Radiographic Pathology Ch 4 Skeletal System

Oblique fracture

45 degrees from long axis. Caused by avulsion or compression.

Bursitis

Affects small fluid filled sacs that cushion the bones (bursae), tendons and muscles near your joint. Occurs when bursae become inflammed. Most common in shoulder, elbow, and hip. (also occurs in knee, heel, and base of big toe) Occurs near joints that perorm frequent repetitive motion.

Angulation fracture

Angular deformity between axes of major fragments.

3 Types of osteomyelitis

Bacterial Osteomyelitis Staphylococcal Osteomyelitis Tuberculous Osteomyelitis

Osteoid Osteomoas

Benign. Bone tumor that is usually less than 1.5cm, arises in femur or tib-fib. Produces pain, worse at night. Teen - young adult. Appears as small round lesion with lucent center less then 1 cm in diameter, surrounded by large dense sclerotic zone of cortical thickening. CT Usually is excised.

Giant Cell Tumors

Benign. End of distal femor or proximal tibia after epiphysial closure. 20-40 years old. Begins as eccentric lucent lesion in the metaphysis, extends to the immediate subarticular cortex of the bone but doesn't involve the joint. As tumor expands towards shaft, it produces appearancec of multiple large bubbles seperated by thin strips of bone. MRI May be premalignant or actually malignant.

Osteochondromas

Benign. Projection of bone w/ cartilaginous cap, especially about the knee. Childhood - teen years. Long axis of tumor runs parallel to the parent bone, points away from nearest joint. MRI Usually benign but may convert to malignancy.

Skeletal System is composed of these two highly specialized connective tissues:

Bone Cartilage

Osteogenesis Imperfecta aka

Brittle bone disease. Caused by lack of organic matrix.

Osteogenesis Imperfecta

Brittle bones. Destructive

Epiphysis

Cap at the end of a long bone that develops from a secondary ossification center.

Metabolic bone disease

Caused by abnormalities of minerals and vitamins which leads to dramatic clinical disorders. Most forms are reversible.

Malnutrition

Causes most types of metabolic bone disease. Evident by lack of calcium in diet.

Internal parts of the bone

Central (Haversian canal) Osteon (Haversian canal) Volkmann's canals Medullary cavity

Paget's disease

Chronic disorder that causes excessive breakdown and formation of bone. Commonly affected bones are pelvis, femur, lower lumbar, and skull.

Other causes of Osteomalacia not related to nutrition

Chronic kidney failure and renal disease.

Rheumatoid Arthritis (inflammatory)

Chronic systemic disease. Inflammation in synovial membane of joints (hands and feet mainly). Fusion and inflammation results in the deformity. Can also occur in C spine.

What type of fracture consists of more than two fragments?

Comminuted

Compression fracture

Compaction of bone trabeculae, decreased length or width of bone. Common in vertebrae or humeral/femoral head.

In what type of fracture is the skin broken?

Compound

Treatment for metabolic bone disease

Correcting your diet.

Medullary cavity

Cylindrical central cavity of the bone containing lipid-rich yellow bone marrow.

Complete fracture

Discontinuity between two or more fragments.

Dislocation

Displacement of bone articulation.

Treatment for Osteoporosis

Drug therapy, exercise, calcium and Vit D.

Osteon

Elementary cylindrical structure of the compact bone made up of four to 20 concentric bone plates that surround the Haversian canal.

Butterfly fracture

Elongated triangular fragment of cortical bone, detached from two other large fragments.

Spiral fracture

Encircles shaft, longer than oblique fractures. Torsional fracture.

Transitional vertebrae

Expanded transerve process. Lumbosacral junction (most common). (can also occur at thoracolumbar and cervicothoracic junctions)

Things that can increase risk for Gout:

Family history of gout. High blood pressure. Diabetes or kidney disease.

Compound fracture

Fracture protrudes through skin.

Comminuted fracture

Fracture with 2 or more fragments.

Osteomyelitis

General term for bacterial infection of bone (usually staph). Starts as bone abscess. Abscess travels through medullary cavity and outward to lift the periosteum. Treatment may involve surgery, drainage of pus, and IV antibiotics over prolonged period.

A disorder of metabolism causing an increased blood level of uric acid is called ________________.

Gout

Cortical bone

Hard and thick layer under the Periosteum.

Congenital Hip Dysplasia

Incomplete Acetabulum formation.

Greenstick fracture

Incomplete fracture with opposite cortex intact. Found almost exclusively in infants and children because of the softness of their cancellous bone.

Gout

Inflammatory arthritis caused by accumulation of uric acid crystals in the joints.

Bone marrow

Inside Cancellous bone. Produces red, white and platelet cells.

Osteomalacia

Insufficient mineralization of the adult skeleton. Loss of bone density. Calcium and phosphorous not absorbed. Vit D deficiency.

Vitamin D

Lacking this vitamin causes calcium deficiency.

Central canal (Haversian)

Lengthwise central canal of the osteon enclosing blood vessels and nerves.

Rickets (metabolic bone disease)

Loss of bone minerals. Occurs in infants and young children before skeletal maturity. Lack of bone rigidity causes gross skeletal changes (bowing of legs)

Osteoporosis (metabolic bone disease)

Loss of calcified bone matrix, reduction of trabeculae. Bones fracture easily, especially in wrists, hips, and vertebrae. Accelerated bone resorption.

Osteogenic Sarcoma

Malignant. Occurs at end of long bone in metaphysis. Tumor consists of osteoblasts which produce osteoid and spicules of calcified bone. 10-25 years. Mixed destructive and sclerotic lesion assoc. w/ soft tissue mass. Irregular periosteal reaction and reactive new bone growth. Sunburst pattern, elevation of periosteum. CT and MRI Can metastasis to lungs.

Chondrosarcoma

Malignant. Tumor of cartilaginous origin, can originate in new or within preeisting lesions. Common in long bone. 35-60 years. Bone destruction, punctuate or amorphous calcification with cartilaginous matrix, endosteal scalloping, cortical destruction. CT Tumor grading depends on maturity and differentiation of cells. Grows slowly, metastasizes later.

Osteopetrosis

Marble bone disease. Additive. Increase in bone density, osteoclastic function doesnt work.

Achondroplasia

Most common form of dwarfism. Cartilage stops producing in the growth plate. Femoral head deformity.

Pathologic fracture

Occurs in area of weakness caused by pathology.

Torus (buckle) fracture

One cortex intact with buckling or compaction of opposite cortex.

Growth of outer bone diameter is dependent upon ______________cells.

Osteoblast

Benign Bone Tumors

Osteochondromas Giant Cell Tumors Osteomas Osteoid Osteomas Simple Bone Cysts Aneurysmal Bone Cysts

_____________ cells are responsible for resorption and bone removal.

Osteoclast

Malignant Bone Tumors

Osteogenic Sarcoma Chondrosarcoma Ewing's Sarcoma Multiple Myeloma

Closed fracture

Overlying skin intact.

Paget's disease can develop into a primary bone cancer known as ______________.

Paget's sarcoma

Incomplete fracture

Partial discontinuity, portion of cortex intact.

Sublaxation

Partial loss of continuity of a joint.

Osteomyelitis criteria

Periosteal elevation Cortical disruption Medullary involvement

Layers of the Bone

Periosteum Cortical (hard bone) Cancellous (spongy bone) Bone marrow

Undisplaced fracture

Plane of cleavage exists without angulation or seperation.

Bowing fracture

Plastic deformation caused by stress too great to permit complete recovery of normal shape but less than the stress required to produce fracture.

Spina Bifida

Posterior defect of spinal canal, failure of the posterior elements to fuse properly.

Infectious Arthritis

Pyogenic organisms that gain entry into the joint by the hematogenous route.

Stress/fatigue fracture

Repeated bone stress. Osteoclastic resorption, followed by development of periosteal callus to repair or strengthen the bone.

The form of noninfectious arthritis characterized by osteoporosis, soft tissue swelling, and erosions of the metacarpophalangeal joints and ulnar styloid processes is ____________________.

Rheumatoid arthritis.

Lack of vitamin D in the diet of infants and children can cause a systemic disease called ______________.

Rickets

Transverse fracture

Right angle to long axis of bone.

Parathyroid Hormone

Secreted when there is a lack of calcium, which leaves the bones weak.

Segmental fracture

Segment of shaft isolated by proximal and distal lines of fracture.

Displaced fracture

Seperation of bone fragments.

Diaphysis

Shaft of a long bone.

Osteoarthritis (DJD)

Similar to RA. Loss of joint cartilage. Bones fuse resulting in deformity. Occurs in weight bearing joints (spine, hip, knee, ankle, fingers). Comes with aging.

Depressed fracture

Skull or tibial plateau. In skull, small object with great force can produce comminuted fracture with portions of fracture driven inward.

Avulsion fracture

Small fragments torn from bony prominences. Caused by indirect tension within ligaments and tendons.

Periosteum

Soft outer covering over the bone's surface. Provides blood flow to bone.

What pathologic condition is present if the posterior elements of one or more vertebrae fail to unite?

Spina Bifida

3 types of Spina Bifida

Spina Bifida occulta Meningocele Myelomeningocele

Treatment for osteogenesis imperfecta

Splinting to reduce fracture and drugs that decrease cell activity.

Cancellous bone

Spongy type of bone inside the Cortical bone.

Function of Bones

Supports framework of the body. Protects vital organs. Levers for muscles to contract and shorten. Produces blood cells. Storehouse for calcium salts.

Phosphorus

Too much phosphorus turns to calcium phosphate which is unusable by the body.

Volkmann's canal

Transerve canals enclosing blood vessels and nerves.

Treatment for Rickets

Vit D.

Metabolic bone disease leads to

bone deformations such as bowed legs, softness in face, rubber like jaws, and unnatural swelling in limbs.

Inflammation of the small fluid-filled sacs that are located around joints and that reduce friction is termed ____________________.

bursitis

The shaft of any long bone is termed the ___________.

diaphysis

The end of a long bone is referred to as the ____________.

epiphysis

Osteopetrosis can cause the bone to ________________ in bone density.

increase

Gout crystals can also deposit in other tissues throughout the body, such as the kidney, which can lead to ____________

kidney stones.

On a radiographic image, dense transverse bands extending across the metaphyses of the long bones are commonly seen in ___________________.

lead poisoning

The extremely common form of arthritis that is characterized by loss of joint cartilage and reactive new bone growth and that is part of the normal wear of aging is ____________________.

osteoarthritis

A benign projection of bone with a cartilage like cap occuring around the knee in children or adolescents is ___________________.

osteochondroma

The special types of cells responsible for the diameter growth of bones are _______________.

osteoclasts

An inherited generalized disorder of connective tissue characterized by multiple fractures and a bluish color of the sclera of the eye is ___________________.

osteogenesis imperfecta

An example of a malignant bone tumor is ___________,___________, and ___________.

osteogenicsarcoma, chondrosarcoma, Ewing's sarcoma

Aging and post menopausal hormonal changes are the major causes of generalized _______________.

osteoporosis

The most common metabolic skeletal disease is ________________.

osteoporosis

A vertebrae that has characteristics of two divisions of the spine is called a ____________________.

transitional vertebrae

The common area of the body radiographed to determine bone age is the ___________ and ___________.

wrist, hand