PMC4484349_01
Knee and ankle radiographs. a & c) Anteroposterior and lateral views of the right knee joint showing changes of osteoarthritis. b &
d) Anteroposterior and lateral views of the left knee joint showing changes of osteoarthritis. The degenerative changes are more profound. e,
f, g) Lateral, anteroposterior and mortise views of the right ankle showing bony ankylosis.
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F1
The radiographs of the right ankle confirmed sound bony ankylosis (Fig. 1).
Clinical photographs. a) Bilateral elbow joints as viewed anteriorly. b) Bilateral elbow joints with maximal flexion. The prominence
of distal humerus and the proximal radio-ulnar complex can be noted on lateral and medial sides respectively. c) Limitation of pronation
movement bilaterally. d) Near full range of supination. e) Puckered scars reminiscent of healed sinuses on the posteromedial aspect of elbow.
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F2
The pronation was restricted to 20 degree on the right side and 30 degree on the left side with the full range supination bilaterally up to 90 degree (Figs. 2, 3).
Range of movement of elbow. a, b) Maximal extension and flexion of right elbow as noted in profile. Note hyperextension on
extension view and prominence of distal end of humerus on flexion view. c, d) Maximal extension and flexion of left elbow as noted in
profile.
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F3
The pronation was restricted to 20 degree on the right side and 30 degree on the left side with the full range supination bilaterally up to 90 degree (Figs. 2, 3).
Radiographs. a, b) Anteroposterior views of bilateral elbow joints showing dislocation of elbow joints and fusion of proximal radius
and ulna. Also note heterotopic ossification. The right ulna is hypoplastic. c, d) Lateral views of right and left elbow in maximal possible
extension. e, f) Lateral views of right and left elbows in maximal possible flexion. g) Short fourth and fifth metacarpals in the right hand. h)
Hypoplasia of the fourth metacarpal in the left hand.
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F4
The patient also had hypoplasia of right fourth metacarpal with cortical thickening (Fig. 4).