Acro-osteolysis

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Acro-osteolysis:

Acro-osteolysis Dr.A.B.M.Shafiqur Rahman NITOR,Dhaka .

Acro-osteolysis:

Acro-osteolysis

Acro-osteolysis:

Acro-osteolysis Def: Disintegration or destruction or erosion of the distal phalanges is called acro-osteolysis.

Aetiology:

Aetiology Neoplasm Infection Trauma Arthritis Metabolic disorder Collagen vascular disease Neurotrophic disorder Occupational & Idiopathic

Neoplasm:

Neoplasm Giant-cell tumors Glomus tumors Carcinoma of the nail bed Subungual sarcomas Metastatic lesions arising from lung kidney or breast

Glomus tumors:

Glomus tumors Commonly arise in the nail bed Causing bluish discoloration & pain on exposure to cold or trauma Commonly occur in female(75%).

Infection:

Infection Pyogenic infection of the distal pulp space can cause it. In X-ray: Irregular destruction throughout the terminal phalanx found.

Arthritis:

Arthritis Psoriatic arthritis : Resorption usually occurs at the tuft of terminal phalanges.. Hypertropic pulmonary osteoarthropathy .

Metabolic disorders:

Metabolic disorders Hyperparathyroidism: Resorption limited to the tuft. Midshaft destruction can also occur. Lesion completely revert to normal after therapy.

Trauma:

Trauma Repeated trauma such as hammer`s disease, electric shock or frostbite, burns, accompanied by irregular v-shaped defects of the overlying finger nails . defects of the tufts may be seen.

Neurotrophic Disorder:

Neurotrophic Disorder Neural leprosy Hereditary sensory radicular neuropathy (HSRN) Any lesion of nervous system causing sensory impairment.

Occupational:

Occupational Polyvinyl chloride reactor-vessel cleaners are affected. Raynaud`s phenomenon always was the first manifestation of the condition. Pathogenesis is unknown.

Figure:

Figure

Idiopathic:

Idiopathic Types: Familial & Nonfamilial. Familial type is transmitted from mother to offspring. Clinical pictures in both familial & nonfamilial are identical.

Idiopathic:

Idiopathic

Clinical feature:

Clinical feature Common C/F are- Painful paresthesia or tactile soreness at the ends of the fingers. Fingers become progressively shorter & thicker at the tips.

Investigation:

Investigation Laboratory investigations: Urinary mucopolysaccharides ,Lactic dehydrogenase, Alkaline phosphatase Parathyroid hormone level may be elevated. X-ray show: Osteolytic destruction of the distal ends of the distal phalanges.

Treatment:

Treatment Treatment of choice consists of management of underlying disease. Interdisciplinary treatment including- Local infection healing Drugs(calcium antagonist,prostacycline derivates etc.)and surgical therapy(excision of calcinosis, sympathectomy)may be helpful.

References:

References Orthopaedics principles & their application- by Samuel L. Turek Internet.

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