Ch 4 Skeletal System

Front 1

Back 1

Osteoarthritis (OA) aka degenerative joint disease, or DJD.
Irregular narrowing of the joint space
bone spurs, called osteophytes, develop and the articular ends become sclerotic.

Front 2

Back 2

Rheumatoid arthritis (RA) is a chronic, systemic inflammatory joint disease.
Narrowed joint spaces.
Diffuse joint deterioration and deformities.
The joint disease is characteristically symmetrical in its erosion of the joints on images.

Front 3

Back 3

Psoriatic arthritis
develops in persons with the skin disease psoriasis. Little, if any, periarticular osteoporosis with psoriatic arthritis.
Usually asymmetrical.

Front 4

Back 4

Tubeculous Arthritis
Chronic, indolent infection that has gradual onset and a slowly progressive course
Spine, Hips, Knees
Most patients have pulmonary TB

Front 5

Back 5

Ankylosing spondylitis is a progressive disease that commonly begins in the sacroiliac (SI) joints and spreads superiorly in the vertebral column.

In the vertebral column, the intervertebral disks and supporting ligaments ossify, which creates a very characteristic image manifestation nicknamed "bamboo spine."

Front 6

Back 6

greenstick fracture
Note the "bend" in the midshaft of the ulna. The cortex is intact on the lateral border, but disrupted on the medial border.
occurs almost exclusively in children.

Front 7

Back 7

incomplete, torus (or buckle) fracture
the open epiphyses in the distal radius and ulna, so this is a pediatric patient.
The white arrowhead points to a slight disruption in the cortex and bone trabecular pattern

Front 8

Back 8

transverse fractures
The 2nd and 3rd metacarpals have complete, transverse fractures. The base of the 2nd metacarpal also appears to be displaced. This type of fracture is often the result of a direct blow.

Front 9

Back 9

Spiral fracture
Notice the arrows. These show the outline of the fracture line that wraps around the shaft of the bone. Spiral fractures are usually caused by a twisting or torsional force.

Front 10

Back 10

open, or compound, fracture
A fracture associated with a breach in the skin.
These fractures are at an increased risk for infection.

Front 11

Back 11

displaced fracture
This fracture might also be described in terms of angulation due to the position of the fracture fragments. Note, too, the artifacts from the spine board.

Front 12

Back 12

Comminuted fracture
There are numerous fracture fragments.
There are also bone fragments protruding through the skin, so this would also be described as open.

Front 13

Back 13

Butterfly fracture
Triangular shape of the fragment.
Look closely and you will see that there are tiny fragments of bone within the fracture lines, so this is also comminuted.

Front 14

Back 14

Segmental fracture
A piece of the shaft is separated by proximal and distal fracture lines.

Front 15

Back 15

Stress fractures
Occasionally, fractures result from repeated stress to certain bones.

Front 16

Back 16

Chronic Osteomyelitis
Inflammation of the bone and marrow cause by a variety of infectious organisms.
Hematogenous Spread
Soft tissue swelling
Periosteum will elevate and the appearance of an irregular bony sleeve called involucrum.

Evidence of the infection includes the lucency in the shaft of the bone near a healed fracture.

Front 17

Back 17

Jones Fracture
Avulsion fracture of the tuberosity of the 5th metatarsal

Front 18

Back 18

Bimalleolar fracture
fracture of both malleoli
one side is usually spiral or oblique and the other transverse

Front 19

Back 19

Jefferson Fracture
Lack of alignment of the lateral masses of C1 with the body of C2. Fracture of C1

Front 20

Back 20

Hangman's Fracture
Misalignment of C2 with C1 and C3.
Hyperextension.
Spondylolisthesesis forward displacement of C2

Front 21

Back 21

Clay Shoveler's Fracture
An aculsion fracture of a spinous process in the lower C-spine of upper T-spine

Front 22

Back 22

Compression Fracture
due to trauma or from osteoporosis
The vertebra collapses on itself due to the weight of the body and lack of bony matrix

Front 23

Back 23

Seat Belt Fracture
Transverse fracture of lumbar cerebral body associated with severe visceral injuries

Front 24

Back 24

Spondylolysis
defect in the pars interarticularis, or neck of the scotty dog.
Cleft in the pars interarticularis without displacement.

Front 25

Back 25

Spondylolisthesis
anterior displacement of one vertebra on another
Common in L4-5 and L5-S1
Lordotic curve is most common

Front 26

Back 26

Herniated Nucleus Pulposus
slipped disk
Traumatic force or fall which causes the softer inner disk material, called the nucleus pulposus, to push out of the more rigid outer ring, or annulus.

Front 27

Back 27

Colles Fracture
Transverse fracture through he distal radius with dorsal (posterior) angulation.
(90 degree angle to shaft)

Front 28

Back 28

Smith's Fracture
displacement of distal fracture fragment is towards the anterior side. Opposite of the Colles Fracture

Front 29

Back 29

The fat pad sign
The posterior fat pad is seen due to the joint effusion. (fluid anterior to the fat pad). Density differences

Front 30

Back 30

Radial head fracture and Fat Pad Signs
elbow injury

Front 31

Back 31

Monteggia
Ulnar shaft fracture associated with anterior dislocation of radius at the elbow.

Front 32

Back 32

Galeazzi
Radial Shaft Fracture associated with posterior dislocation of the ulna at the wrist.

Front 33

Back 33

Anterior dislocation of the Shoulder

The humeral head superimposes the glenoid in a normal shoulder. Note that the humeral head is located under the coracoid process.

Front 34

Back 34

Scoliosis
is an abnormal lateral bending and twisting of the vertebral column.

Front 35

Back 35

Osteopetrosis
The increase in bone density is due to a failure of the osteoclasts to break down dead bone cells, so these old bone cells accumulate in the bone marrow, which in turn, fails to develop, resulting in severe anemia and other blood disorders.

Is a rare heredity disease.

This disease is nicknamed "marble bone" disease, which is descriptive of its radiographic appearance.

Front 36

Back 36

Osteogenesis Imperfecta
nicknamed "brittle bone" disease due to the fact that the bones are easily fractured with minimal force.

Blue sclera of the eye is a common indicator of this condition in the newborn infant. Radiographically, bones are radiolucent and healing fractures often demonstrate profuse callus formation.

Front 37

Back 37

Achondroplasia
is an autosomal dominant hereditary condition, with most cases due to spontaneous mutations. Characteristics = normal size trunk with drastically shortened limbs and exaggerated lordosis ("swayback") in adults.

Front 38

Back 38

Congenital hip dysplasia
often referred to as development dysplasia of the hip, or DDH.
Characterized by malformation of the acetabulum and laxity of associated ligaments.

Front 39

Back 39

Osteomyelitis
Is a serious infection of the bone and marrow.

A nuclear medicine bone scan is invaluable to detect this infection in the early stages

Front 40

Back 40

Osteoporosis
is a disease characterized by a loss of bone matrix. Radiographic evidence of osteoporosis is a loss of bony trabeculae with lucencies in the bone.

Note the lack of trabecular pattern within the vertebral bodies. There is an extreme loss of bone density, with only the cortical margin distinctly visible. Over time, the loss of bony matrix makes the vertebra susceptible to compression fractures.

Front 41

Osteomalacia

Back 41

Literally, bone softening; a metabolic disease of bone caused by vitamin D and/or calcium deficiency or, more often, as a result of end-stage renal disease.

Football looking intervertebral disc spaces
Thicker cortical outlines then in Osteoporosis.

Front 42

Back 42

Rickets
is a similar condition that occurs in children, commonly caused by a vitamin D deficiency.

Front 43

Back 43

Gout
is caused by faulty uric acid metabolism.
The most common site of gout is the first metatarsophalangeal joint.

1) one joint
2) swelling of soft tissue
3) white flecks of uric acid
4) bone deterioration

Front 44

Back 44

Paget's disease
is also called osteitis deformans.
Metabolic disease due to the similarity of having a disturbance in osteoblast and osteoclast balance.

"cotton wool" appearance

Front 45

Back 45

Osteochondromas or Exostosis
Benign
Cartilaginous cap that arises in childhood or teens.

Cauliflower-shaped lesion that grows away from the adjacent joint and parallel to the shaft, as demonstrated in the accompanying image.

Front 46

Back 46

Enchondromas
benign cartilaginous neoplasms
asymptomatic
hands or feet
These tumors appear radiographically as mostly lucent lesions with some calcifications, thinned cortex, and often a sclerotic margin.
Solitary lesions
*Pathological process that expands the bone.

Front 47

Back 47

Giant Cell tumors or osteoclastomas
Uncommon benign bone tumors.
Common sites include the distal femur, proximal tibia, distal radius, and spine.
*Arise after epiphyseal closure

Front 48

Back 48

Osteoma
Is an abnormal production of compact bone that usually occurs in the bones of the cranium or facial bones.
Slow-growing and asymptomatic, unless the location impinges upon organs of hearing or vision, or obstructs paranasal passages.

They can cause pain and appear as sharp round dense lesions that are rarely larger then 2cm.

Front 49

Back 49

Osteoid Osteoma
These tumors cause a sclerotic area with a small, radiolucent center, termed a nidus.

Local Pain, which increases at night and is easily relieved by asprin

Front 50

Back 50

Simple bone cyst
is a true fliud filled cyst with a wall of fibrous tissue, (proximal femur or humerus at the metaphysis)


(aneurysmal bone cyst- blood-filled)

Front 51

Back 51

bone island or enostosis
is a small growth of compact bone within the cancellous bone.

They are solitary, sharply demarcated areas of dense compact one that occur most commonly in the pelvis and upper femur.

Every bone except the Skull.

Front 52

Back 52

Osteosarcoma or osteogenic sarcoma
bone malignancy
Being highly aggressive and rapidly growing, these tumors are often quite large when initially found.

Radiographically seen as sclerotic lesions with small, radiating spicules, thus earning the nicknames of "sunburst" patterns.

Front 53

Back 53

Chondrosarcomas
are malignant, primary tumors of cartilaginous origin. The accompanying image demonstrates a common manifestation of this tumor, a lytic lesion with irregular borders (arrowheads) and varying degrees of calcifications (black arrows)
Long Bones

Front 54

Back 54

Ewing's tumors

most common malignant primary bone tumor found in children

Radiographically, Ewing's tumors are mostly lytic lesions with a large soft tissue mass and no calcifications, and they can resemble bone infection, as demonstrated in the screen image.

Front 55

Back 55

Multiple myeloma
is a neoplasm of a plasma cell that occurs in the bone marrow.
appears as numerous, punched-out lesions, often nicknamed "Swiss cheese"

Front 56

Back 56

Bone metastasis
Most common Malignant bone tumors

Several primary cancers spread to the skeleton, including kidney, breast, and prostate cancers.

Favorite sites are the ones that contain red bone marrow

Front 57

Back 57

skeletal diseases as either additive or destructive

Front 58

Back 58

Spina Bifida
A developmental defect in which the posterior elements of the vertebral column fail to fuse

Front 59

Meningocele

Back 59

is a herniation of the protective coverings of the spinal cord through the open space in the vertebra.

Front 60

Back 60

Meningomyelocele
in which the protective coverings and the spinal cord protrude through the opening. Usually, the spinal nerves are damaged, causing various degrees of disability.

(This lateral projection demonstrates a large soft tissue shadow posterior (arrows) to the lumbar spine. Note the lack of spinous processes on the lower lumbar vertebra. The soft tissue mass is a meningomyelocele that herniated through the defect in the posterior elements of the lumbar vertebra.)