MSK Flashcards
Ossification centre in elbow:
CRITOL: -
- Capitellum typically ossifies between 6 months and 1 year of age .
- Radial head.
- Internal medial epicondyle.
- Trochlea.
- Olecranon.
- External lateral epicondyle typically ossifies between 10 and 14 years of age .
Which line is used to suggest supracondylar fracture?
most common paeds elbow fracture.
Anterior humeral line: the anterior humeral line should pass through the middle of the ossified capitellum on the lateral view. If abnormal, suggests supracondylar fracture.
Which line is used to suggest elbow dislocation?
radiocapitellar line: the radiocapitellar line should pass through the capitellum on all views. If abnormal, suggests elbow dislocation.
Which muscle attaches to … Iliac crest apophysis:
Abdominal muscles.
Which muscle attaches to … Anterior superior iliac spine ( ASIS) :
Sartorius.
Which muscle attaches to … Anterior inferior iliac spine AIIS :
Rectus femoris.
Which muscle attaches to … Ischial tuberosity apophysis:
Hamstrings.
Which muscle attaches to … Pubic ramus:
Hip adductors and gracilis.
Which muscle attaches to … greater trochanter:
gluteus medius and minimus.
Which muscle attaches to … Lesser trochanter:
Iliopsoas.
If there is concern for child abuse, a complete skeletal survey using ……..bone technique (for children under 2 years of age) should be performed, including frontal views of all long bones, rib views with obliques, skull, pelvis, hands/feet, and entire spine.
high-resolution
List the fractures specific for child abuse:
- Classic metaphysical fracture
- Posterior rib fractures
- scapula fracture.
- sternum fracture.
- spinous process fracture.
Key findings in achondroplasia: (5)
- Narrowing of interpedicular distances in the lower spine causes spinal stenosis that is compensated for by a characteristic lumbar lordosis as the child learns to walk.
- Posterior scalloping of vertebral bodies.
- Characteristic tombstone iliac wings.
- Flat acetabula, with short femoral necks.
- Frontal bossing of the skull
………..is most common lethal skeletal dysplasia. It is inherited in an …….. manner.
Thanatophoric is most common lethal skeletal dysplasia. It is inherited in an autosomal dominant manner.
Key findings in Thanatophoric dysplasia
- Flattening of vertebral bodies, causing H-shaped vertebral bodies with diffuse narrowing of interpedicular distance.
- Curved telephone receiver femurs.
Which type of salter Harris is SUFE?
Type 1
Best projection to evaluate the physeal widening and displacement
Frog leg lateral projection
Perthes usually affect children between the ages of …….. And ….. SUFE affects children between…..
Perthes : 4-8 yrs SUFE : 10-16 yrs
Bilateral SUFE is seen in …… and ……
Sickle cell
Steroid
Define Perthes disease or Legg Calve Perthes (LCP)
This is avascular necrosis of capital femoral epiphysis ossification centre
Early Imaging findings of Perthes on radiography and bone scan
X-ray : early - subtle sclerosis of femoral head Decreased uptake on bone scan
Late imaging finding of Perthes
Signs of osteonecrosis - femoral head becomes flattened and distorted with signs of OA
Bone scan shows increased uptake due to attempted repair
Ewing sarcoma is most commonly arises from
- Femoral diaphysis, followed by
- flat bones of pelvis Also in
- tibia ,
- humerus and
- ribs
Most common site for Ewing mets
Lung
Characteristic appearances of Ewing sarcoma
Permeative lesion in medullary cavity with wide zone of transition and associated aggressive lamellated ( onion skin) or spiculated periosteal reaction
With LCH histopathologically ………bodies are seen on electron microscopy within histiocytes
Birbeck bodies
What are the clinical subtypes of LCH
- Eosinophilia Granuloma
- Hand Schuller Christian
- Letterer Siwe
- Pulmonary LCH
Triad in hand Schuller Christian
Multi-focal but unisystem:
- Pituitary hypophysitis causing diabetes insipidus
- Exophthalmos
- Lytic bone lesion - usu affecting the skull
6 year old male child with polydipsia, polyuria. Suspected diabetes insipidus.
Hand-Schüller-Christian disease
triad of diabetes insipidus, proptosis, and lytic bone lesions.
Most common pathogen in patients with sickle cell and osteomyelitis
Salmonella
What is chronic recurrent multi focal osteomyelitis (CRMO) associated with ?
SAPHO SYNDROME :
Synovitis
Acne
Pustulosis Hyperostosis
Osteitis
Name the most distinctive radio graphic feature of leukaemia
Meta physeal Lucent band
Ddx of Meta physeal Lucent band (4)
- Leukaemia / lymphoma
- Severe illness
- TORCH infection
- Scurvy
- mets neuroblastoma
Ricket is a metabolic bone disorder caused by inadequate ………..
Vitamin D
What is the diagnosis?
Expansion, fraying and cupping of long bone metaphyses associated with adjacent periosteal new bone
Ricket
The effect of Ricket on ribs
Classic rachitic rosary - anterior cupping of the ribs with widening of the rib epiphyseal cartilage
Name the variant of Ricket rickets seen with non ossifying fibroma due to tumour metabolites causing deranged vit D metabolism
Oncogenic Ricket
Wimberger sign vs wimberger ring sign
Wimberger sign is seen in syphilis - destructive erosion of medial aspect of proximal tibial metaphysis
wimberger ring sign in scurvy - increased density of ossification centre
There are many named findings in Scurvy radiology, most of which are outlined here.
Name one condition causing symmetrical periosteal reaction in a child
Syphilis
JIA is usually Rh factor ….
Negative
What is the diagnosis?
< 5 yrs presenting with fever , anaemia , leukocytosis, hepatosplenomegaly and polyarthritis
Still disease = JIA + systemic illness
intermittent spiking fevers are typically noted, which helps distinguish JIA from other diseases such as infection, other inflammatory diseases and malignancy.
Migratory salmon coloured light pink rash involving the trunk and/or extremities and hepatosplenomegaly are also frequently observed in patients with systemic onset.
Name a RF for developmental dysplasia of the hip
Breech birth
What is the normal alpha angle?
> 60 is normal The bone portion of the acetabulum should cover at least 50% of cartilaginous femoral head
What is DDH?
An alpha angle less than 60 or less than 50% coverage of femoral head by acetabulum is abnormal suggesting DDH
Delivered by LSCS for breech position. Left hip movements restricted.
? Diagnosis
DDH
Unaffected right hip shows normal position of femoral head. Alpha angle is 60 - 62’.
Affected left hip shows abnormal position of femoral head. Alpha angle is 46 - 48’.
What is the diagnosis?
Osteochondrosis of medial aspect of the proximal tibial metaphysis causing bowing (tibia vara), gait deviation and leg length discrepancy
The condition is commonly bilateral.
Blount disease
What is the diagnosis?
Medial sloping of distal radius caused caused by dysplasia of medial distal radial physis and resultant growth disturbance
Madelung deformity
In the metacarpal sign, a line drawn along the heads of the 4th and 5th metacarpals will intersect the head of the 3rd metacarpal if shortening is present. The shortened 4th metacarpal is the key to the sign. Seen in Turner’s syndrome.
What is the diagnosis?
Osteochondrosis of capitulum
Panner disease
What is the diagnosis?
Osteochondrosis of medial epicondyle
Little league elbow
What is the diagnosis?
AVN of multiple thoracic vertebral bodies leading to multiple compression fractures
Scheuermann kyphosis
What is the diagnosis?
AVN of lunate
Kienbock disease
What is the diagnosis?
AVN of tibial tuberosity-
chronic fatigue injury due to <strong><u>repeated microtrauma</u></strong> at the patellar ligament insertion onto the tibial tuberosity, usually affecting boys between ages 10-15 years.
Osgood schlatter disease
a child presenting with anterior proximal tibial pain and swelling.
Fragmentation and soft tissue swelling over the tibial tuberosity.
Osgood Schlatter
What is the diagnosis?
AVN of 2nd MT head
Freiberg infarction
This is a self limited Osteochondrosis of navicular
Kohler disease
This is a calcaneal apophysitis rather than Osteochondrosis and is a cause of heal pain
painful inflammation of the apophysis of the calcaneus.
Sever disease- x-ray is usually normal.
This is ideopathic sternocleidomastoid enlargement causing in inability to fully straighten the neck
Torticollis - resolves with physical therapy
Neonates on ……. For CHD may have periosteal reaction
Prostaglandin
20 year old with foot pain
diagnosis?
Sclerosis and collapse of the second metatarsal head in keeping with Freiberg infraction.
8 year old with foot pain.
navicular is wafer-like (thinned) and fragmented with sclerosis. Kohler disease.
13yo Physically active girl with knee pain.
Self-limiting traction apophysitis of the patellar apex.
Sinding-Larsen-Johansson disease
RF: Cerebral palsy
a saucer-shaped / scoop like radiolucent cortical irregularity involving the posteromedial aspect of the distal femoral metaphysis at the attachment of the adductor magnus tendon. The lesion lacks an outer margin
Cortical desmoid
Do NOT touch lesion
DDx of Celery stalk metaphysis
- congenital infections:
- congenital rubella
- congenital syphilis
- congenital cytomegalovirus (CMV)
- osteopathia striata
