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OSTEITIS CONDENSANS ILII

RICHARD A. RENDICH and A. V. SHAPIRO J Bone Joint Surg Am. 1936;18:899-908.

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OSTEITIS
BY RICHARD A. RENDICH, BROOKLYN, From the Radioogicai Division of

CONDENSANS
M.D., NEW Connty York AND

ILII v. A. SHAPIRO,
M.D.,

YORK Hospital, Departmeiu of Hospitals,

Kings New

City

,\Then in

examining a localized

roentgenograms area of increased adjacent and case and

in

of the

pelvis,

one involving

occasionally usually the

a case

notes the in-

the

ilium

density,

ferior tion
as

and medial portion In 1926 Sicard, Gally, and

having

to the Haguenau
the skeleton

sacro-iliac in France They spoke

and

joint. discussed of osteitis

described

condiwhich

contributed
occurred

five
elsewhere

reports. also the

condensans vertebrae.

involved

the

os

calcis

fourth

and

fifth

lumbar

They took pains to exclude the possibility of an osteoplastic type of metastasis in the vertebral lesion. B#{225}rsony and Polg#{225}rcalled attention to this condition in 1928, referring to it as osteitis condensans ilii. Btrsony described the lesion as a sclerosing bone disease, easily demonstrable by x-ray and confined to the
Os

ilii

tion

in The

These a period next in

authors of one mention 1932 when

described fifteen cases and one-half years. of the Fritz subject Berent was at

which

came

to

their

attenin to the

a gynecological the Hospital condition. patients a zone to the condition

congress

Gottingen trauma

correlated

incident During the have observed roentgenographic made and the Characteristically dense bone in chondrosis; of the joint. in diameter, the sacrum. normal bone On the

to childbirth. past few years twelve patients and laboratory findings that may form in this portion the the

at the Kings County who exhibited this studies of these basis of this paper. condition of the to there occurs ilium adjacent starts a very near small

authors Complete have been of markedly sacro-iliac

the

syn-

usually It

involvement be limited

the most inferior portion area, several millimeters of the from ilium as it adjoins the surrounding of the roentgeno-

or it may involve the entire extent The area may be sharply demarcated or it may gradually merge with it. usual negative it appears as if that as pointed out in the involved bony spaces and the very fades
1936

portion by area. Bdrsony; On be seen

gram had been underexposed, nor bony structures are visible exposed and cium opaque The outer
VOL.

no trabeculae a purposely overto be thickened

film, irregular. deposit

however, The than

the lacunar usual, ends

trabeculae appear entire

may

as if filled with a greater calinvolved zone has a uniformly at more the sacro-iliac gradually into joint. the
899

appearance. sclerosis of
NO. 4,

abruptly somewhat

The normal

border
XVIII,

the
OCTOBER

lesion

900 iliac bone. The

The

R.

A. RENDICH

AND

A.

v.

SHAPIRO

sacro-iliac
joint space

joint
is clear,

proper
is of

never
normal the on iliac or

shows
width, on the

any
and sacral

evidence
presents side. no

of

involvement.

irregularities

of the

articular

surfaces

either

FIG.
Osteitis condensans

1-A
ilii of the left side.

FIG.
Osteitis condensans ilii of the right

1-B
side. Note the sharp demarcation of the

sclerosed

zone

and

the

lack

of involvement
THE

of the
JOURNAL

sacro-iliac
OF BONE

joint.
AND JOINT SURGERY

OSTEITIS

CONDENSANS

ILII

901

The
festations

ordinary
of

maniany are t.he appears origin into near

osteo-arthritis absent. Although volvement have its

the the
tend volve portion

inferior joint,
upward a

portion it may
to the

of cxiniliac

considerable of

bone, to
entire

even the
iliac

reaching crest.
surface

The
of

the
may lique joint, the

sacro-iliac
become Due and to direction because superimposition the of

joint
sclerosed. obthe Note sacral appears of sacrurn.

FIG.

2-A film to show

Purposely overpenetrated bony trabeculae and filling

in of the

thickening intertrabecular

of the spaces.

that, due to the superimposition surfaces in the anteroposterior to extend across the joint

of the iliac and view, the process space to involve the

of

the

auricular

sur-

faces of the ilium and sacrum, it often appears as if the sclerosis the extends joint, through

involving side.
cases is Inwhere parto ilium appearas the if fused. FIG. oblique Same process sacro-iliac case as involves joint. Fig. 2-B view showing that stops sharply at is not involved. the the 2-A. Oblique only the ilium and The sacral surface

the
deed, the

sacral
in sclerosis may space, sacrurn almost in be

ticularly
it lar and ing taken

pronounced,
difficult

distinguish

the
the

articu-

Roentgenograms

position strate readily

not

to

demon-

the joint space prove that the

involve the joint.

process the the

stops sacruni is small iliac

no

sharply
never

at
involved,
condensation of

the

iliac
but was

surface
in one

and
case

does

Bdrsony of the
case
VOL.

states series well as as

that on
joint

the
the
XVIII,

authors
intervening
NO. 4,

a similar
shows
1936

zone borders.

found enough,

on in this

sacral

Significantly

involvement.

OCTOBER

902

R.

A.

RENDICH

AND

A.

V.

SHAPIRO

FIG.

3-A

4
4C3

.+tk;

p
CI,

FIG.

3-B views lack

THE

Bilateral

osteitis

condensans

ilii. bone and

Oblique the

illustrating

the

sharp

limitation sacro-iliac joint.

of the

process

to the

iliac

of encroachment
OF BONE

on the
AND

JOURNAL

JOINT

SURGERY

OSTEITIS

CONDENSANS
.m
C

ILII

903

FIG.

Case

F.

H.

Bilateral

osteitis

4-A condensans

ilii.

Before operation.

FIG.

4-B section of the of bone removed was from sacro-iliac joint.

Same that
VOL.

case. part of
NO.

At the
4.

operation ilium adjacent

1936

a fairly to

large oblong the upper half

XVIII.

OCTOBER

904

H.

A.

RENDICH

AND

A.

V.

SHAPIRO

has by four the ported equal

lateral,

The been others

condition described as being uniin of reand inwas

although of the cases group definite bilateral here

volvement

observed.
Were it not for

the
these clinical

fact

that
cases

some
present

of

complaints

referable
osteitis

to properly to the

this

area, be relclass of

condensans

would egated
FIG.

roentgenographic curiosities, interesting

but cal

Early

case showing

a very small area ofcondensation.

of rio known
significance.

clini-

However,
the usually sacro-iliac that of

sonic region.

of these In
and
frequently

patients cases
l)aiIl,

have
over The pain

definite
the
(lown

complaints occur, the

region,

referable complaint
either

to is
uni-

where
often
radiating

symptoms

low-back thigh and

sacro-iliac

lateral
the
ing;

or
several

l)ilateral,
patients

corresponding

leg.

complained
on

niay limp
ProPort

be
may

obtained
occur
1011 at( t
0

on assulmug the ffected a

extent of

inability the recumbent side. The

.

of

the posterior surface of may be aggravated by bendto lace their shoes. Relief position. Occasionally a degree of pain has not been

the

can
authors,

be

entirely
with

ascribed
very cases definite are

to It must

questionable.

involveinen t Whether these complaints osteitis condensans in the is, opinion of the be stressed that in this series cases have sclerosis, but without symptoms referable to

occurred this area.

discovered the

incidentally Such findings reason for may

on palpation

to

examinations

of or

systems sis should

sacro-iliac

other not

than the be seized

findings in

skeletal. upon as
which cases of

as a localized osteoscleroany type of lumbosacral

are overhe t usually scant

symptoms informative.

the patient osteitis

present.
condensans

Physical
not very

and region are normal.

Tenderness

involved reflexes
in an

and
article usually result

slight Little
in and

muscular
is

spasm
in regard stated

known multiparae, late finding

may be noted. to the etiology. osteitis concluded

periosteal,

The deep FritzBerent

earlier

definitely

that
and of

condensans occurs only that Osteitis condensans

ligamentous, and capsular

in

females, is the trauma due to one

to

gravidity

and

labor.

He

infers
THE

that
JOURNAL

this
OF

condition
BONE AND

is
JOINT

limited
SURGERY

OSTEITIS

CONDENSANS

ILII

905

sex.
has been

This series
in which

inference
disproved by

the
ported,

here have

nite observed In the

there male

cases

redefibeen male. series Icmale

in the present
were and three nine

patients. Bone
been cases

syphilis in by the the type

Pagets by serological

has these hisnonof

dis-

excluded

studies, tory,
bone Likewise,

and

by

characteristic
involvement.

ease, myelitis,
thritis,

sclerosing
tuberculosis, Hodgkins marble-bone,

osteoosteo-arEarly case area adjacent showing to the FIG. process most 6 limited inferior to a small triangular part of the sacro-iliac

lymphogranulomatosis, disease, and

joint.
ment

The
in this

sacral
case.

surface
types of our to

appears
metastases satisfaction

to show

similar
have in l)een all of each

involvegiven

osteoplastic

consideration and present cases. A very thorough the cases failed to wise, the blood in eight of the in which meters balance merit
uncover

have

been

excluded of of the

the of were made in the case

examination show evidence

entire osseous determinations and the

7.2 units

system involvement. of

ill

niultiplicity

Like-

calcium and phosphorus twelve cases were all normal

was performed was

which phosphatase

an of no

operation blood. to

generalized Blood Gaily,

in the os

disturbance excluded. and and

calcis

of Osteitis studies

per 100 cubic centithe calcium-phosphorus

appears further
anything

be definitely
of significance.

fibrosa likewise describe

the fourth

and

its failed osteitis

variants to conlumbar

consideration. Sicard,
also
process.

urine Haguenau
and in

As
densans

mentioned,
as occurring

and

fifth

vertebrae.
involved striking

by
and as well

It seems a similar
fairly as the

probable
extensive axiilary

We

that bones other have observed sclerosis the of coracoid

of the scapula.

than the sacrum may one case that shows a and acromion procThis has not been

be

esses

border

in-

cluded with those of the group of idiopathic

known entity.

the

osteitis localized frequently parts

1936

condensans osteoscleroses

series, it hut rather

does belong than to

to any

other

islands
VOL.

Radiologists have of bone in various

XVIII. NO. 4. OCTOBER

of

the

found small condensed and osseous system, particularly

sclerosed about

906

R.

A. RENDICH

AND

A.

V.

SHAPIRO

the pelvis.
compact

shoulder While

am!

the small

bony often referred

literature texts,

islets to
and their

are
in in

the most

significance
lacking.
losis

is

still
to mauibe

Osteopoikiappears striking
on a

a more
festation

more

widely
scale. rfhe

distributed question osteitis ilii relation as

to any

whether

condensans

bears

above

is
the

to the necessarily to
iii

I
FIG.

for
7

future

de-

Zones

of

condensation

process, tile acromion The relationship of ilii is unknown. itself. would described
rfIie

amid sclerosis in the coracoid of process, and the neck of the scapula. light these structures to osteitis condensans knowledge,

termine,

hut,
our no

the present

definite

relationship of
separate areas of

suggests degree
the in

constancy
to small

location
osteitis condensed

and
hone

the

extent
from found

and
occasionally

of
previously

sclerosis
other parts

seem

condensans ilii

of

the

skeleton.
as an

rfrauI3a

etiological

factor

seems series some

to gave mild

deserve equivocal trauma

the

little

consideration. of hayintervals
was The most etiologi-

While ing

several

fallen to the

or

of the patients of this of having sustained onset

failed

histories at varying
sclerosis injury.

prior

of their
to give therefore,

symptoms,
any history remains

others whom in
of antecedent questionable. represent A local

pronouiicecl cal significance,

In that
embolism

a discussion sclerosis
with be bacteria

of of ivory

ivory
of low

vertebrae,
virulence.

B#{225}rsony and
areaction chronic

Schulhof to a bacterial
infection

suggest
might

the

vertebrae may might

thereby

set up, and

eburnation

result

just
merits

asdoesit

in

Garr#{232}s in of in-

sclerosing
In

osteoniyelitis. the
opinion of the authors, this possibility consideration
in the

the the

etiology entire

volvement

of osteitis indifferent sacral

cOlldeflsans cases-from

ilii. variation The an area of several a process basis. years ilium

OF

extent

millimeters

to

almost folany of

surface of the ilium-suggests ity, probably on a low-grade inflammatory lowed and examined after one and one-half
appreciable change or of the progress in the

of great chronicCases have been without showing brings

AND

roentgenograms.

A consideration

blood

supply
THE

of the
JOURNAL

out
JOINT

a point
SURGERY

BONE

OSTEITI8

CONDENSANS

ILl!

907 foramen the inferior is occurs with portion of the the seat local to are but contwo which of

interest great the

osteitis

and regularity sacro-iliac

possibly in that joint. That the foramina

of significance. part of the This a

ilium

A nutrient adjacent

to

condensans.

is the part relationship that osteitis instead are

of the ilium that may exist between is an interesting of one foramen in this location,

blood sider. or three

supply and It occasionally nutrient

condensing happens which crest. which the in

point there

situated

extend higher toward of osteitis condensans

almost

This may the process of the condition, thorough ilium. as

have a bearing on is more extensive, in so many others, of the

those cases involving the knowlUntil

It edge

the entire is apparent of the cause

sacral that must

surface in this wait upon

knowledge

effect. etiology

we become thoroughly conversant with the histopathology, the will in all likelihood remain obscure. In one case of the present series, a section of sclerosed moved during an operation to stabilize the joint. A review ture It to reveals seems present no case in which there are operative or histological worthwhile, this case therefore, in somewhat in view greater of the pathological detail. of two

bone was reof the literafindings. available, data

children were both who pain in the right sacro-iliac region. After bending, he would experience pain and difficulty in straightening The pain had been severe enough to incapacitate him for a week at a time. He had had short intervals that were symptom-free. There had been no sciatic radiation, the having been localized to the region over the sacro-iliac synchondrosis. There had been well,
no played past major any illnesses. The occupation, that of salesman, could not possibly

F. H., male, aged five years previous

thirty-six, married and the father to admission had begun to experience

up. pain
have

etiological role. In his youth, the patient hadbeen very active and had participated in all the major sports. Six months after the original onset, he had fallen and landed onhis right hip. This time he had been incapacitated for three weeks with the same type of pain in the right sacro-iiac region. A right-sided limp had followed this and the pain was present
only at intervals, joint. along in bed to remained get although there was 2, month. 1935, always a he sensation of residual soreness over the

right
managed and again

sacro-iiac

The
till January
for one

pain was

always
when

aggravated
had to

by
he

bending.
brought home

The
from

patient
work

While was he lying

fiat

appeared,
on During surgeon.

except
March the

on
21, second

graphic

diagnosis was

twisting 1935,with bilateral

or

turning.

the
osteitis

diagnosis

admission,

entered sacro-iiac condensans ilii. the patientwas operated of

He

in bed the pain almost the hospital on February arthritis. The roentgenoupon by the orthopaedic

dis4 and

The

preoperative

diagnosis
very

sclerotic. The physical findings prior operation to a slight rigidity of the lumbar muscles. The laboratory findings were all essentially negative. The blood calcium was 11.1 milligrams per 100 cubic centimeters. The blood phosphorus was 3.9 milligrams per 100centicubic meters. The phosphatase was 7.2 units per 100 cubic centimeters of lood. b A section of bone was removed from the involved portion of the sacral surface of the

fusion to the

was done. At operation, right sacro-iliac joint was

was sacro-iliac arthritis, it was noted by the surgeon that

and a sacro-iliac right the iliac bone adjacent

were

scant,

there

being

present only

ilium
dent
VOL.

at
There

operation lacunae.
NO. 4,

for is a marked

pathological condensation There

study. of appearto
1936

The the

report osseous

of tissue

Dr.

William with

Hala

follows: of the evi-

obliteration

former
XVIII,

be

no

osteolytic

or

osteoclastic

changes

in

the

OCTOBER

908
bone In and neither is

R. there

A.

RENDICH any evidence less

AND of

A.

V.

SHAPIRO osteoclasts of the

or osteoblasts. spaces contain an unusual number of myocytic andplasma types of cells. The significance of the plasma cells is undetermined. In general, the lesion appears to be of an osteitis condensans type. It is apparently independent of any inflammatory or other etiology, so far
overactivity fact, these cells are more or conspicuous by their absence.

marrow The

as can densed regular

be ascertained from the histology bone there appear to be depositions

of
of

the
lime

specimen.
salts which

Occasionally,
occur more or

in
less

the
in

conir-

osteitis
The

linear areas, condensans.

patient very

but

more

or less after

parallel weeks.

to the

lamellae stifi in

of the
a plaster

bone.
jacket,

Diagnosis:
but

was discharged marked

four

He was

had

obtained

relief.

an

Judging inflammatory It picture is to be

from

the basis

foregoing might a basis that the condensans, on account

be

pathological excluded,

report, whereas

it would appear that from the roentgenoundertaken opinion of the on of the pain.

graphic account orthopaedic

such noted

seems quite likely. operation in this was not case but was indicated, of the disabling

of the osteitis surgeon,

in the character

SUMMARY

We larger

have area of

an unusual bone affection dense sclerosis, occurring not of involving the etiology the sacro-iliac is not

on

characterized the iliac and

side definitely

by a of the

smaller sacro-iliac not due to

or

synchondrosis,

joint, clear; the

osteo-arthritis. The nature and

pathogenesis

is unknown; known of

the clinical significance It does not fall definitely bone diseases or affections, nutrient foramen suggests a It is condition important, that may

is debatable. within but the a low-grade to in avoid the

the category of any of the type of lesion in the region inflammatory nature. ascribing nature of an

the to

if only be more

clinical significance incidental roentgenofor in all roentgenoshould be completely gradually uncovered, and another en-

graphic

finding. the condensans pelvis so that, added to should be carefully looked and, when found, the cases as new facts and findings are and vague list of wifi bone become affections. clear, the

Osteitis grams of investigated much tity that may

is now be

uncertain

REFERENCES BkRsor4r, TH., imn

tIND

POLGAR,

F.:

Ostitis

condensans

ilei-ein

bisher

nicht d.

beschriebenes

Krankheitsbild. BARSONY, Ta.,

Rontgenstrahlen,
BERENT, FRITZ:

Fortsch.
SCHULHOF,

XLII, Beitrage
XXXII,

a. d. Geb. 0.: Der 597, 1930.

d. Rontgenstrahlen, Elfenbeinwirbel.

XXXVII, Fortschr. a.

1928. 663,
Geb. d.

zur Pathologie der Kreuzdarmbeinfugen. Arch. f. Orthop. 642, 1933. Zur Atiologie der Ostitis condensans ilei. Fortschr. a. d. Geb. d. ROntgenstrahien, XLIX, 263, 1934. SICARD, GALLY, lIT HAGUENAU: Ost#{233}ites ondensantes, c a #{233}tiologie inconnue. J. de Radiol. et dElectrol., X, 503, 1926.

u. Unfall-Chir.,

THE

JOURNAL

OF

BONE AND

JOINT

SURGERY