Unusual bone changes in sickle-cell disease in childhood

A review of the roentgenograms of 126 children with sickle-cell disease seen over a five-year period (1956–61) at Kings County Hospital Center (Brooklyn, N. Y.) disclosed several unusual skeletal changes which are the subject of this report. The changes to be emphasized here have been included in the excellent discussions of sickle-cell disease by Middlemiss (1) and by Moseley (2). In general, three types of bony abnormalities occur. Marrow hyperplasia, involving the long and short tubular bones and the axial skeleton, frequently results in the roentgen appearance of widened medullary cavities and intertrabecular spaces, with cortical thinning. A second type of osseous lesion results from infarction. The roentgen appearance due to this cause varies according to (a) the site and extent of infarction, (b) the degree of surrounding hyperemia, (c) the state of osteoclastic resorption and osteoblastic repair, and (d) the effect of weight-bearing on compromised bone. A third complication is osteomyelitis, parti...