Pathological Fractures and an Introduction to Radiology

Question 1

Types of Imaging (5)

Answer 1

• Ultrasound
• X-ray
• CT
• MRI
• Nuclear medical scans

Question 2

Ultrasound

Answer 2

• Electricity —> Vibration
• Vibration passes through structures
• Good at viewing soft tissue
• Limited penetration

Question 3

X-ray

Answer 3

• X-rays are short wavelength electromagnetic
radiation
• Similar to γ-rays
• Good at seeing air and bones
• Limited detail and difficult to see soft tissue

Question 4

CT

Answer 4

• 3D X-ray
• Multiple x-rays pieced together in software
• Quick – much more information
• Difficult to appreciate subtle changes in soft tissue
• Larger dosage of radiation, so some risk associated with it

Question 5

MRI

Answer 5

• Complex mechanism
• Slow
• Expensive
• Cannot be used if people have magnetic metal implants (pacemakers)
• Large amounts of information – different phases allow you to image
different things

Question 6

What is a fracture? When do they occur?

Answer 6

A break or crack in a bone

Can be normal – under significant force

In some conditions, bones can become weaker, fracture from minor forces= pathological fracture

In older people, fractures are a cause of significant morbidity and mortality

Question 7

Morbidity

Answer 7

The condition of suffering from a disease

Question 8

Mortality

Answer 8

The number of deaths in a the population from a particular cause

Question 9

Normal Bone

Answer 9

• Made up of collage and calcium phosphate
• Constantly remodelled: osteoblasts build bone, osteoclasts remove bone
• Calcium absorbed in the small intestine and kidneys using Vitamin D
• Calcium levels and osteoclast activity modulated by PTH

Question 10

Causes of weak bones: in children

Answer 10

• Bone cysts
• Rickets
• Osteogenesis imperfecta
• Infection
• Cancer

Question 11

Causes of weak bones: in adults

Answer 11

• Osteoporosis
• Osteomalacia
• Infection
• Paget’s disease
• Cancer

Question 12

Bone Cysts

Answer 12

• Fluid filled spots inside bone
• Develop during growth of bones
• Usually does not cause any problems
• Occasionally, can weaken bones enough to break

Question 13

Rickets and Osteomalacia

Answer 13

• Caused by low Vitamin D leads to reduced calcium absorption leading to
impaired mineralisation of bone
• In children: Bones grow without mineralisation
• In adults: Impaired bone remodelling, causes brittle bones

Question 14

Weak Bones: Infection (Osteomyelitis)

Answer 14

Causes area of bone breakdown due to bacterial infection

Question 15

Weak Bones: Osteogenesis Imperfecta

Answer 15

Autosomal dominant inherited condition
Brittle bone disease

Question 16

Weak Bones: Paget’s Disease

Answer 16

High turnover of bone
Leads to areas of high and low density

Question 17

Weak Bones: Cancer

Answer 17

Can be primary or secondary
Breakdown of bone for tumour growth

Question 18

Osteoporosis

Answer 18

• Mostly affect cancellous bones
• Causes deterioration in the trabecular bone matrix
• Results in a reduction in bone mass

Question 19

Assessing Risks for Osteoporosis: FRAX

Answer 19

Tool that puts risk factors together to determine risk of osteoporosis

Question 20

Assessing Risks for Osteoporosis: DEXA Scan

Answer 20

• Bone density scanning
• Used if someone is at significant risk of osteoporosis
• Helps to guide treatment

Question 21

Fragility Fractures (Type of Pathological Fracture)

Answer 21

• A fracture which results from a force that would not ordinarily result in a
fracture secondary to osteoporosis.
• A fracture of the hip/vertebrae
• Fracture after a fall from standing height

Question 22

Management of Fractures (5)

Answer 22

• Early identification and intervention for risk factors
• Falls prevention
• Strength training and physio, medication review, home assessments etc.
• Calcium and Vitamin D supplements
• Bisphosphonates (only given to us some patients, usually > age 75)