UNIT 4: Wk2 Flashcards
Rheumatoid arthritis
Progressive, systemic, inflammatory connective tissue disease affecting primarily synovial joints, although heart muscle and lungs may be involved
Radiologic features of RA
Soft tissue changes
Articular erosions
Osteoporosis
Joint deformities
The typical RA deformities in hand
Swan neck : distal IP joint
Boutonnières deformity : proximal IP joint
Osteoarthritis
Degenerative joint disease
Radiologic features of OA
Joint space narrowing, asymmetrical
Subchondral sclerosis
Osteophyte formation
Pseudocysts
Temporary joint effusions
Radiologic characteristics of osteoporosis
Cortical thinning
Loss of trabeculae
Fractures
T score of 0 =
= bone density is equal to that of a healthy young adult
T score of -1 to +1 means
Normal bone density
Z score
A comparison of a persons bone density with that of an average person of the same agent sex
Fracture
a break in the structural continuity of bone; occur in predictable patterns determined by viscoelastic properties and biomechanics of load
most common type of epipheseal fracture
type II - growth plate and metaphasis
What is the purpose of search pattern
Describes the methodology of looking at an image in an organized fashion
Helps ensure that everything possible to see has been accounted for
What is that ABCS search pattern
Alignment
Bone density
Cartilage
Soft tissue
What items are considered when performing search A?
Skeletal architecture, contour of bone, alignment of bones to another
What items are considered when performing search B?
Bone density, textural abnormalities, local bone density changes in areas of stress
What items are considered when performing search C?
Normal joint space width with proper disc thickness, subchondral, bone (smooth surface), epiphyseal plates
What items are considered when performing search S?
Muscles, fat pads, joint capsules, periosteum
PRACTICE DOING ABCS ON A FILM
Look some up or watch the lecture again… review that quiz
Categories of skeletal pathology
Congenital
Inflammatory
Neoplastic
Metabolic
Traumatic
Vascular
Misc.
How are skeletal pathologies described in terms of location?
Monostotic: 1 bone
Monoarticular: 1 joint
Polystotic: many joints
Polyarticular: many joints
Diffuse: nearly all bones/joints
Characteristics seen on films of OSTEOPOROSIS
Cortical thinning
Loss of trabeculae
Fractures
Characteristics seen on films of Osteomyelitis infection
Soft tissue swelling
Loss of tissue planes
Draining sinus tracts
Sequestration and involucra
Characteristics seen on films of infectious ARTHRITIS
Soft tissue swelling
Periarticular rarefaction
Joint space narrowing
Subchondral erosion
Joint effusion
Characteristics seen on films of infectious CELLULITIS
Soft tissue swelling
Radiolucent streaks or bubbles representing GAS GANGRENE
Characteristics seen on films of TUMORS
BENIGN: narrowing zone of transition, well defined margins
MALIGNANT: poorly defined margins
RA or OA: bilateral involvement of hands, wrists, feet, elbow, knees, hips
RA
RA or OA: unilateral involvement of synovial or cartilaginous joints of spine, hips, knees, first Mets, and phalanges
OA
RA or OA: swan neck or boutonnier deformities common
RA
RA or OA: nodes at DIP and PIPs, valgus/varus at knee
OA
RA or OA: which one has generalized osteoporosis in its later stages?
RA
RA or OA: which one has symmetrical joint space? Which one is asymmetrical?
Symmetrical RA
Asymmetrical OA
Define a fracture
A break in the structural continuity of bone or cartilage
7 elements used to describe a fracture
- Anatomic site and extent
- Type of fracture
- Alignment
- Direction of fracture line
- Presence of special features (avulsion)
- Associated abnormalities (dislocation)
- Secondary fractures that may occur (stress or pathological)
How is fracture location described in the peds population?
Described by region of development (diaphyseal, metaphyseal, physeal, epiphyseal)
Diaphyseal
Involves the central shaft
Metaphyseal
Involves the expanding end
Physeal:
involves the epiphyseal growth plate
Epiphyseal
Involves the epiphysis
Incomplete green stick fracture:
The shaft is fractured on the tension side whereas the Cortex and periosteum remain intact on the compression side
Is a torus fracture complete or incomplete
Incomplete
Torus fracture
An impaction fracture that results in buckling of the cortex
Is plastic bowing fracture complete or incomplete fracture
Incomplete
Plastic bowing fracture
Even when the force is removed, the bone remains bowed
What are the two approaches to fracture management?
Reduction- returning fragments to normal anatomical position
Fixation - maintaining fracture fragments in position after reduction to achieve healing
What are the two methods of reduction?
Open: surgically exposed site when closed reduction fails
Closed: fragments are physically guided into position by manipulation/traction
What are the two types of fixation?
Internal - screws, plates, pins, wires
External- cast immobilization/splint
Creeping substitution
Fractures may heal by formation of callus or by direct osteoblastic activity
Late effect during the process of fracture healing
Complex regional pain syndrome and bone length discrepancy
What are commonly missed fractures on radiographs
Spine: C1/C2, C6/C7
UE: scaphoid and radial head
LE: femoral neck, patella, calcaneis
How do you treat a patient if it seems like there’s a fracture, but radiographs come back normal?
Treat as if there is a fracture with immobilization and re radiographs in 1-2 weeks to verify
What is an eponym?
Convenient type of orthopedic shorthand used to describe orthopedic trauma
Avoided due to anatomic in exactness
