternal dislocations of the clavicle revealed that closed reduction often fails. In six of our seven patients retraction of the shoulders with caudal traction on the adducted arm, while the patient was supported by an interscapular bolster, achieved reduction of the dislocation. We analyzed the mechanism of this and other methods of closed reduction.

Adolescent↗

[Sterno-costo-clavicular hyperostosis (author's transl)].

The authors report two cases of sterno costo clavicular hyperostosis. Six cases have been described in previous reports by Köhler (five cases) and CAMUS (one case). This disease begins with sterno costo clavicular pain that develops with exacerbations over several years. Biologically, there is a no specific inflammatory syndrome. Radiologically, clavicles sternum and first ribs are enlarged and increased in density. There is also an ossification of the sterno clavicular and sterno costal junctions. Phlebography sometimes show subclavian veins occlusion. Histological finding is hyperostosis without osteoclast inclusions. The main differential diagnosis is the Paget's disease.

Adult↗

Epiphyseal fracture-retrosternal dislocation of the medial end of the clavicle: a case report.

Epiphyseal fracture-retrosternal dislocation of the medeial end of the clavicle is an unusual injury. It may occur as a result of a blow either indirectly on the posterolateral aspect of the shoulder girdle or directly over the sternal end of the clavicle. It is clinically impossible to differentiate from the true posterior dislocation even with the computed tomography, but the treatment for either lesion is the same. Recently we uneventually treated a 15-year-old boy with conservative treatment and got a satisfactory result. The purpose of this paper is to draw the attention of the readers to the rarity and serious nature of such injury and the potential difficulties in establishing diagnosis and achieving reduction.

Adolescent↗

Scapulothoracic dissociation.

Scapulothoracic dissociation is an uncommon and devastating traumatic injury. A review of 72 cases in the English literature shows that a broad range of musculoskeletal and neurovascular injuries resulting from blunt trauma have been classified as scapulothoracic dissociation since the term was first used in 1984. A review of the current clinical signs and radiographic findings that define scapulothoracic dissociation, as well as a brief description of treatment options and outcomes, is presented.

Acromioclavicular Joint↗

Bacterial arthritis.

In this review of the 1990 septic arthritis literature, we revisit synovial fluid leukocytosis, examine the utility of synovial fluid glucose and protein measurements, and look at the levels of two cytokines, tumor necrosis factor and interleukin-1, in infected joint fluids. We see the many faces of gonococcal arthritis and the ravages of septic arthritis when the host has rheumatoid arthritis. Should we recommend antibiotic prophylaxis for the rheumatoid patient with a prosthetic joint who is undergoing a procedure that leads to transient bacteremia? What are some of the salient features of septic arthritis when it involves the sternoclavicular or sacroiliac joints? We also look at some unusual microorganisms, eg, group C Streptococcus, Streptococcus viridans, Listeria monocytogenes, Pseudomonas cepacia, Pseudomonas maltophilia, and Neisseria sicca. In patients with acquired immunodeficiency syndrome, we encounter reports of septic arthritis, osteomyelitis, and spinal epidural abscess caused by opportunistic microorganisms. Two unusual sites of infection include the C1-2 lateral facet joint and subacromial bursa without involvement of the glenohumeral joint. Finally, we examine how to drain a septic knee: the orthopedic point of view.

Arthritis, Infectious↗

Scapulothoracic dissociation: evaluation and management.

Scapulothoracic dissociation is an infrequent injury with potentially devastating outcomes. Knowledge of this injury is based on small patient series and case reports. The aim of this article is to review the evaluation, management and functional outcomes following scapulothoracic dissociation. Often caused by high traction forces applied to the shoulder girdle, there is a complete loss of the scapulothoracic articulation with lateral scapular displacement and intact skin. This is frequently associated with muscular, ligamentous and osseous injuries to the shoulder girdle, vascular injuries to the subclavian, or axillary, vessels and brachial plexus lesions. In the acute setting, the timely diagnosis of the associated neurovascular injuries is crucial. Severe neurovascular and soft tissue compromise often requires an early above-elbow amputation. Further, complete brachial plexus avulsions are associated with a limited potential for functional recovery.

Acromioclavicular Joint↗

Salmonella virchow: abscess former amongst the contemporary invasive Salmonellae?

Abscess formation associated with salmonella infections has long been recognized--but without implicating a particular serotype. The pathogenicity, invasiveness and increasingly frequent isolation of Salmonella virchow in the UK is well established. It's propensity to abscess formation is, however, less well recognised. We report 5 patients with abscesses due to S. virchow. This represents a disproportionate number of abscesses in relation to the salmonella isolations in North East Scotland during the 5-year period under scrutiny. We suggest that this organism should be considered as aetiologically relevant even where there is no history of preceding gastrointestinal infection.

Abscess↗

Retrosternal dislocation of the clavicle.

Retrosternal dislocation of the clavicle is an uncommon injury which may affect the mediastinal structures in a life-threatening way. Therefore, computed tomography is mandatory. Manipulation in the acute situation is the treatment of choice. In case of failure or old dislocation, open reduction with stabilization of the joint is required. The literature on this subject has been reviewed and an additional two cases are reported.

Adult↗

Atraumatic retrosternal dislocation of the clavicle.

Atraumatic retrosternal dislocation of the clavicle is an exceedingly rare event and three out of four previously reported cases lack any radiological evidence. We report the case of a 30-year-old male patient who presented an atraumatic retrosternal dislocation of the clavicle without a history of previous injury and underlying pathology. The diagnosis was delayed and established by a CT scan ten days after and initial presentation of the symptoms. A successful, stable, closed reduction under general anaesthesia was performed ten days after the initial presentation, having a cardiothoracic surgeon immediately available. There was no recurrence and the patient remains asymptomatic 18 months later.

Adult↗