-
Osteochondroma
- MC BBT of the APPENDICULAR SKEL
- pedunculate (aka: coat hanger)
- sessile
-
hereditary multiple exostosis HME
- multiple osteochondromas
- 20% undergo malignancy
-
unicameral bone cyst (UBC) aka: Simple Bone Cyst
- diaphyseal/metaphyseal
- centrally located
- <20 yo, fluid filled
- "FALLEN FRAGMENT" sign
-
Aneurysmal bone cyst (ABC)
- diaphyseal/metaphyseal
- eccentrically located
- < 20 yo, BLOOD FILLED
-
Giant Cell
- epiphyseal
- 20-40 yo
- 20% quasi-malignant
- soap-bubble
-
osteoid osteoma
- night pain= relieved by aspirin
- radiolucent central nidus
- severe reactive scoliosis
-
Brodies Abcess (Aka Chronic osteomyelitis)
night pain releived by aspirin, appears like osteoid
-
Enchondroma
- MC BBT of the HAND
- may have stippled appearance
- multiple enchondroma's= ollier's disease
- with soft tissue calcification is known as Maffucci's Syndrome
-
Hemangioma
- MC BBT of the SPINE
- vertical striations
- corduroy cloth appearance
-
Enostoma
- bone island, round or oblong radiopaque
- hands, feet, pelvis
-
Osteopoikilosis
mltpl bone islands
-
Osteoblastoma
- MC BBT of the Neural Arch
- 10-30 YO
-
OSteoma
- MC BBT to affec the skull
- MC in frontal sinus: caldwell projection
-
Fibrous dysplasia
- monostotic- 70% associated with Rind Sign, polyostotic 30%
- resoptoin of bone replaced w/ fibrous tissue
- deformities: saber shin tibia, sheppards crook
- * ground glass
- * cafe au lait w/ cost of maine (jagged edges)
-
Neurofibromatosis
- family history
- scoliosis
- cervical kyphosis, vert body scalloping, IVF enlargement
- *cafe au lait w/ Coast of Cali. (smooth edges)
-
Multiple Myeloma
- > 50yrs old cachexia, weight loss
- aplastic anemia
- MC 1* malignancy of bone
- malignant proliferation of plasma cells infiltrating bone marrow
- Mtpl dark densities that are similar in size (punched out lesion)
- *vertebra plana
- *Rain drop skull
- Labs: M spike on immuno electrophoresis
- :reversal of A/G ratio, Bence jones urinalysis, elevated ESR,
- Bone Scan: COLD
-
Mets
MC malignant tumor of bone
-
lytic mets
- > 40 yo, unexplained weight loss, skeletal pain at night
- trabeculare reabsorbed= dark bone
- moth eaten/permeative pattern
- swiss cheese appearance in the skull
- lab: alk phosphotase
- Bone Scan: hot
-
hodgkins
- MC mets in 20-40 yo
- ivory white vertebrae w/ ant. body scalloping
- unilateral hilar lymphadenopathy
- Xray: PA chest
- lab: reed sternberg cells on biopsy
-
Blastic Mets
- > 40, ivory white vertebrae
- porostatic carsinoma
- labs: increased alk phos
- bone scan: hot
-
pagets
- males over 50
- basilar invagination : (chamberlines/mcgregors lines)
- stages: lytic/destructive, combo, sclerotic, malignant (stage 4)
- cortical thickening, bowing deformities, coarsened trabeculae, bone expansion
- picture frame vertebra
- labs: increased alk phos, urinary hydroxyproline
- bone scan: hot
-
osteosarcoma
- MC malignancy found in kids 10-30
- periosteal reaction: spiculated/radiating/sunburst
- labs: incr. alk phos,
-
chondrosarc/fibrosarc
.40, spiculated appearance
-
ewing's sarcoma
- 10-25yo, MC in diaphysis
- permeative lesion
- onion skin (laminated)
- bone expansion, codmans triangle
- saucerization
- *mimics infection
-
Chordoma
- > 40 yo aberrant notochordal cell tumor
- MC in Sacrum
- 2nd MC in skull
-
Ivory verts
pagets, hodgkins, blastic mets
-
Scoliosis
- females 13-19
- named for the side of CONVEXITY
-
Rotary Scoliosis
SPs rotate to the concavity
-
Simple Scoliosis
SPs deviate to the convexity
-
Scoliosis measurements
- 25 yo and younger
- under 20 degrees: adjust/monitor
- 21-40 deg: send to orthopedist for milwaukee bracing
- 40+: surgical consult
- 50+ cardiopulmonary compromise
-
Monitor scoliosis
- rissers sign: iliac crests
- wrist films: best method, L wrist
- Tanner stages: pubertal development
-
RA (Stills in kids)
- bilateral loss of jt space
- rat-bite erosions
- pannus
- symmetrical
- bouchards and haygarths nodes
- swan neck/boutonniere/ular deviation
- labs: +RA latex, +FANA, +ESR, +CRP
-
AS (aka marie strumpell)P
- males 15-35 yo, low back pain/AM stiffness
- SI jt: bilateral fusion (ghost jt)
- + chest expansion, foresters bowstring, iritis, lewins
- spine: shiny corner sign, bilateral syndesmophytes, squaring off vert body, bamboo spine, dagger sign, trolley track
- labs: +HLA B27, +ESR
-
Enteropathic arthropathy
- females MC
- AS w/ GI dysfunction
-
Psoriatic arthritis
- Males 20-50 yo
- silver scales, pitted nails, sausage digits, auspitz sign
- Spine: pencil in cup, mouse ear, ray sign
- Lab: +HLA B27
-
Reiters
- males 20-30
- urethritis, conjuctivitis (chlamydia) calcaneal spur, non-marg. syndesmo
- labs:+HLA B27
-
SLE
- females
- sunlight precipitates a rash
- malar/butterfly rash
- alopecia
- raynauds, ulnar dev
- labs: LE prep, FANA RA latex, ESR, leukopenia, thrombocytopenia, anti-dna
-
Sleroderma (progressive systemic sclerosis)
- females 30-50, CREST syndrome, erosions of the distal tufts
- Labs: +FANA, RA latex (30%)
-
osteitis condesans ilia (osteitis triangularis)
- multiparous females 20-40
- bilateral/symmetric triangular sclerotic area
- self resolving
- no labs
- treatment: trochanteric belt
-
DJD/ OA
- non-inflammatory
- MC on finger and weight bearing jt
- stiffness- improves w/ activity
- MC C5/C6
- Spine: ivd narrowing, osteophystes, endplate sclerosis
- Hand: heberden's, bouchard's
-
DISH
- males > 40
- DM association
- ossification of the PLL (OPLL)
- Spine: flowing hyperostosis, candle wax, 4+ segments
-
synoviochondrometaplasia
- MC jt affected is the knee
- multiple loose bodies w/in jt round/ovoid shape
-
HLAB-27 +
- PEARS:
- Psoriatic
- Enteropathic
- AS
- Reiters
- Ulcerative colitis/chron's
-
Gout
- males > 40yo
- overproduction of uric acid
- recurrent episodes, pain, monarticular, hot/red/swollen jt
- MC site is the MTP of the big toe
- labs: uric acid, ESR, jt aspiration
- Rx: acute-colchicine, chronic-allopurinol
-
CPPD/Pseudogout
- thin linear calcification
- chondrocalcinosis when in cart
- MC at knee
-
hydroxyapatite deposition disease (HADD)
- MC in shoulder
- round/oval calcification near insertion of tendon/burs
-
Septic arthritis
- fever, chills, hx of trauma/surgery
- warm, tender, swollen jt
- lab: WBC count
-
AVN
- self resolving 8mos-2 yrs
- Trauma!
- no labs
- MRi is best, Bone scan
-
preiser's
AVN: carpal scaphoid
-
Osgood Schlatter
tibial tuberosity/avulsion/apophositis AVN
-
Scheurermann's
AVN vert endplate
-
Legg calve perthes
AVN femoral epiphysis
-
kohlers
AVN of tarsal navicular "cold" feet
-
keinbochs
carpal lunate avn ("kind hands")
-
-
blount's avn
medial tibial condyle
-
freibergs
avn of head of 2nd mtp
-
osteochondritis dessicans
- avn of medial femoral condyle
- 16-25 yo athlete, knee locks on ext
-
-
scheuermann's dx
- mc b/n 10-16 yo males, mtpl shmorls nodes
- radiographic signs:
- 1) slight loss of ant body height
- 2) mtple end plate irrecularieties
- lab; none, special test; MRI
-
Legg calve perthes
- boys 4-9 yo
- avn of femoral head
- fragmentation crescent sign, snow capped
- refer to orthopedist--> A brace
- stop physical activity & adjust
-
Slipped capital femoral epiphysis
- boys 10-16 yo, salter harris type 1 frx
- refer to orthopedist
- femoral head slides inferior and medial/femoral neck slides sup/lat
- lines: klein's, shentons, skinners
-
congenital hip dysplasia
- Putti's Triad: 1) hypoplastic femoral head, 2) shallow acetabular shelf, 3) femoral head outside acetabulum
- + orthos: ortolani's, barlows, allis
-
Protrusio acetabuli
- axial migration of the femoral head- uniform loss of space
- MC w/ RA
- bilateral: otto's pelvis
- radio sign: obliteration of kohlers teardrop
-
avulsion frx
bone torn away by mm or lig
-
comminuted frx
2 or more fragments
-
diastasis
displacement or separation of a slightly movable jt
-
compound/open racture
skin ruptured/ open skin
-
greenstick/hickory stick
incomplete frx in kids
-
torus/buckling fracture
incomplete frx, one side of cortex affected
-
impaction frx
bone fragments driven into one another
-
occult fracture
- clinically evident but not visualized on xray
- may become evident in 10 days
-
stress/fatigue fracture
insufficiency or repetititve stress causing a fracture
-
Bonnett's
fracture of the 1st metacarpal
-
boxers frx
2/3rd metacarpal
-
bar room frx
4/5th metacarpal
-
Scaphoid
MC frx carpal bone
-
night stick frx
proximal ulna
-
monteggia
frx of ulna, radial head displacement
-
galeazzi
frx of the distal 1/3 of radius w/ dislocation of the distal radioulnar jt
-
colles
frx of distal radius w/ posterior displacement of distal fragment
-
smith's frx
distal radius w/ anterior displacement
-
bathroom frx
distal phalynx
-
march frx
stress frx of the 2/3/4th metatarsal
-
jones frx/ aka: dancers
transverse frx of the proximal 5th metatarsal
-
hangman's frx
bilateral pedical frx of C2 w/ hyper ext injury
-
clay shovelers
- avulsion frx of SP
- MC at C6-T1
- hyper flextion injury
-
jefferson/bursting frx
- anterior (rust sign) and post arches of atlas
- due to axial compression
-
odontoid fractures
- type 1) avulsion of the tip
- type 2) fracture through the base of dens. MC and Most severe
- type 3) fracture through the body of C2
-
teardrop
- avulsion frx of the ant inf aspect of the vert body
- MC at C2
- acute ant cervical cord syndrome *instable*
-
Most severe cervical fracture
- teardrop- avulsion of the anterior aspect of the vert. body
- anterior cervical cord syndrome
-
Salter harris
- type 1) horizont frax through growth plate
- 2) growth plate and metaphysis *MC*
- 3) plate and epiphysis
- 4) plate, epiphysis and metaphysis
- 5) compression eformity of the growth plate *Most Severe*
-
most common salter harris
type 2- growht plate and metaphysis
-
most severe salter harris
type 4- compression deformity of the growth plate
-
osgood schlatter
- tibial apophysitis
- cho-pat brace
- 10-16 yo, soccer player
- hip flex/knee ext
-
riders bone
- avulsion of the ichial tuberosity
- MC in horseback riders, herdlers, cheerleaders
-
chance/seatbelt frx
- horizontal frx through single body and post arch
- MC at L1-L3: lapbelt MVA
-
malgaigne
- ipsilateral double vertical fracture of the superior pubic/ ischiopubic rami
- si jt dislocation/fracture
-
duverny
fracture of the iliac wing
-
buckle handle frx
sup. pubic ramus & ischiopubic jxn frx contralateral to impact
-
straddle frx
- bilateral dble vertical fractures
- superior pubic rami & ischiopubic jucntions
-
MC treatment for frx in neck
hard collar
-
MC dislocated carpal
- lunate
- associated w/ pie sign
-
Terry thomas sign
Scaphoid, 2nd mc dislocated carpal bone
-
signet ring sign
associated with scaphoid dislocation
-
SLAP
- sup labrum ant to post
- glenoid labral tear
- instability
-
GH jt
- bankhart avulsion
- hill sacks/hatchet deformity
-
posterior ponticle
- arcuate foramen
- atlanto-occipial lig calcification
- *transmits the sub-occipital nerve and artery
-
downs syndrome
- 20% born without the transverse lig
- increased ADI/ instability
- stress films before treatment
-
os odontoideum
normally developed part of dens is not fused with C2 body
-
dens fracture: what brace?
philedelphia collar
-
congenital block
- adj vert fused from birth
- wasp waist
- hypoplastic disc
-
klippel-feil syndrome
- webbed neck, low hairline, decreased ROM
- congenital blocks
- sprengles deformity: unilateral non-descended scapula
- omovertebral bone: calc of rhomboid mm
-
pedical agenesis
contralateral pedical hypertrophy and sclerosis
-
butterfly vert
failure of the center of the body to ossify
-
spina bifida
- failure of lamina to fuse
- increased alpha-fetoproitein, folic acid deficiency
-
transitional vert
- sacralization- l5 tps fuse, form jts w/ sacrum
- lumbarization: 6 lumbars
-
facet tropism
- asymmetric articular plates
- MC L5/S1
-
Knife clasp
- spina bifida at S1 w/ L5 enlargement
- pain on extension
- folic acid deficiency (B9)
-
-
coxa valga
greater than 120*, mikulicz line
-
madelungs deformity
- shortened distal radius
- prominency of ulnar styloid
- post. sublux of distal ulna
-
negative ulnar variance
- ulna is shorter than radius
- seen with: scapholunate dislocation
-
pelligrini steida
calcification of the medial collateral lig
-
myositis ossificans
- calc of the mm belly
- MC at biceps and quads, hx of trauma
-
AAA
- MC distal to renal arteries
- sits in front of L2-4
- radiographic signs: aortic dilation, curvilinear calcification, fusiform appearance
- tests: doppler, ultrasound, ultrasonography
- test: MRA, angiogram
-
AAA
- 3.8-5cm refer to vascular specialist
- over 5 cm send to ER
-
Cholelisthiasis
- females, fat, forty, fertile, flatulant
- gallstones at L1-L2 pain referral to the inf. border of R scapula
- *murphys sign: inspiratory arrest
- test: barium swallow, ultra sound
-
uterine fibroid
- MC benign tumor in females
- fibroid cyst/leiomyoma (tumor of smooth mm)
-
Calcified prostate
- males < 50
- psa, acid phosphatase, mets, alk phos, painless
- prostatitis: painful and boggy
- carcinoma: painless, hard, nodular
-
phleboliths
- calcification within veins asymptomatic
- MC incidental finding on an xray
-
fat pads
- elbow: radial head fracture
- seen on lateral view
-
Sickle cell anemia
hair on end appearance
-
H shaped vertebra
sickle cell
-
thalassemia
- cooleys anemia, mediterranean anemia
- erlenmeyer flask deformity
-
hyperparathyroidism
- females 30-50
- over active parathyroid gland
- calcium increase, phosphorus decrease
- salt and pepper skull
- rugger jersey spine
-
salt and pepper skull and rugger jersey spine
hyperparathyroidism
-
osteoporisis
- herediatary
- absence of marrow
- anemia
- bone within a bone (early)
- sandwich vertebrae (late)
-
rickets
- def. of vitamin D, Ca+ or phophorus
- seen at growth plates
- mm tetany/weakness
- paintbrush metaphysis
-
CT scan
- different planes
- uses contrast
- 10x better than plain film
- LUNG
- measured in HOUNSFIELD UNITS
-
MRI: Spinal cord or brain
- 100 x better soft tissue than CT
- no radiation dose, gadolinium
- T1: fatty pathology
- T2: water density
-
dexa scan
- measures bone density
- osteoporosis
-
bone scan (scintigraphy)
- injection of radioactive substance: technetium 99
- hot is positive: avn's, mets, pagets, hodgkins, fractures
- scan whole body at once
- most invasive, least specific
-
basilar angle aka: martins basilar angle
- nasion to center of sella turcica. basion (ant. foramen magnum) to sella turcica.
- angle >152* indicates platybasia
-
mcgregors line
- hard palate to base of occiput
- odontoid is >8mm above the line in males or >10mm above in females, indicates basilar impression
- *most accurate line for basilars*
-
chamberlains line
- hard palat to opishtion (post FM)
- odontoid >7mm above indicates basilar impression
-
macre's line
- anterior FM (basion) to posterior FM (opisthion)
- indicates basilar impression if occ is above it
-
atlantodental interspace
- c1 ant tubercle to odontoid
- > 3mm in adults, >5mm in kids indicates transv lig instability
-
georges line
post. body alignment: should be smooth
-
post cervical line
- line drawn at spinolam jxn
- discontinuous line indicate A to P malposition: anterolisthesis/retrolisthesis
-
stress lines in c-spine
- drawn at post bodies of C2/C7
- flexion should intersect at C5/6
- ex should intersect at C4/5
- altered by mm spasm, jt fixation, disc degen
-
prevertebral soft tissue space
- retropharyngeal >7mm
- retrolaryngeal >14mm
- retrotracheal >22mm
-
Cobbs method
- scoliosis measurement
- preferred method
-
risser ferguson method
values are 25% below cobb method
-
sacral inclination
- normal: 30-72*
- average: 46
-
lumbosacral angle: sacral base, fergesons angle
- normal 26-57*
- average: 41*
-
meyerding grading of spondylolisthesis
determines degree of anterolisthesis
-
ullmanns line: garland thomas line
- line drawn parallel and through sacral base. perp line drawn from sacral promatory
- l5 beyond perp. line- spondlo
-
eisensteins method for sagittal canal measurement
<15mm: spinal canal stenosis
-
canal/body ratio
- ratio: 1x2/3x4
- higher the ratio, smaller canal
- >1.6 at L3-5 canal stenosis indicated
-
lumbosacral disc angle
normal 10-15*
-
lumbar gravity line
- ferguson's line
- line should intersect the sacral base
- line ant to sacrum: possible hyperlordosis
- line post to sacrum: possible hypolordosis
-
macnabs line
- parallel and through the inferior end plate
- line intersects the sup. articular process of the vert below: extension malpositon
- facet imbrication suspected
-
hadleys S curve
should be smooth, interruption of the line indicates subluxation or facet invovlement
-
kohlers line
pelvic inlet to outer aspect of obturator
-
shentons line
- smooth line drawn along inf femoral neck to obturator
- interrupted line indicates dislocation, neck frx or SCFE
-
iliofemoral line
- smooth line from outer ilium across jt onto femoral neck
- bilateral asymmetry indicates SFCE, dislocation, frx or dysplasia
-
femoral angle (mikulicz angle)
- normal 120-130*
- coxa vara <120
- coxa valga >130
-
skinners line
- parallel and through femoral shaft, perp line tangential to tip of gr. trochanter
- fovea capitis should be above or at the level of the line, below the line indicates frx, sfce, coxa vara
-
kleins line
- line drawn along outer margin of femoral neck
- femoral head should intersect the line
- failure to intersect indicates SCFE
- *best line for SCFE*
-
patellar position
patellar lengthe and tendon length should be about equal
-
patellar alta-
- patella moved superior
- tendon >20% longer than the tendon
-
patella bana
patella moved inferior
-
heel pad measurement
- >25mm in males, >23mm in females increased thickness
- often indicates acromegaly
-
boehlers angle
- 3 highes pts on the sup aspect of the calcaneous connected
- normal is 28-40*
- < 28* indicates calcaneal fracture of dysplastic calcaneus
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