Image Evaluation

Image Evaluation PowerPoint PPT Presentation

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There are numerous categories of pathology in the evaluation of skeletal disease. Developmental and congenital disordersInflammatorySkeletal dysplasiasTraumatic Neoplastic Metabolic disordersVascular disordersMiscellaneous. Pathological Classification. Developmental

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Image Evaluation

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1. Image Evaluation Upper Limb

3. Pathological Classification Developmental – Significant deviation from the norm resulting from a congenital or hereditary defect. E.g. Achondroplasia Inflammatory – Disorders resulting from a inflammatory origin. E.g. Rheumatoid Skeletal dysplasias – Dysplasia (Latin for “Bad Form”), abnormalities of skeletal growth and strength, e.g Osteopetrosis Traumatic – Physical Injury Neoplastic – Tumours benign and Malignant. Metabolic – Resulting from biochemical processes e.g Rickets, Fluorosis Vascular – Originating from a blood disorder and causing bony changes, e.g Thalassemia Miscellaneous – Others which don’t easily fit any other category, e.g joint infections and arthritis

4. Today Osteoarthritis Fractures of the wrist Elbow – Fat pad sign or ‘sail sign’ Skeletal Dysplasia - Osteopetrosis Tumours

5. Degenerative Joint Disease – Many varieties and causes Osteoarthritis Diffuse idiopathic skeletal hyperostosis Rheumatoid arthritis Ankylosing Spondylitis Psoriatic spondyloarthropathy Reiters syndrome Gout Neuropathic osteoarthropathy Juvenile chronic arthritis

6. Osteoarthritis

7. Markers of Osteoarthritis Non-uniform joint space narrowing. Subchondral sclerosis (sclerosis – dense white appearance radiographically, corresponding with overgrowth of bone). Osteophyte formation. Subchondral cyst formation Subluxation (partial dislocation), deformity, malalignment.

10. Osteoarthritis – degenerative disease

12. Fractures

13. Frequently encountered fracture types

14. Torus or buckle fracture

15. Colles’ fracture Mechanism – dorsiflexion. Fracture of the distal portion of the radius with dorsal displacement. Appearance referred to as the “dinner fork deformity”.

16. Smith’s fracture Reverse colles’ fracture. Mechanism – variable. Fracture of distal portion of radius with palmer displacement. Less common than Colles’ fracture.

17. Fat pad sign – intracapsular fat pad displacement

18. Fat pad sign – intracapsular fat pad displacement Fat pads are anterior and posterior. Fat pad performs a triangular lucency anterior to the distal humerus. Intracapsular fat pad displacement indicates a joint effusion. This sign usually indicates the existence of intracapsular fluid or blood and is often indicative of a fracture – not always well seen!

20. In the absence of and obvious fracture, this sign very often will indicate the presence of a fracture of the Radial head that is not easily seen with standard projections, and additional objections should be performed in this case in an attempt to exclude fracture. Need a true lateral projection in order to visualise the fat pad. Obliquity of the humerus will hid the fat pad!

21. Chisel Fracture

22. Skeletal Dysplasias

23. Skeletal Dysplasias - Osteopetrosis Is a rare hereditary bone disorder – may also be called marble bone disease. Sclerosing dysplasia. May be benign or malignant! Patterns off diffuse osteosclerosis. This bone, while dense, is very brittle, fragile and fractures easily.

24. Osteopetrosis Normal

25. Tumour – Radiographic appearances Osteolytic lesion in the metaphyseal portion or the distal radius. Extension into the subchondral region. Tumour extension to the cortical rim. “eggshell” cortical rim still intact. Mild bony expansion No obvious extension into the soft tissues

26. Giant Cell Tumour Usually affect the metaphyseal portion of long bones. 10% are malignant. Most occur in the distal radius, distal femur and proximal tibia and humerus. Typical age at onset – 30-50yrs. Giant cell tumours of the distal radius are more likely malignant than at any other site.

28. Ouch! Amputation at the wrist in an industrial accident

29. Terminology Sclerosis – extra bony growth Subchondral – area of bone under the articular cartilage Cyst – fluid filled Osteophyte – extra bone growth to strengthen area of weakness Osteopetrosis – sclerosing skeletal dysplasia Chisel fracture – a form of radial head fracture Torus or buckle fracture Fat pad sign Colles fracture – angulation of fracture fragment posteriorly (dinner fork deformity) Smiths fracture – angulation of fracture fragment anteriorly Radiolucent – radiographically lacking density Osteosclerotic – Bone forming Osteolytic – Bone destroying Dysplasia – bad growth

30. Homework Monteggia’s Fracture – dislocation (Forearm) Galeazzi’s Fracture – dislocation (Forearm) Bennett’s Fracture – (Thumb)

31. References Eisenberg, R.L. & Johnson, N.M. Comprehensive Radiographic Pathology. Mosby. 2003. Taylor, J. & Resnick, D. Skeletal Imaging of the spine and extremities, Saunders. McKinnis, L.N. 1997, Radiographic evaluation of normal versus pathologic bone. In Fundamentals of orthopaedic radiology, F.A. Davis Company, Philadelphia, pp 30-70

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