Week 3: Skeletal System Pt 2 Flashcards
The pineal gland and pituitary gland are controlled by the
Hypothalamus
Hypothyroidism
Under activity of them thyroid gland
Hyperthyroidism
Over activity of the thyroid gland
Bone Densitometry/DXA
An important modality in the evaluation of osteoporosis. DXA units readily show bone density by evaluating the bone mass of the distal radius, femoral neck, and lumbar spine. The results of bone densitometry are used in combination with routine laboratory tests of blood and urine to determine loss of bone mass. Bone mineral densitometry reports indicate the amount of bone mass present and compare the density of an individual to norms used during evaluation
Osteopenia
A radiographically visible decrease in bone density
Osteoporosis
a commonly known metabolic bone disorder in which the structural integrity of the trabecular pattern of bone is destroyed and is identified as a bone mass less than 648 mg/cm2
Primary Osteoporosis vs Secondary Osteoporosis
•Primary osteoporosis: most common, may be further classified as postmenopausal or senile(old age)
•Secondary osteoporosis: most often associated with an existing disease of the endocrine system or is the result of a medication
Cause of Osteoporosis and the effect on the bone structure:
• Thinning cortical bone & enlargement of the medullary canal; without diameter changes
• Bones become “porous”
• Subject to compression fractures
• Bones cave from weakened structure
Osteoporosis etiology: Is it genetic, congenital, hormonal, metabolic, or chromosomal?
Metabolic (and hormonal)
Is osteoporosis additive or destructive? Do we increase of decrease technique?
Destructive, decrease the technique
Best modality for Osteoporosis
Bone mineral densitometry, radiography
Osteomalacia
a condition caused by lack of calcium in tissues and failure of bone tissue to calcify
*also known as Rickets if it occurs before growth plate closure
If osteomalacia occurs before growth plate closure, it is known as ______
•What causes this?
•Rickets
•Caused by a lack of vitamin D and calcium in a child’s diet. However, rickets can also be caused by a genetic defect or other underlying health conditions
Etiology of Paget’s disease?
Unknown
Two stages of Paget’s Disease are
► Osteolytic: breakdown of bone
► Osteoblastic: replaced by soft and poorly mineralized bone
Paget’s radiographic appearance
Cotton wool
Modality to help detect Paget’s
Nuclear medicine
Is Paget’s disease additive or destructive?
can be considered both an additive condition because of the increased bone growth and a destructive condition because the added bony matrix is much less dense
What is Acromegaly?
an endocrine disorder caused by a disturbance in the function of the pituitary gland; this disorder primarily affects the skeletal system
Acromegaly etiology
caused by excessive secretion of GH in adults
Acromegaly Radiographic appearance
Radiography demonstrates enlarged sella turcica & changes in skull bones
Acromegaly modality choice
MRI is modality of choice to evaluate the pituitary gland
Acromegaly physical characteristics
prominent forehead and jaw, widened teeth, and abnormally large, spade-like hands, and a coarsening of facial features
Fracture
a discontinuity of bone caused by mechanical forces either applied to the bone or transmitted directly along the line of a bone
Epistaxis
Nosebleed usually present with a nose fracture
Dislocation (luxation)
joint dislocation, or luxation, results when a bone is out of its joint and not in contact with its normal articulation
Subluxation
a partial dislocation, often occurring with fracture
Benefits of digital imaging in fracture evaluation
helpful in evaluating soft tissue structures surrounding a skeletal fracture because images can be manipulated to demonstrate details of both soft tissue and bone
T or F: Radiography is important for skeletal trauma evaluation
True
T or F: Wet fiberglass or plaster cast requires routine exposure factors
False, exposure factors must be increased
T or F: One projection is enough for evaluating trauma
False, at least 2
T or F: Long bone trauma requires joints above and below to be radiographed
True
Identify the responsibilities of the radiographer while imaging patients suspected of fracture
• Set appropriate technique to optimize visualization of bony and soft tissue structures
• Cast, no cast
• Assess the patient
• Inquire how injury occurred
• Communicate with radiologist
• Note points of tenderness, pain
• Provide detailed patient history
Delayed union vs Malunion vs Nonunion
•Delayed union: fracture that does not heal within the usual time
•Malunion: a fracture that heals in a faulty position
•Nonunion: a fracture in which healing does not occur and the fragments do not join
Open (Compound) Fracture
•Bone has penetrated the skin
•Potential to lead to Osteomyelitis
Closed (Simple) Fracture
the skin is not penetrated which reduces the chance of infection
Impacted Fracture
Fractured bone end is jammed into the cancellous tissue of another fragment
Comminuted Fracture
Sometimes, one or more fragments separate along the edges of the major fragment in addition to the major line of the fracture.
Complete, Noncomminuted Fracture
one in which the bone has separated into two fragments. The fracture may be recognized according to the direction of the fracture line. A spiral, transverse, or oblique fracture is an example of this type
Avulsion Fracture
Fragment of bone is pulled away from the shaft
Incomplete Fracture
Those in which only part of the bony structure gives way, with little or no displacement. A common example is the greenstick fracture.
Greenstick Fracture
Incomplete fracture, cortex breaks on one side without separation or breaking of the opposing cortex
Growth Plate Fracture
Involve the end of a long bone of a child. The fracture may be limited to growth plate cartilage and is thus not directly visible unless displacement occurs, or it may extend into the metaphysis, epiphysis, or both
Stress Fracture
Usually occur as a result of an abnormal degree of repetitive trauma. They are generally found at the point of muscular attachments, as in the tibia or fibula of a runner.
Fatigue Fracture
Occur at sites of maximal strain on a bone, usually in connection with unaccustomed activity. Most frequently, fatigue fractures are found in the metatarsals, particularly the second metatarsal
Occult Fracture
In an occult fracture, clinical signs are manifested without radiologic evidence. Follow-up examination within 10 days reveals bone reabsorption or displacement at the fracture site. The most common sites for occult fractures are the carpal scaphoid and the ribs
Differentiate between:
•Closed reduction:
•Open reduction:
•Closed reduction: The most common treatment is splinting, casting, or both. Requires that a local or general anesthetic be given to the patient for pain management.
•Open reduction: Required when orthopedic hardware is needed to maintain fracture reduction or when an open fracture needs to be irrigated (flushed out)
What is the Salter-Harris system and briefly describe the “grading”
Fractures are numbered I through VI, with I being least severe and VI being most severe. Comparison projections are often used with such fractures to compare growth plate appearances, and MRI may be used to further evaluate epiphyseal separations. Healed injuries of this type may result in an alteration of the length of the involved bone. Because of possible length discrepancies, frequent radiographic examinations may be required, often up to years after the injury.
Colles Fracture
Fracture through the distal inch of radius. The fragment is angled backward on the shaft.
Smith Fracture
Displacement of the distal fragment toward the palmer aspect of the hand
Boxer’s Fracture
occurs on the fifth metacarpal (occasionally fourth) as a result of a blow to or with the hand
Bennett Fracture
Fracture and dislocation of the first carpometacarpal joint. An Avulsion fracture.
Monteggia Fracture
Fracture of the proximal third of the ulnar shaft, with anterior dislocation of the radial head
Pott Fracture
Dislocation of the ankle joint and fracture of both malleoli in the ankle
Trimaleolar Fracture
Involves the medial and posterior malleoli of the tibia and lateral malleolus of the tibia
The most common wrist fracture is ________ and when present, it externally resembles a(n) ________
Colles fracture; dinner fork
The most common metacarpal fracture is the ________
Boxer’s fracture
Discuss the significance of the “fat pad sign”
Radiographically, how might the following indicate the presence of a fracture?
•Posterior fat pad:
•Anterior fat pad:
The elbow “fat pad sign” may be an indicator of a nonvisualized underlying fracture of the bones of the elbow.
•Posterior fat pad: Visualization of a posterior fat pad is considered a sign of a possible underlying fracture or dislocation. If the joint capsule is distended by fluid as a result of a fracture, the posterior fat pad becomes displaced from bone and is visible on the lateral projection of the elbow
•Anterior fat pad: In the elbow, normally a small accumulation of fat is present adjacent to the anterior surface of the distal humerus and the anterior surface of the proximal radius. The anterior fat pad may also be displaced, giving a sail-shaped appearance.
Differentiate between the following and identify the bones affected in each injury.
•Tripod fracture:
•Blowout fracture:
•Tripod fracture: The zygoma is fractured at all three sutures: frontal, temporal, and maxillary.
•Blowout fracture: A direct blow to the front of the orbit that transfers the force to the orbital walls and floor.
Which bone has the slowest healing time following a traumatic injury?
Mandible
The most frequently fractured facial bone is the
Nasal bone
Describe the Hills-Sachs deformity:
A compression fracture of the humeral head. It occurs on the superior and posterior head of the humerus because of impaction of the humeral head against the glenoid labrum during dislocation
Another term (and acronym) for Battered child syndrome is:
Nonaccidental trauma (NAT)
Describe Shaken Baby Syndrome or Abusive head trauma:
•How does it occur?
•What modalities are useful in diagnosing this condition?
•Abusive head trauma, a severe type of physical abuse that affects the child’s head and neck.
•How does it occur? Shaking of the child causes whiplash injury to the neck and brain trauma such as a subdural or subarachnoid hematoma, with no evidence of trauma to the external cranium. High morbidity & mortality rate: 25%
•What modalities are useful in diagnosing this condition? CT & MRI
Describe Avascular necrosis:
•What anatomical structures are most likely to be affected?
•Which modality can best demonstrate this condition in the early stages?
Bone death resulting from inadequate blood supply.
•What anatomical structures are most likely to be affected? hip, knee, shoulder, or carpal scaphoid
•Which modality can best demonstrate this condition in the early stages? MRI
Giant Cell Tumor (GCT)
•Aggressive neoplasms characterized by a “soap bubble” appearance
•Lucent lesion in the metaphysis, usually at the distal femur (Merrills)
•Decrease exposure factors (Osteoclastic disease)
