Les fractures sur rachis ankylosé associées à une spondylarthrite ankylosante (SPA) sont connues à l’inverse de celles associées à une hyperostose vertébrale ankylosante (HVA). L’objectif de ce présent travail est de rechercher les problèmes diagnostiques, les modalités cliniques et iconographiques, les risques neurologiques, et de présenter une classification à partir des observations réunies sur une période de 17 ans.

Purpose of the study Spinal fractures in patients with ankylosing spondylitis or idiopathic skeletal hyperostosis can raise difficult diagnostic and therapeutic problems. Spinal fracture is well known in ankylosing spondylitis but exceptional in diffuse idiopathic skeletal hyperostosis. The purpose of the present work was to identify clinical and radiological features in patients with ankylosing spondylitis, to determine whether similar risks and clinical expression are observed in patients with diffuse idiopathic skeletal hyperostosis, and to present a radiological classification of these fractures. We did not assess therapeutic methods in the present study. Material and methods Forty-eight fractures in 48 patients were observed over a period of 17 years. Twenty patients (mean age 62 years) had ankylosing spondylitis and 28 patients (mean age 81 years) had diffuse idiopathic skeletal hyperostosis. A fall was the immediate cause of the fracture in more than half of the patients. No notion of trauma could be identified in six patients. The radiological classification was established as follows; type I open-wedge anterior fracture, type II "sawtooth" fracture, type III occult or radiologically invisible fracture, type IV non-specific fractures comparable to other spinal fractures. A computed tomography was obtained in all patients seen after 1992 and magnetic resonance imaging was performed in case of suspected extradural hematoma. The ASIA classification (as modified by Frankel) was used for cord injuries. Clinical course and complications were noted. Results Diagnosis was established the day of fracture in 32 patients (12 spondylitis and 20 hyperostosis) and between day 2 and 30 for 16 (8 spondylitis and 8 diffuse idiopathic skeletal hyperostosis). The radiological clasification was: type I n = 30, type II n = 4, type III n = 8, type IV n = 6 (one odontoid fracture, five compression fractures). Three patients had extradural hematomas (2 spondylitis and 1 hyperostosis). Thirty-four patients (11 spondylitis and 23 hyperostosis) had cord injuries, including 16 with a symptom-free interval. The ASIA classification was: type A n = 4, type B n = 6, type C n = 20, type D n = 4. Thirty-two patients died within the first three months after spinal fracture (10 spondylitis and 22 hyperostosis), due to bed rest related complications in 30. One patient died after rupture of an aortic aneurysm. Discussion Spinal fractures in patients with ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis generally occur spontaneously or after low-energy trauma. Subsequent complications have serious consequences. Late diagnosis either results from missing a radiologically visible fracture or from the presence of an occult "paper thin" fracture. We do not have experience with diagnostic scintigraphy or magnetic resonance imaging. In our opinion, repeating standard x-rays the second and third weeks and use of a spiral scan or multiple spiral scan could provide early diagnosis. Conclusion The possible diagnosis of spinal fracture should be explored very extensively in patients with a symptomatic ankylosed spine who present symptoms compatible with spinal fracture, with or without trauma.

Purpose: Ankylosing spondylitis and Forestier hyperosteosis produces a fused vertebral column. The fused vertebrae can be considered like a “spine-bone” which has particular features different from those of the mobile spine. The purpose of this retrospective analysis was to investigate the clinical and radiological particularities of the spine-bone in order to reduce the delay to diagnosis. Material and results: Forty-eight spinebone fractures were observed over a 17-year period by one practitioner. Twenty of the patients (mean age 62 years) had ankylosing spondylitis and 28 (mean age 81 years) had hyperosteosis. All of the patients were men. Twenty-five were victims of falls, eleven victims of traffic accidents, and six victims of sports accidents (all with ankylosing spondylitis). No notion of trauma could be identified for six patients. Sixteen fractures were diagnosed within 1 to 28 days. Forty-four patients had cord injury including 16 cases which developed secondarily. Four types of fracture were identified: - type I = anterior opening fracture: 30 patients, - type II = “sawbone” fracture: 4 patients, - type III = “rasp line” fracture: 8 patients, - type IV = fractures comparable to other fractures of the vertebral column: 6 patients. Fractures diagnosed late were four anterior opening fractures, eight “rasp line” fractures, and four “sawbone” fractures. A CT scan was obtained in all cases and an MRI in 30. Three compressive spinal extradural haematomas were diagnosed. Thirty-two patients died, 31 patients with spinal injuries due to decubitus-related complications and one by rupture of an aneurysm of the aorta. Discussion: This series illustrates several points. Fracture without trauma is frequent. Diagnosis is made late. Fractures gone undiagnosed lead to neurological complications or nonunion. Diagnosis of “rasp line” fractures cannot be made on standard x-rays, leading us to order a scanner and/or an MRI in all patients with a painful ankylosed spine even if the standard x-ray does not show any fracture. Neurological and extradural haematoma are serious complications. Mortality is high in these debilitated patients. Knowledge of these exceptional fractures of the vertebral column is necessary to improve diagnosis and prognosis.

Diagnosis of sacroiliitis may be difficult to establish in patients under 25 years of age since growth is not yet completed and joint damage is often still minor. A prospective study of 200 subjects with a median age of 22 years was carried out to compare the value of CT scan and conventional radiology. The study population included 32 healthy subjects and 168 consecutive patients with presumptive spondylarthropathy including 36 with bilateral sacroiliitis and 8 with unilateral sacroiliitis. Conventional roentgenograms and CT scans were performed in every patient. Blind reading of roentgenograms and CT scans was carried out by two pairs of observers with differing experience. CT scan provided no additional information when reading was done by experienced observers : rates of mistaken and doubtful results were similar with both investigations (10 %) ; specificity of both tests was comparable (90 %) but sensitivity was significantly greater for CT scan (91.2 %) than for conventional roentgenograms (71.6 %), reflecting improved detection of roentgenographically occult sacroiliitis. Less experienced observers obtained better results with CT scans, illustrating the ease of interpretation of CT scan images. Analysis of false-positive CT scans revelaed that normal variations and, above all, features due to as yet uncompleted growth were the main sources of mistakes. These mistakes cancelled the advantage of increased sensitivity of CT scan studies and explained why CT scan failed to improve diagnosis.

Diagnosis of sacroiliitis may be difficult to establish in patients under 25 years of age since growth is not yet completed and joint damage is often still minor. A prospective study of 200 subjects with a median age of 22 years was carried out to compare the value of CT scan and conventional radiology. The study population included 32 healthy subjects and 168 consecutive patients with presumptive spondylarthropathy including 36 with bilateral sacroiliitis and 8 with unilateral sacroiliitis. Conventional roentgenograms and CT scans were performed in every patient. Blind reading of roentgenograms and CT scans was carried out by two pairs of observers with differing experience. CT scan provided no additional information when reading was done by experienced observers: rates of mistaken and doubtful results were similar with both investigations (10%); specificity of both tests was comparable (90%) but sensitivity was significantly greater for CT scan (91.2%) than for conventional roentgenograms (71.6%), reflecting improved detection of roentgenographically occult sacroiliitis. Less experienced observers obtained better results with CT scans, illustrating the ease of interpretation of CT scan images. Analysis of false-positive CT scans revealed that normal variations and, above all, features due to as yet uncompleted growth were the main sources of mistakes. These mistakes cancelled the advantage of increased sensitivity of CT scan studies and explained why CT scan failed to improve diagnosis.

A Sacrate chordoma with an urologic expression is investigated in radiology, scanner and IRM.Histological diagnostic is made by punction under scanner. Differential diagnostics are treated.

The authors report a case of giant cell tumor. This case was unusual by its location (rib and vertebra), its size and its important inner thorax extension. This tumor was studied with different imaging methods and particularly MRI. The sensitivity of MRI is confirmed by the surgery in complete agreement with MRI findings.

Four patients with an old fracture of the capitellum humeri were treated by simple excision of the fragment. The results were good in two patients and fair in the two others. The event of a painless period in two cases raised the problem of the limits with the osteochondritis dissecans.

Four patients with an old fracture of the capitellum humeri were treated by simple excision of the fragment. The results were good in two patients and fair in the two others. The event of a painless period in two cases raised the problem of the limits with the osteochondritis dissecans.

Polyorchidism is a rare abnormality. A case is reported of a small scrotal supernumerary testis associated with a large varicocele. A torsion of this testis probably occurred and the vascular pedicle seemed atrophic. Despite abnormal fertility with oligozoospermy the accessary testis was removed. A review of relevant literature is made giving details of embryology of this anomaly.

In order to establish a sagittal plane curve reference table for standing subjects examined laterally, we determined an easily reproducible standard posture. A sample of 100 healthy subjects from 20 to 29 years of age, was chosen (43 women, 57 men). The reciprocal angulations of each vertebral body in relation to the others were fed into a digitalizer and studied by computer. The study particularly concerns maximum kyphosis, maximum lordosis, sacral base slopes, and the tilt of intermediate vertebral bodies. The dispersion of the results is remarkably wide and, within the extreme values, the distribution is irregular. Individual correlations of these values are often dispersed, but spinal morphotypology. For considerable lengths, average values cannot be used as norms, given the wide span of values. Only the extreme limits are useful for the appreciation of curves as excessive, insufficient, or inverted.