Skeletal Anatomy/Pathology Flashcards
Osteoblasts
Bone building cells
Bone remodeling
Continuous build up and breakdown process of bone
Osteoclasts
Bone breakdown cells
Ossification
Bone formation
Resorption
Bone destruction
Periosteum
Fibrous membrane that lines the outside of bones except articular surfaces
Diaphysis
Main shaft like portion of bone
Epiphysis
End of bones
Epiphyseal plate
Cartilage area for long bone growth (growth plate)
Medullary cavity
Hollow cylinder center of bone lined by the endosteum
The medullary cavity is filled with ?
Yellow bone marrow (fat storage)
Enchondial ossification
Bone formation by expansion formed by hyaline cartilage
A majority of bones form by
Enchondial ossification
Cortical bone
Aka compact bone (20% of skeleton)
Dense outer layer shell of bone, strong/tightly packed
Cancellous bone
Aka spongy bone (80% of skeleton)
Semi hollow inner portion of bone; trabecular
Trabecular
“Struts and braces”, scaffold like
Spaces between “struts and braces”
Red bone marrow; blood cell production
Basic function of bones
PMS: Production Protection Movement Storage Support
Production (of bone)
Red bone marrow
Protection (of bone)
Vital organs of body
Movement (of bone)
Levers for muscle action
Support (of bone)
Framework of the body
Storage (of bone)
Minerals and fat
Types of fractures
Displaced or undisplaced, complete or incomplete, open or closed, simple or comminuted
Fracture
Disruption of bone caused by mechanical forces applied directly to the bone or transmitted along the shaft of a bone
Fractures are the most
Common skeletal abnormality demonstrated by general radiography and typically appears as a Radiolucent line crossing a bone that disrupts the bones margin
Displaced fracture
Occurs when the fragments of bone are out of their normal alignment
Undisplaced fractures
Occur when the bone is broken but alignment remains unchanged
Fractures are classified by their…
Extent, direction, position, number of fracture lines, integrity of overlying skin, displacement of bone
Complete versus incomplete fractures
Refer to the fracture line
Complete fractures
Describe a fracture that has a discontinuity between two or more fragments
Incomplete fragments
Describes a fracture that has only partial discontinuity of a bone
Open fractures
Aka compound fractures; when bone(s) pierce through and disrupt overlying skin, resultant infections
Closed fractures
Occur when the fractured bone(s) do not disrupt the overlying skin
Simple fractures
Occur when the fracture results in no more than two bony fragments
Comminuted fractures
Occur when the fracture results in more than two bony fragments, often multiple fragments
Butterfly fragment
Type of comminuted fracture resulting in elongated triangular fragment isolated by proximal and distal lines of fracture
Direction of fractures
The relation of fracture to the long axis of the bone affected, can be transverse, oblique, or spiral
Transverse fracture
Fracture with a 90 degree angle to the long axis of the bone
Oblique fracture
Fracture with a 45 degree angle to the long axis of bone
Spiral fracture
Encircles the shaft of the long axis, caused by rotational/torsional forces
Avulsion fractures
Small fragments of bone torn from prominences as a result of indirectly applied tension from tendons and ligaments
Segmental fracture
A segment of the shaft isolated from the proximal and distal shaft by fracture lines
Compression fracture
Results from compression and compaction of the bone resulting in decreased length or width of the bone
Stress fracture
A segment of the shaft isolated from the proximal and distal shafts by fracture lines
Greenstick fracture
Incomplete fracture with the opposite cortex intact. Normally occurs in infants and small children.
Torus fracture
Buckling or impaction of one cortex while the opposite cortex remains intact. Normally seen in children.
Metaphysis
The wider part at the end of the shaft of a long bone, adjacent to the epiphyseal plate; located between the epiphysis and diaphysis
Scoliosis
A twisting and curvature in the lateral perspective of the spine, somewhat like an “s” curve
Lordosis
Anterior concavity in the curvature of the lumbar and cervical spine, as viewed from the side
Kyphosis
Anterior convexity in the curvature of the thoracic spine, sacrum, and coccyx, as viewed from the side
Bursitis
Inflammation of the bursae (small fluid filled sacs located near the joints that reduce the friction caused by movement). Not well visualized on X-ray, ultrasound is used.
Spondylolisthesis
Spondylolysis with displacement of vertebral alignment
Pathological fracture
Occurs when the bone weakens due to another process such as a tumor, infection, or metabolic disease
Transitional vertebra
Vertebra with characteristics of another spinal region, occurring most frequently at the limbo sacral junction
Spina bifida
A posterior defect of the spinal canal, resulting from failure of the posterior elements to fuse properly
Osteopetrosis/marble bones
Rare hereditary bone dysplasia results in osteoclasts dysfunction; prevents bone marrow formation, bones become brittle causing stress fractures
Osteogenesis inperfecta / brittle bones
Inherited generalized disorder of connective tissue characterized by multiple fractures, unusual blue color of the whites of eyes, and early hearing loss. Adults with this are usually wheelchair bound.
Achondroplasia
Most common form of dwarfism results from diminished proliferation of cartilage in the growth plate (decreased Enchondral bone formation).
Congenital hip dysplasia
Dislocation of hip which results from incomplete acetabulum formation caused by physiological and mechanical factors
Osteoarthritis
Degenerative joint disease characterized pathologically by the loss of joint cartilage and reactive new bone formation. Primarily affects weight baring joints (knees/spine/hip/ankle) also hands and feet
Rheumatoid arthritis
Autoimmune disease, a Chronic systemic disease of unknown cause that appears primarily as a nonsupperative inflammatory arthritis of the small joints of the hands/feet
Ankylosing spondylitis
Chronic inflammation affecting the spine, starts inferior and works its way superior up the spine
Osteomyelitis
Inflammation of the bone and bone marrow
Osteoporosis
Generalized or localized deficiency of bone matrix in which the mass of bone per unit volume is decreased in amount but normal in composition
Osteomalacia
Insufficient mineralization of the adult skeleton after closure of the epiphyseal plates; failure of calcium and phosphorus deposits in formation of the bone matrix
Rickets
Systemic disease of infancy and childhood that is the equivalent of osteomalacia in the mature skeleton
Gout
A disorder in the metabolism of purine in which an increase in the blood level of uric acid leads to deposition of uric acid crystals in the joints, cartilage, and kidney
Paget’s disease
One of the most common chronic metabolic diseases of the skeleton. Destruction of bone, followed by a reparative process results in weakened, deformed and thickened bony structures that tend to break easily.
Club foot/talipes
Congenital deformity of foot in which the foot is twisted and relatively fixed in an abnormal position; occurs in 1 in 1000 births
Syndactyly
Congenital anomaly characterized by the fusion of fingers or toes
Polydactyly
Congenital anomaly characterized by the presence of more than the normal number of fingers or toes
Tendonitis
Inflammation of the tendon, usually from strain. Common examples are tennis elbow, golf elbow, Achilles tendinitis, DeQuervains tenosynovitis (gamers thumb)
Tenosynovitis
Inflammation of a tendon sheath caused by calcium deposits, repeated strain or trauma, high blood cholesterol levels, rheumatoid, gout, or gonorrhea
Osteophyte
A bony outgrowth, usually found around the joint area
Articular cartilage
Type of hyaline connective tissue that covers the articulating surfaces of bone within synovial joints
Osteopenia
Condition of sub normally mineralized bone
Typhos/tophi
A calculus containing sodium rate deposits that develops in particular fibrous tissue, typically in patients with gout.
Transitional vertebra also occur at the cervicothoracic and thoracolumbar junctions forming a
Floating rib
Spina bifida occulta
Mild form of Spina bifida where the bone is split at L5 or S1
Occulta- hidden / asymptomatic
Meningomyelocele
Herniated meninges and spinal cord
False joints formed between the transverse processes of L5 and the Iliac Crest are known as
Psuedoarthroses
Cervical spine
Normally 7 vertebra, transverse process foramina
Thoracic spine
Normally 12 vertebra with ribs bilaterally
Lumbar spine
Normally 5 LARGE vertebra that are not fused to adjacent bodies
Radiographically, osteopetrosis appears as
A generalized increase in bone density (considered an additive pathology)
Severe cases of osteogenesis imperfecta include
Bowed legs/arms, scoliosis, and kyphosis
Osteogenesis imperfecta patients will suffer from multiple fractures due to
Severe osteoporosis and thin, defective bone cortex
Fracture sites for osteogenesis imperfecta patients may appear as
Bone tumors due to extensive callus formation at fracture sites (destructive pathology)
Achondroplasia results in
Short limbs and an average size trunk
Achondroplasia is characterized radiographically by
Abnormally short/wide long bones
Congenital hip dysplasia is more common in
Females
Assessment of congenital hip dysplasia, the hip
“Pops out of place” upon flexion and abduction of hip
Congenital hip dysplasia is radiographically demonstrated by
AP pelvis and cleaves method of the hip(s)
Club foot/talipes results in various anomalies but most commonly
Talipes Equinovarus
Treatment for club foot/talipes
Progressive casting, braces, surgery.
Frequent X-ray follow up
Osteoarthritis radiographic appearance
Narrowing of joint spaces, osteophyte (bone spur) formation along articular edges (hyper dense bone)
With advanced osteoarthritis disease
Subluxation may occur
Osteoarthritis is the ? arthritis
“Wear and tear”
Infectious arthritis
Caused by pyogenic organisms gaining access to a joint space by the Hematogenous route from surgery or trauma to the joint space
The most common infectious arthritis is a migrating form
Lyme disease with a classic bullseye appearance
Symptoms of infectious arthritis include
Severely tender joint space, high fever, shaking and chills
Vector
Insect that spreads disease
Radiographic appearance of infectious arthritis
Soft tissue swelling causing fluid distention if the joint space and destruction of the joint cartilage erosion of the cortical bone
Rheumatoid arthritis affects women
3 times more often than men
The average onset age for rheumatoid arthritis is
About age 40
Rheumatoid arthritis can be protracted or progressive leading to a
Crippling deformity of the affected joints
Rheumatoid arthritis begins as inflammation of synovial membrane causing
Excess exudate to be produced which erodes the bone/joint surfaces
Rheumatoid arthritis often works its way
Proximally toward the trunk until every joint in the body is affected
Rheumatoid arthritis results in severe deformity of the joints with occurrence
Of bones fusing the joint spaces
Rheumatoid arthritis variants
Ankylosing spondylitis
Reiters syndrome
Psoriatic arthritis
Ankylosing spondylitis most frequently begins in the
SI joints bilaterally and can result in fusion (Ankylosing) of joints
Ankylosing spondylitis AKA
Bamboo spine
Ankylosing spondylitis causes blurring of
The articular lines of the sacrum and ilium
Reiter’s syndrome
Reactive arthritis characterized by arthritis, urethritis, and conjunctivitis; primarily affects young males after a GI or vanereal disease; affects heels, toes, and SI joints
Reiter’s syndrome affects bilaterally but not
Symmetrically, only minimal affects to spine
Psoriatic arthritis
A rheumatoid like destruction involving peripheral joints in patients with psoriasis, primarily effects the DIP joints of the feet and hands, primarily the distal hands
Stress, rheumatoid, gout, arthritis, and infections are the most common causes of
Bursitis.
Rotator cuff tears
A tear of one of the four shoulder muscles allowing a passageway between the shoulder joint and subacromial bursae
Rotator cuff tears are best demonstrated by
Arthrogram, CT and MRI. ultrasound may be used due to cost/less invasive.
Meniscal tears
Often occur in correlation with ACL and PCL tears. Can be acute or degenerative in nature.
Meniscal tears are best demonstrated by
MRI (more accurate and less invasive than arthrography)
Bacterial osteomyelitis
Inflammation of bone and bone marrow caused by infectious pathogen from hematogenous spread
Acute osteomyelitis
Affects red bone marrow rich long bones (commonly tib/fib and femur)
Bacterial osteomyelitis is commonly found in
Drug abusers and diabetics; spread from soft tissue infections and vascular deficiencies.
Bacterial osteomyelitis begins as
an abscess of bone and can spread along the periosteum very rapidly if not treated.
Bacterial osteomyelitis is best detected by
Bone scan, a nuclear medicine procedure looking for “hot spots” (fractures/infections)
Osteoporosis is usually caused by
An accelerated absorption of bone due to osteoclast activity surpassing osteoblasts activity
Osteoporosis may also occur as a result of
Decreased bone formation (osteoblasts) with prolonged steroidal use and prolonged immobilization of extremities
A 50-70% loss of bone mineralization is required to
Demonstrate osteoporosis on plain film
It is recommended that KVP be decreased in order to increase the absorption of the beam and produce a
Shorter scale of contrast for osteoporosis patients
Osteoporosis is considered to be a ? Pathology
Destructive
Osteoporosis is commonly diagnosed by
Bone densitometry (DEXA)
Causes of bone loss include
Aging, post menopausal hormone changes, poor diet, inactivity, and long term medications (steroids, anti-convulsants)
Radiographic appearance of bone loss
Thinning cortical bone best demonstrated in spine/pelvis, kyphosis, compression fractures, or anterior displacement of vertebral bodies over one another
In the skull, bone loss appears as
A spotty loss of density and loss in sella turcica and dorsum sallae
Fragility fractures
Broken bones resulting from minimal trauma usually caused by bone loss
Treatment of bone loss
Prevention is the best cure!
Weight baring exercise, hormone replacement therapy, adequate vitamin and mineral intake, supplements (vitamin d/calcium), medications.
In severe cases verteboplasty is done to
Prevent further collapse of vertebral bodies
Osteomalacia is caused by
Inadequate intake of calcium, vitamin d, phosphorus, kidney failure, renal diseases where calcium is lost in the urine; failure of the body to absorb necessary nutrients
Osteomalacia appears radiographically
As a loss of bone density, thinning of the cortical bone, deossification of medullary cavity, bones may be bent due to stress/loss of minerals
Rickets is caused by
Deficiency of vitamin d and calcium, lack of sunlight, lack of physical activity
Rickets appears radiographically as
Bowing of bones, lack of calcification, increase in growth of non calcified tissue, most often seen in fast growing bones (sternal ends of ribs, proximal humerus/tibia, distal radius/ulna)
Rickets treatment
Doses of vitamin D and calcium supplements
Primary gout
Caused by inherited enzymatic defects that cause over production of uric acid
Secondary gout
Hyperuricemia caused by an overproduction of uric acid due to metastatic carcinoma, myeloma, drugs, or a decrease in excretion due to kidney failure
Gout appears radiographically as
Early detection cannot be determined due to the changes manifesting late in the disease process, earliest signs include joint effusion
Advanced gout presents as
Severe destructive lesions with joint space narrowing, characteristic large soft tissue masses
Padget’s disease presents most commonly in
Mid life and affects men twice as much as women, it affects 3% of people over age 40
The pelvis is the most common and often the initial site of manifestation of
Padget’s disease
Padget’s disease in long bones
The destructive phase starts at one end and extends along the shaft for varying distances and usually ends in a v shaped pattern. Upon repair, the bone is enlarged with widened cortex.
Padget’s disease in the skull
A well defined area of radiolucency is seen in the destructive phase of the disease.
Padget’s disease in the spine
Enlargement of the vertebral body occurs with an increase in cortical bones.
There is no known cure for Padget’s disease, the progression can be slowed by
Administering biophosphonates or administering calcitonin (these minimize the resorption of bones and inhibit osteoclastic activity).
