Summary
We report five cases of irregularity of the apophysis of the ischial tuberosity (Kremser's disease). In four, plain radiographs showed that the density of the radiolucent area increased within several months of a minor injury. Serial computerised tomography demonstrated new bone formation across the widened apophyseal plate, although there was no change in the shape or density of the apophysis itself. The separation repaired and remodelled spontaneously within a year. In one case, CT showed that the apophyseal ossification centre was smaller than that on the opposite side. Our findings showed that in four cases the irregularity of the apophysis of the ischial tuberosity may have been caused by an avulsion fracture, but the appearance in the fifth case was a normal variant of the ossification centre.
Résumé
Présentation de cinq cas d'irrégularité apophysaire de la tubérosité ischiatique. Chez quatre de ces patients, la densité de la zone radiotransparente telle qu'on la voit sur les radiographies standard avait augmenté en l'espace de quelques mois à la suite d'un traumatisme mineur. La tomodensitométrie sérielle révéla un os nouvellement formé au travers de la plaque apophysaire élargie, bien que l'apophyse elle-même ne montrât aucune modification ni de densité ni de forme. Dans ces cas le décollement apophysaire s'est spontanément réparé et remodelé en une année, sauf chez trois patients chez qui un fragment osseux non vascularisé est apparu après dix mois, avec incorporation encore visible 3 ans plus tard sur les radiographies. Dans le dernier cas, la tomodensitométrie a montré que le point d'ossification apophysaire était plus petit que celui du côté opposé. En outre, il n'y avait aucune altération sur les tomodensitométries. Ces observations suggèrent que dans les quatre cas l'irrégularité apophysaire, appelée maladie de Kremser, pourrait être induite par une fracture par arrachement ou par un décollement épiphysaire. Cependant, dans le cinquième cas, une anomalie du point d'ossification a montré une irrégularité semblable à celle que l'on observe sur les radiographies dans la maladie de Kremser.
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Watanabe, H., Chigira, M. Irregularity of the apophysis of the ischial tuberosity. International Orthopaedics 17, 248–253 (1993). https://doi.org/10.1007/BF00194190
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DOI: https://doi.org/10.1007/BF00194190