OSTEO-ARTICULAR SYSTEM - USMF

OSTEO-ARTICULAR SYSTEM

Bony structure

• Gross section

photographic image of

proximal part of the

femur

• X-ray image of the

same gross section


Distribution of lines of

force in the region of

femoral neck

Bone Tissues with greater density will absorb

more of the xray so less of the beam reaches

the film plate. The resultant image is

therefore lighter.

Bone Tissues with less density will allow

more xray to reach the film so it will be

darker. This is called radiodensity and is

determined by:

*composition of the structure

*thickness of the structure

ANATOMY OF BONE

Compact Bone: forms outer shell or cortex

of bone; dense

Cancellous Bone

(synonymous with trabecular bone or spongy

bone): forms the inner aspect

of bone except for the marrow

cavity; spongy

Periosteum: Covers the

cortex; fibrous layer which

contains blood vessels,

nerves and lymphatics.

Endosteum: Membrane lining

the inner aspect of the

cortex and medullary

(marrow) cavity

Diaphysis: Shaft

Metaphysis: Flared part at

either end of shaft

Epiphysis: Either end of the

bone

The MAINradio-imagistic

methods of investigation

Radiography / Radioscopy

CT

MRI

Fistulography

Angiography

Scintigraphy, PET-CT

USG

Computer Tomography

Definition:

Classification of fracture:

Complete

By mechanism;

By number

By direction of fracture’s line

Incomplete

By mechanism;

Types of fracture: by mechanism

Force fracture

Stress fracture

Direct fracture

Indirect fracture

Gunshot fracture

Pathological fracture

Gunshot fracture

Uncommon fractures

◆ Stress andpathologic etiologies

Presentation material for educational purposes only.

All rights reserved. © 1999 URMC Radiology. 21 / 30

Types of fracture: by number:

Unique

Multiple

Communited

Concurrent

Unique (simple) fracture

Multiple fracture = more than

one line of fracture

Concurrent

fracture

Complete fracture

Types of fracture: by direction


Symptom of fracture – line of fracture

• a. Transversal • d. T-shaped

• b. Oblic • e. V-shaped

• c. Longitudinal

Imaging semiology of fractures:

Fracture’s trajectory

Displacement of fractured fragments


Symptom of fracture – displacement of fragments

• a. Lateral • d. Longitudinal by

• b. Longitudinal by interlocking

sliding • e. Angular

• c. Longitudinal with • f. Rotation

elongated extremity

Fracture Rx vs CT

Mandible Fracture

Mandible fractures are due to direct trauma. Most are comminuted

and typically involve both sides of the mandible

Spine Fractures

Oblique fracture of a lower cervical

spinous process,

commonly C7.

It results from hyperflexion, commonly from

shoveling snow.

Compression Fracture

Compression fractures of the spine are

common in elderly and osteoporotic

patients. They result from anterior or

lateral flexion. The typical appearance

is loss of height of the anterior aspect

of the vertebral body with preservation

of the posterior elements and generally

the posterior aspect of the vertebral body.

.

Pathological Fracture - Humerus

Pathologic fractures result from an

underlying abnormality of the bone,

usually either from a primary bone

tumor or from metastatic disease.

However, pathologic fractures may

result from metabolic conditions as

well. A pathologic fracture results

when normal stress is placed onto

abnormal bone.

Greenstick Fracture

The greenstick fracture results from

direct trauma. There is an incomplete

fracture of a long bone (radius or ulna)

with cortical disruption on one side and

deformity on the other, resulting in

bowing of the bone.

Boxer’s Fracture

So named because of the common

occurrence in prizefighters, the

fracture involves the distal

metacarpal neck, usually of digit

five. The distal fracture fragment

is volarly angulated and may be

externally rotated. The injury

results from direct trauma to the

hand.


Radiograph of the femur

Shortening of the bone

by sliding of the

fragments

Imaging semiology of luxation (dislocation)

◆ Posterior

elbow

Dislocations


Radiograph of the

elbow

Changes in correlation

of articular surfaces

(displacement)

Imaging diagnosis of osteoarticular

pathology

• Changes in shape and dimensions

1. Bone atrophy / hypertrophy

2. Bone inflation

3. Bone deformation

• Changes of structure

1. Osteoporosis

2. Osteosclerosis

3. Destruction

4. Osteonecrosis

5. Osteolysis

• Changes in periosteum

1. Periostosis

2. periostitis

• Changes in soft tissues

Changes in shape and dimensions

Bony deformity

Arched • Angular • S-shaped


Bone atrophy

Eccentric • Concentric


Radiograph of the leg

Bone atrophy by

compression


X-ray of the femur

Blown bone (bone

inflation)

X-ray of the

femur

Thickening of the

bone

(hyperostosis=

hypertrophy)

a. Uniform

b. Unilateral

Changes of the contours

Osteoporosis

Normal

Spongiose bone

Compact bone


Changes of structure


X-ray of lumbar part of spine


X-ray of the knee

Hypertrophic

osteoporosis

Ankilosis

Osteosclerosis

Normal

Spongiose bone

Compact bone


X-ray of the leg. Osteosclerosis.

Focal sclerosis • Diffuse sclerosis



X-ray of the femur

Osteodestruction in

osteomyelitis


X-ray of the foot

Osteodestruction in tuberculosis osteitis


X-ray of the leg

Osteodestruction in

osteogenic sarcoma


X-ray of the leg

Osteodestruction in

metastasis


X-ray of the arm

Osteodestruction in

solitary bony cyst


X-ray of the forearm

Osteodestruction in giant cell tumor of the bone


X-ray of the leg

Osteodestruction in giant cell tumor of the bone


X-ray of the foot fingers

Osteolysis of the falangs


X-ray of the elbow

Osteolysis of the articular

ends


X-ray of the knee

Spongiose sequestrum


X-ray of the femur

Cortical sequestrum

Localization of sequestrum

Intraosseous • Penetretion • Extraosseous

(in cavity)


Changes in soft tissues

The options are many such as:

• Gas in the soft tissues - a sign of an open

fracture or gas gangrene

• calcification of various nature

• Increase and decrease volume

• The presence of foreign bodies

Calcification of various nature

Gas in the soft tissues

Increase and decrease

volume

The presence of foreign bodies


X-ray of the femur

Intraosseous localization

of the sequestrum


X-ray of the leg

Linear periostosis


X-ray of the femur

Stratified periostosis


X-ray of the femur

Fringe-shaped periostosis


X-ray of the femur

Ruche-shaped periostosis


X-ray of the leg

Acicular periostosis

X-ray of the knee

Thinning of the radiological articular space Uniform • Non-uniform

Articular changes


X-ray of the pelvis

Thickening of the radiological articular space on

right in osteochondropathy


Thickening of the

radiological articular

space by destruction of

articular ends.


X-ray of the knee

Subchondral plate

sclerosis


X-ray of the shoulder

Osteophytosis


X-ray of the

coxofemoral joint

Arthrosis deformans


Radiograph of the

elbow

Changes in correlation

of articular surfaces

(displacement)

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OSTEO-ARTICULAR SYSTEM - USMF