Test #3 Flashcards
Bone death d/t inadequate blood supply. M/C hematologic condition of bone
Osteonecrosis
What are AKAs for osteonecrosis?
Ischemic necrosis
Aseptic necrosis
Osteonecrosis that has juxtaarticular involvement
Avascular necrosis
Osteonecrosis that has metaphyseal or diaphyseal involvement
Medullary bone infarct
Small fragment of bone that’s necrotic
Osteochondritis dissecans
What are 4 causes of in bone infarction?
Intraluminal obstruction
Arterial wall disease
Vascular compression
Physical disruption of vessel
What are causes of osteonecrosis?
(VINDICATE) Vascular - Sickle cell anemia INfection - septic emboli Drugs - alcoholism/corticosteroids Inflammatory - Pancreatitis Congenital - Gaucher's dx Autoimmune - SLE, RA Trauma - Radiation, fx, dysbarism Endocrine - Cushing's dx
Central area of necrosis surrounded by ischemic & healing tissue indicates what type of infarction?
Metaphyseal-Diaphyseal infarction
What’s the M/C type of Metaphyseal-Diaphyseal infarction?
Medullary
Cortical involvement in metaphyseal-diaphyseal infarction indicates what condition?
Sickle cell
What are the M/C locations for metaphyseal-diaphyseal infarcts?
Dist. femur
Prox. tibia
Prox humerus
What is the procedure of choice to detect metaphyseal-diaphyseal infarcts?
MRI followed by bone scintigraphy
What is the 1st radiographic sign of metaphyseal-diaphyseal infarcts?
Area of rarefaction (area is osteopenic)
What are the M/C locations of epiphyseal necrosis (AKA Avascular necrosis, bone-end necrosis)?
Femoral & humeral head
Dist. femur
What are the 4 pathologic stages of epiphyseal necrosis?
Avascular
Revascularization
Remodeling & repair
Deformity
Which part of a ball & socket joint undergoes necrosis?
The convex surface
What is the most reliable finding for avascular necrosis (AKA epiphyseal necrosis, bone-end necrosis)?
Subchondral fx AKA Crescent sign
What is the earliest radiographic manifestation of avascular necrosis (AKA epiphyseal necrosis, bone-end necrosis)?
A little bit of sclerosis
What is the radiographic staging system for rating avascular necrosis?
FICAT
Osteonecrosis of the hip is known as what in the adult?
Chandler’s disease
What age/gender is affected by osteonecrosis of the hip AKA Chandler’s disease?
M:F 4:1, 30-70 yrs of age
What is the typical distribution of osteonecrosis of the hip AKA Chandler’s disease?
50% bilateral & asymmetrical
What shape is the necrotic area of osteonecrosis of the hip AKA Chandler’s disease and what region does it affect?
Wedged shaped; anterosuperior weight-bearing region
What signs are assoc. w/ osteonecrosis of the hip AKA Chandler’s disease??
Snowcap sign (sclerosis) Crescent sign (subchondral fx) - Most reliable Bite sign (wedged or semilunar shape) Step defect (cortical collapse)
What is SONK?
Spontaneous OsteoNecrosis of the Knee
What is the M/C site for SONK?
Medial condyle of dist. femur
Lateral condyle
Age/gender most affected by SONK?
slight female predominance usually 60+
What are the clinical signs of SONK?
Acute sudden onset of pain
Gradual increase in intensity
Tenderness over involved area
How long does it take for radiographic manifestations of SONK to show up?
5 weeks to months
What are some radiographic signs of SONK?
Altered articular contour (flattening) Altered bone density Crescent sign May see loose bodies Articular changes
3 Categories of osteochondrosis
1st - True AVN’s - Legg Calve Perthe
2nd - Osteochondrosises d/t trauma - Osgood-Schlatters
3rd - Growth variants - Kohler’s disease
AVN of the humoral head is known as?
Hass’s disease
M/C cause of Hass’s disease
predisposing factors (fx, dislocations)
AVN of scaphoid is known as?
Preiser’s disease
M/C cause of Preiser’s?
secondary to fx (usually through the neck)
AVN commonly of the 2nd metatarsal head?
Freiberg’s disease
Age/gender M/C affected by Freiberg’s?
F>M, 13-18 yrs of age
Freiberg’s is usually assoc. w/ what?
Shoes, high heels
What are radiographic signs of Freiberg’s?
May have loose body
Metatarsal head may by more splayed out or flattened
Can see crescent sign
AVN of carpal lunate?
Keinboch’s disease
Age/gender M/C affected by Keinboch’s?
M:F 9:1, 20-40 yrs of age
M/C cause of Keinboch’s?
Trauma or repetitive work
What is the normal variant assoc. w/ Keinboch’s?
75% of pts have (-) ulnar variants (ulnar too short)
AVN of the capitulum?
Panner’s Disease
Panner’s disease usually affects who?
Kids in throwing sports (males 4-10yoa)
AVN of tarsalnavicular?
Kohler’s Disease
What age is affected by Kohler’s?
~5 yrs of age
AVN of the femoral capital epiphysis. AKA as Coxa Plana
Legg-Calve-Perthe
Age/gender M/C affected by Legg-Calve-Perthe?
Males, 3-12 yrs, peak age 5-7
Legg-Calve-Perthe is assoc. w/ what signs?
Waldenstrom sign (increased med. joint space) Crescent sign (subchondral fx) Snow-cap sign (sclerosis) Gage's sign (shortening of femoral neck) Sagging Rope Sign - Other side of femoral head projected differntly d/t deformity
This “disease” is characterized by soft tissue changes, displaced skin lines, patella lig. thickening, & blurring of Hoffa’s fat.
Osgood-Schlatter’s Disease
Age/gender M/C affected by Osgood-Schlatter’s?
Males 11-15 yrs of age
Clinical signs of Osgood-Schlatters?
Pain, swelling over ant. tuberosity
Pain that is made worse in tendon against resistance
This is AKA vertebral epiphysitis, juvenile kyphosis, & osteochondrosis juvenilis dorsi
Scheuermann’s Disease
Age/gender M/C affected by Scheuermann’s?
Males 13-17
What spinal region is Scheuermann’s M/C seen?
75% in mid-thoracic
What are the 3 radiographic criteria for Scheuermann diagnosis?
- Ant. wedging involving at least 3 contiguous vertebrae
- Irregular endplates d/t Schmorl’s nodes
- Decreased disc height
This is characterized by a small necrotic segment of subchondral bone
Osteochondritis Dissecans AKA Koenig’s disease
What are some causes of Osteochondritis Dissecans AKA Koenig’s disease?
History of trauma may or may not elicit
Shearing, rotatory forces may initiate
Age/gender M/C affected by Osteochondritis Dissecans AKA Koenig’s disease?
Males 11-20 yrs of age
What is the M/C locations of Osteochondritis Dissecans AKA Koenig’s disease?
Lat. aspect of med. condyle
Dome of talus
What is the best view to see Osteochondritis Dissecans AKA Koenig’s disease?
Intercondylar view
Growth variant that affects the secondary center of ossification of calcaneous?
Sever’s (sp) disease
This is characterized by deficiencies of various clotting factors leading to bleeding into joints & bones
Hemophilia
Hemophilia is M/C caused by lack of which factors?
Factor VIII (Hemophilia A, Classic) Factor IX (Hemophilia B, Christmas disease)
M/C locations to see hemophilia, clinically?
Knee
Ankle
Elbow
What are the stage of hemophilic arthropathy?
- Soft tissue swelling
- Osteoporosis
- Osseous lesions
- Cartilage destruction
- Joint disorganization
What are the radiographic features of hemophilia in the knee?
Enlarged epiphysis
Widened intercondylar notch
Squared inferior patella
What “deformity” is assoc. w/ hemophilia in the ankle?
Tibiotalar slant deformity
What are the 4 M/C causes of tibiotalar slant deformity?
- Hemophilia
- Sickle cell anemia
- JRA
- Metaphysial/Epiphysial dysplasia (MED)
Pseudotumors in the femur & pelvis are d/t what?
Intraosseous hemorrhage
This is congenital hemolytic anemia charac. by abnormal genetically transmitted hemoglobin
Sickle cell anemia
What is the most symptomatic type of sickle cell anemia?
Homozygous form HbS-S
What age range does onset of sickle cell usually occur?
6 months - 2 years
This is painful swelling of the fingers & toes during the 1st several years of life assoc. w/ sickle cell
Dactylitis (Hand-Foot syndrome)
Infections assoc. w/ sickle cell are caused by what organism?
Salmonella
What are the 4 M/C causes of generalized osteopenia, radiographically?
- Osteoporosis
- Osteomalacia
- Hyperparathyroidism
- Infiltrative disease
What radiographic sign is seen w/ sickle cell in the spine?
Reynold’s sign or H-shaped vertebra
What radiographic appearance does sickle cell have in the skull?
Hair on end appearance (more common in thalassemia)
What are radiographic features of sickle cell in the hands & feet?
Destructive bone lesions as a result of infarction &/or Salmonella infection
What are radiographic features of sickle cell in the long bones?
Changes related to infarction & infection
AVN of femoral & humeral heads
Tibiotalar slant deformity
What are radiographic features of sickle cell in the pelvis & spine?
Sclerotic changes are common
What are radiographic features of sickle cell in the soft tissues?
Extramedullary hematopoiesis
Cholelithiasis
Punctate splenic calcification after infarction
This is a hereditary disorder of hemoglobin synthesis leading to anemia
Thalassemia
What is thalassemia AKA?
Cooley’s anemia
Mediterranean anemia
What are the 3 forms of thalassemia?
Major
Intermediate
Minor
What are clinical features of thalassemia?
Onset - last half of 1st year Survival beyond 3rd decade rare Pallor, underdevelopment, organomegaly Altered facies Decreased hemoglobin
What are some radiographic features assoc. w/ thalassemia?
Coarse trabeculation (honeycomb appearance)
Hair-on-end in skull
Sinuses obliterated (rodent facies)
Cardiomegaly
Erlenmeyer flask deformity (d/t undertubulation)
Infection of bone & marrow?
Osteomyelitis
Implies a septic process of the joint itself?
Septic arthritis
Contamination of cutaneous, subcutaneous, tendinous, ligamentous, & bursal structures?
Soft tissue infection
Type of osteomyelitis M/C caused by staph aureus?
Suppurative osteomyelitis
Type of osteomyelitis M/C caused by TB (Mycobacterium tuberculosis)?
Non-suppurative osteomyelitis
Risk factors for osteomyelitis?
Immunosuppressed individuals Alcoholics Newborns IV drug users Diabetes Sickle-cell Post-surgical Vascular insufficiency
What organisms other than M. tuberculosis are assoc. w/ Non-Suppurative Osteomyelitis?
Treponema pallidum (syphilis) Actinomycosis (fungal) Coccidioidomycosis (fungal)
What are routes of contamination for infection?
Hematogenous
Contiguous Source
Direct Implantation
Postoperative Infection
95% of pyogenic infections involve what part of the skeleton?
Appendicular skeleton
What bones of the appendicular skeleton are most often affected by infection?
Femur (M/C)
Tibia
Humerus
Radius
What is the M/C age group affected by infections?
2-12 yrs of age (mostly males)
What are the clinical manifestations of bone infection in childhood & infancy?
Sudden onset of high fever
Localized pain & swelling
Chills
Loss of limb function
What are the clinical manifestations of bone infection in the adult?
Insidious onset
Fever & malaise
Edema, erythema, & pain
Bone infection is frequently assoc. w/ pre-existing infections of what other systems?
Genitourinary
Skin
Respiratory
What are the M/C organisms assoc. w/ Mainliner’s Syndrome?
Staph. aureus
Pseudomonias
Mainliner’s Syndrome frequently involves what joints?
SC joint Spine SI joints Pubic Symphysis (S Joints)
What spinal region are most infections found?
T/L junction
What spinal region is M/C affected by Mainliner’s Syndrome?
Csp
What are lab features assoc. w/ bone infection?
Elevated white cell count
Schilling shift to the left (increase in neutrophils & band cells)
Elevated ESR
(+) blood cultures w/ hematogenous
What path. features of the infantile pattern of vascular supply?
Vessels may penetrate the physis
Higher incidence of septic arthritis
What path. features of the childhood pattern of vascular supply?
Epiphyseal supply is separate
Hematogenous osteomylelitis affects the metaphysis more often & not physis or epiphysis
What path. features of the adult pattern of vascular supply?
Metaphyseal vessels gradually penetrate the physis
Increased incidence of septic arthritis secondary to osteomyelitis
What is the mechanism assoc. w/ hematogenous dissemination?
Usually direct extension from extravascular sites of infection
Necrotic bone d/t infarction, looks chalky?
Sequestrum
Bony collar from periosteal new bone, b/co new cortex?
Involucrum
Defect in involucrum leads to discharge. Most often assoc. w/ chronic osteomyelitis
Cloaca
This is a squamous cell carcinoma assoc. w/ Cloaca?
Marjolin’s ulcer
Time before osseous changes are evident radiographically in the extremity? Spine?
Extremity - about 10 days
Spine - about 21 days
What are imaging features seen in the extremity assoc. w/ infection?
Soft tissue changes (earliest findings) M/C in metaphysis Moth-eaten or permeative pattern of destruction Medullary & cortical destruction Periosteal response (Codman's triangle)
What are late changes seen in extremity during infection?
Sequestrum
Invlucrum
Cloaca
Sclerosis
What are imaging features seen in the spine <20 yrs assoc. w/ infection?
Initial disc involvement –> disc narrowing
Paraspinal edema
Endplate destruction
Osteolysis
What are imaging features seen in the adult spine assoc. w/ infection?
Begins in vert. body then disc
Vertebrae destruction, collapse, paraspinal swelling
Bony ankylosis may be seen
Localized, aborted suppurative osteomyelitis. M/C staph aureus. Often assoc. w/ hx of previous infection. Localized pain worse at night relieved by aspirin
Brodies Abscess
What age/gender is Brodies Abscess seen in?
Young, male, children
Where are the M/C skeletal locations for Brodies Abscess?
Metaphysis Distal tibia Prox. tibia Fibula Dist. radius
What is the radiographic features of a Brodies Abscess?
Oval, elliptical, or serpiginous radiolucency w/ rim of sclerosis
What are the general charac. of septic arthritis?
M/C below age 30
M/C monoarticular
M/C caused by staph aureus
M/C knee & hip
What are clinical features of septic arthritis?
Restricted ROM
Erythema
Fever
Labs typical infection
What are radiographic features of septic arthritis?
Soft tissue changes in about 3 days Loss of subchondral white line Juxta periarticular osteopenia Destruction of articular ends Bony or fibrous ankylosis