Bone And Joint: Final Exam

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Most common organism for acute suppurative osteomyelitis

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Staphylococcus aureus

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Most common pathway of spread for acute suppurative osteomyelitis

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Hematogenous

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Age: Acute Suppurative Osteomyelitis

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2 - 12 years (children)

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Skeletal Location: Acute Suppurative Osteomyelitis

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- Large tubular bones (lower extremity)
- Spine

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Early Imaging Findings: Acute Suppurative Osteomyelitis

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- Soft tissue swelling
- Bone destruction
- Periosteal reaction
- Wide zone of transition

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Latent Period for Onset of Radiographic Findings: Acute Suppurative Osteomyelitis

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- Extremities: 7 - 10 days
- Spine: 21 days

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Late Imaging Findings: Acute Suppurative Osteomyelitis

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- Involucrum formation
- Sequestrum formation
- Cloaca formation
- Sinus tract

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Findings of Infectious Spondylodiscitis in Children

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Disc involved first

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Findings of Spinal Suppurative Osteomyelitis in Adults

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Starts in anterior vertebral endplate followed by vertebral destruction and secondary disc involvement

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Imaging Findings: Infectious Spondylodiscitis

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- Post-operative spines
- ANTERIOR vertebral body
- Disc destruction
- Vertebral body destruction (endplate loss)
- Paraspinal abscess

** Loss of subchondral plate

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Most Common Organism: Brodie's Abscess

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Staphylococcus aureus

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Clinical Findings: Brodie's Abscess

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Night pain, relieved by aspirin

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Imaging Findings: Brodie's Abscess

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- METAPHYSIS of tubular bones
- Geographic radiolucency
- Sharp margins
- Variable surrounding sclerosis

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Skeletal Location: Brodie's Abscess

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KNEE, ANKLE, tibia

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Most Common Pathway of Spread: Septic Arthritis

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Hematogenous spread (or direct implantation)

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Most Common Organism: Septic Arthritis

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Staphylococcus aureus

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Imaging Findings: Septic Arthritis

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- Joint effusion distorts fat folds
- Moth eaten bone destruction
- LATE: bony ankylosis

** Rapid loss of joint space
** Loss of subchondral plate/white line

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Septic Arthritis in IV drug users

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Mainliner's Syndrome
- Pseudomonas infection
- S Joints: spine, SI, symphysis, sternoclavicular, (s)acromioclavicular

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Skeletal Location: Septic Arthritis

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KNEE and HIP

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Imaging Findings: Chronic Osteomyelitis

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** Sclerosis
** Cortical thickening

- Periosteal new bone formation
- Osseous destruction
- Sequestrum

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Malignant Degeneration: Chronic Osteomyelitis

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Degeneration caused by pus leaking out of the pus tract
- Fibrosarcoma
- Squamous cell carcinoma (MARJOLIN'S ULCER)

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Age: Tuberculosis

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2 - 30

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Skeletal Location: Tuberculosis

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- 50% SPINE (Pott's Disease)
- 30% hip
- 20% pubic symphysis, wrist, SI joints, shoulder

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Skeletal Location: Pott's Disease

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- Most Common at Thoracolumbar Junction

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Radiographic Latent Period: Pott's Disease

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21 days

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Early Imaging Findings: Pott's Disease

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- Early disc space loss
- Anterior vertebral body destruction
- Subligamentous spread (ALL)
- Erosion of vertebral bodies
- Skip lesion

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Late Imaging Findings: Pott's Disease

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- Pathologic vertebral collapse
- Angular kyphosis (Gibbus Deformity)
- Retropharyngeal, paravertebral calcification
- PSOAS CALCIFIED ABSCESS

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Phemister's Triad

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Tuberculosis (Pott's Disease)
- Progressive and slow joint space narrowing
- Juxta-articular osteoporosis (peri-articular osteopenia)
- Peripheral erosions of the articular surfaces

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Spina ventosa

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Tuberculosis of the finger; tuberculous dactylitis

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Pott's Puffy Tumor

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Tuberculosis of the forehead; with scalp abscess

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Weaver's Bottom

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Subgluteal infective bursitis with direct extension to the ilium

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Imaging Findings: Sickle Cell

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- H Shaped Vertebra
- Osteonecrosis

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Imaging Findings: Thalessemia

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- Hair on End Appearance of Skull
- Erlenmeyer Flask Deformity

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Imaging Findings: Hemophilia

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- Growth abnormalities
- Ballooning of epiphysis
* Osteopenia
- Arthropathy
- Pseudotumors (FEGNOMASHIC)

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Skeletal Location: Hemophilia

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KNEE

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Imaging Findings: Hemophilia

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- Bloody joint effusions
- Synovitis, pannus
- Cartilage degeneration (OA)
* Widening at intracondylar notch
- Squaring of patella

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Synonyms of Osteonecrosis

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- Ischemic necrosis
- Avascular necrosis (EPIPHYSIS)
- Aseptic necrosis
- Bone infarct (METAPHYSIS, DIAPHYSIS)

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(4) Stages of Avascular Necrosis

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1. Avascular
2. Revascularization
3. Repair and remodeling
4. Deformity

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Imaging Findings: Osteonecrosis

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- Subchondral cysts
* Sclerosis: bite sign, snowcap sign
* Mottled sclerotic appearance
* Crescent sign
- Collapse/flattening of articular surface
- Fragmentation

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SONK vs. OCD

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- SONK: weight bearing side
- OCD: non-weight bearing side

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Age: LCP

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3 - 12

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M : F Ratio: LCP

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5 : 1

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Early Imaging Findings: LCP

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- Soft tissue swelling
- Wide medial joint space
- Small femoral head
- Epiphysis fragmentation
- Sclerosis
- Crescent sign
- Waldenstrom Sign

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Waldenstrom Sign

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- More than 2 mm side to side
- > 11 mm absolute value of the medial joint space

This is an unspecific finding indicative of joint effusion only; numerous etiologies

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Late Imaging Findings: LCP

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- Mushroom cap deformity
- Subchondral cysts
- Wide, short femoral neck
- COXA VARA, coxa magna, coxa plana
- Enlarged greater trochanter
- Sagging rope sign
- Degenerative changes

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Freiberg Disease

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AVN/stress fracture/infarction of the 2nd metatarsal head

- Primarily seen in ladies who wear high heels
- Sclerosis and fragmentation

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Keinbock Disease

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(Lunatomalacia)
- AVN of the lunate
- Associated with negative ulnar variance but the biggest cause is FOOSH

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Osgood-Schlatter's Disease

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- Stress injury to the tibial tuberosity
- Sclerosis and fragmentation

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Diagnostic Criteria: Scheuermann Disease

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Anterior Wedging
- > 5 degree
- (3) continuous segments

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Imaging Findings: Scheuermann Disease

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- Irregular endplates (Schmorl's nodes)
- Loss of disc heigh
- Kyphosis (>40°)

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AVN of Infrapatellar Pole

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Sinding-Larsen-Johansson (Hurdler's/Jumper's Knee)

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AVN of vertebral body

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Kummel Disease

* Intravertebral vacuum phenomenon
- Crescent sign in vertebral body
- Loss of body height

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Bulbosing of ischiopubic synchondrosis

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Van Neck Disease

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Blount Disease

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- Problem of the medial tibial plateau
- Can lead to significant bow legging (unilateral and bilateral)

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Chandler's Disease

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LCP in the adult

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AVN of the talar dome

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Diaz Disease (aviator fracture)

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AVN of the shoulder

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Hass Disease

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Flattening of the navicular

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Kohler Disease

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AVN of scaphoid

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Preiser Disease

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AVN of capitulum of humerus

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Panner Disease

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Diagnostic Criteria of Sever Disease

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Painful calcaneal squeeze

- Calcaneal apophyses is always sclerotic and fragmented
- Severs in clinical diagnosis only; not based on radiographs