HIPS Flashcards
Avascular necrosis
- Sclerosis and lucency with flattening of the femoral head
- Acetabulum is preserved
- Right hip joint appears normal
? Vascular calcification
? H-shaped vertebrae
? Splenomegaly
? renal transplant
Diag- AVN
Causes-> ( STAR- Steroids, trauma, alcohol, haematological, rheumatoid, renal failure)
Manage:
1) MRI-> confirm diagnosis, grade ( >25% increased risk of collapse)
2) Referral to orthopaedics
3) Cause of collapse
Diaphyseal achalasia
- Large sessile/ pedunculated sclerotic metaphyseal bone lesion
- Arises off the cortex and continuous with medullary cavity
- Erylenmeyer flask deformity
Diag-
Complications
- Compress neurovascular
- Degeneration into chondrosarcoma-> MRI and >1,5cm cartilage cap
- Risk is 1% solitary and 5 % for multiple
- Clinical features of degeneration are pain and increase in size
Enchondroma
- Lesion
- The pattern of calcification appears consistent with chondroid matrix, with a “ring and arc” pattern evident. -No significant endosteal scalloping, cortical breach, periosteal reaction, or soft tissue mass.
MRI
Tl ->there is a predominant low-to-intermediate signal
intensity lesion, with high signal fod superiorly.
-> lobulated contour.
-> T2 fat-saturated image, there are more clearly defined clusters of numerous high signal intensity locules.
Malignant features 1) Pain - Proximal location 2) Endosteal scalloping > 2/3 3) Increased lucency 4) fracture/ cortical destruction 5) Increased activity in comparison to iliac crest on delayed-phase bone scintigraphy 6) Early and exponential enhancement on dynamic gadolinium-enhanced MRI
Malignant risk
1% solitary
10% Ollier
50% maffuci
Management
F/U 6 months and then annualy
Haemachromatosis
1) Hook osteophytes ( 2-5 of r 2 and 3)
2) Subchondral cysts
3) Calcification of Triangular fibrocartillage
4) Loss of joint space in the STT and 1st CMC joint
Diag- Haem
DD- CPPD
Management
1) CXR- Dilated cardiomyopathy
2) Sequale- parkinsonian symptoms, diabetes
4) CPPD- Crystal analysis-> positive birfringence under polarised light
Pagets
- > cortical expansion
- > trabecular thickening
Fibrous dysplasia
- > Diametaphysis/ diaphysis
- > Well defined
- > Thick sclerotic rim
- > Expansile
- > Endosteal scalloping
- > Groundglass matrix
- > ? Fracture
- > ? bowing deformity
MRI–> Pathological fracture or malignant degeneration
STIR-> Intermediate to high signal
Multiple lytic lesions in a child
1) LCH
2) Multiple enchondromas
3) Jaffe-campanacci syndrome
4) Hyperparathyroidism
Lis franc
- > Malalignment of the 2nd TMTJ
- > Osseous fragment
- > Medial margin of intermediate cuneiform
- > Lateral margin of 1st MT does not allign with lat margin of medial cuneiform ( oblique)
- > Medial margin of 3rd MT does not allign with medial margin of lat cuneiform
- LOOK for vascular calcification
Lis franc joint
-Lat margin of medial cuneiform –> MEDIAL margin of 2nd MT
Gout
- Juxta - articular erosions
- ‘Double contour’ sign on ultrasound
Cervical instability
Anterior atlantodental interval ( <3mm)
Cervical canal diameter 14mm
1) Trauma
2) Rhuematoid
3) CPPD
4) HADD
5) Down’s
5) Marfans
Arthropathy
Mono
- –> MUST DO JOINT ASPIRATION
- > Infection
- > PVNS
- > Gout
- > Synovial chondromatosis
Soft tissue tendon mass
1) Fibromatosis
2) GCT of the tendon sheath
3) Synovial sarcoma
TALK
-> recurrence of GCT is 24%
Anterior intercondylar notch lesion
1) Cyclops-> Does not need to be ACL reconstruction
2) PVNS
3) Synovial haemangioma
SLACC wrist
- Widening of scapholunate interval
- Arthropathy of the radioscaphoid and STT
- dorsal angulation of lunate ( DISI)
- calcification of the triangular fibro cartillage
–> SLACC wrist
Graded according to the Watsons staging
SNAC
- SCAPHOID FRACTURE
- Arthropathy of the radioscaphoid and STT
- dorsal angulation of lunate ( DISI)
- calcification of the triangular fibro cartillage
–> SNAC wrist
