Paraplegic para-articular calcification.

Abnormal ossification or calcification of the joints is seen in osteo-arthritis, Charcot's joints, and the Pellegrini-Stieda syndrome; less well-known is that seen in the soft tissues not involving the joint surface, consequent upon disease or injury of the nervous system. This condition has a variety of names: "para-osteo-arthropathy" (Dejerine, Ceillier, and Dejerine, 1919); "neurogenic ossifying fibromyopathy" (Soule, 1945); "paraplegic neuro-arthropathy" (Solovay and Solovay, 1949); "paraarticular ossification" (Freiburg, 1952). This condition has been described particularly in paraplegia caused by trauma to the nervous system. Indeed, 40-50 per cent. of patients with traumatic paraplegia have been described by various authors as suffering from abnormal ossification or calcification round the hip or knee joints; these are the joints usually involved, but the condition may occur anywhere below the level of the neurological lesion. However, calcification and ossification do not follow only trauma of the central nervous system. Voss (1937) gives a list of conditions with which they may be associated. This includes lesions not only of the brain and spinal cord, but also of the peripheral nerves. The present paper describes two cases of paraarticular calcification following encephalo-myelitis, and one following craniotomy for a cerebral tumour. In order to form some idea of the incidence, we have examined the radiographs of the hip joints of 51 patients with other nervous diseases causing paraplegia or immobility (Table). Whether ossification or calcification results appears to depend partly on the stage of development (Brailsford, 1941) and partly on the state of the local blood supply (Watson Jones and Roberts, 1934). TABLE