Skeletal System

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Skeletal System
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Physiology of the Skeletal System

• Periosteum
• Fibrous membrane covering the surfaces of bone
• Diaphysis
• The main shaft like portion of long bones
• Epiphysis
• The ends of the bone

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Physiology of the Skeletal System

• Medullary or marrow
• The hollow tube like structure within the
  diaphysis
• Endosteum
• Lines the medullary canal

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Two types of bone

• Compact bone
• The outer layer of bone
• Cancellous (spongy) bone
• The inner matrix of bone

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Ossification Process

• Osteoblasts
• Produces new bone around outer circumference of
  bone
• Osteoclasts
• Absorbs old bone and increases the diameter of
  the medullary cavity

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Congenital Anomalies of the Skeletal System

• Transitional vertebra
• A vertebra that takes on the characteristic of
  the vertebra on either side of it.
• Example a cervical vertebra with a rib attached

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Congenital Anomalies of the Skeletal System

• Spina Bifida
• A posterior defect of the spinal canal resulting
  from failure of the posterior elements to fuse
  properly
• Radiographic Findings
• Depending on the location of the malformation and
  severity, various anomalies may exist.

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Congenital Anomalies of the Skeletal System

• Osteopetrosis Marble Bone
• There in an increase in bone resorption
• Radiographic Findings
• Very dense bone which usually need increased
  technical factors

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Congenital Anomalies of the Skeletal System

• Osteogenesis imperfecta Brittle Bone Disease
• The skeleton does not ossify properly.
• Often characterized by a blue coloration of the
  white sclera of the eye
• Radiographic Findings
• Thin cortical outlines allowing for fracture with
  minimal trauma

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Congenital Anomalies

• Osteogenesis Imperfecta
• Brittle Bone Disease

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Congenital Anomalies of the Skeletal System

• Acondroplasia
• Failure of cartilage that becomes bone to form
  properly
• Causes dwarfism
• Radiographic Findings
• Posterior scalloping of lumbar vertebral bodies

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Congenital Anomalies

• Achondroplasia

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Metabolic Bone Disease

• Osteoporosis
• Generalized or localized deficiency of bone
  matrix.
• Major causes are aging and postmenopausal
  hormonal changes.
• Radiographic Findings
• Cortical thinning with irregularity and
  resorption of the inner surfaces.
• Most evident in spine and pelvis.

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Metabolic Bone Disease

• Osteomalacia
• Insufficient mineralization of the adult
  skeleton.
• Radiographic Findings
• Appears as a loss of bone density.

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Non-Neoplastic Bone Changes

• Osteomalacia
• rickets

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Metabolic Bone Disease

• Rickets
• Systemic disease of infancy and childhood that is
  equivalent of osteomalacia in the mature
  skeleton.
• Radiographic Findings
• Early changes are best seen in the fastest
  growing portions of bone (sternal ends of ribs,
  proximal ends of tibia and humerus, distal ends
  of radius and ulna).

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Metabolic Bone Disease

• Gout
• An increase in the levels of uric acid in the
  joint.
• Radiographic Findings
• Appearance of cystlike lesions

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Mertabolic Bone Disease

• Paget Disease (osteitis deformans)
• A destruction of bone in which soft bones are
  constantly replaced with calcified bone that
  causes and enlargement known as acromegaly
• Radiographic Findings
• Cotton ball appearance of the skull during
  reparative phase and sharply demarcated
  radiolucency during the destructive phase.

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Benign Bone Tumors

• Bone Cyst
• A wall of fibrous tissue filled with clear fluid
• Radiographic Findings
• Not demonstrated unless a pathological fracture
  occurs.

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Benign Bone Tumors

• Osteochondroma (exostosis)
• Arises from the cortex and grows parallel to the
  bone
• Radiographic Findings
• Usually contains a cartilaginous cap with
  flake-like calcifications in it.

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Benign Bone Tumors

• Endochondroma
• Most often found in the hands and feet
• Radiographic Findings
• A well demarcated tumor which causes thinning and
  scalloping of the cortex

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Benign Bone Tumors

• Giant Cell Tumor (osteoclastomas)
• Most common in long bones of young people in
  their early 20s
• Radiographic Findings
• It appears as large bubbles separated by thin
  strips of bone, likened to a mass of soap
  bubbles

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Benign Bone Tumors

• Osteoid Osteoma
• Tumor usually found in the femur or tibia.
• Classic symptom is pain that is markedly worse a
  night but is relieved by Aspirin
• Radiographic Findings
• An area of dense bone surrounding a radiolucent
  area of cartilage (nidus)
• Most commonly shown on tomography

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Malignant Bone Tumors

• Chondrosarcoma
• Malignant tumor of the cartilage
• Radiographic Findings
• Appears as a radiolucent area

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Malignant Bone Tumors

• Osteogenic sarcoma (osteosarcoma)
• Highly malignant
• Occurs in long bones
• Radiographic Findings
• Characteristic sunray appearance from mixed
  areas of radiolucent and dense areas

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Malignant Bone Tumors

• Ewing sarcoma
• Shows up primarily in children 5-15.
• Occurs in the diaphysis of long bones
• Radiographic Findings
• Bones have a stratified new bone formation
  causing the onion peel appearance

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Malignant Bone Tumors

• Multiple Myeloma
• Multiple lesions in various areas of the body,
  particularly the flat bones
• Radiographic Findings
• Punched out osteolytic lesions, not unlike a
  Swiss cheese effect.

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Malignant Bone Changes

• Multiple Myeloma

• Swiss Cheese Appearance

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Bone Metastases

• The most common malignant bone tumor spreading by
  means of the blood stram or lymphatic vessels or
  by direct extension.
• Radiographic Findings
• A broad spectrum of radiographic appearances is
  apparent due to the extent of the disease

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Joint Pathology

• Arthritis
• An inflammation of the joint

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Types of Arthritis

• Rheumatoid arthritis
• Starts as an inflammation of the synovial
  membrane which leads to a thickened tissue that
  grows inward and damages the cartilage
• Radiographic findings
• Soft tissue swelling around the joints in the
  early stages
• Decrease in joint space with eroded bone ends and
  subluxation in later stages
• Boutonniere deformity or abnormal flexion
  occurs in advanced stages
• Swan neck deformity an abnormal hyper
  extension occurs in advanced stages

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Arthritis

• Osteoarthritis

• Rheumatoid arthritis

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Arthritis

• Gout

• Tophus

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Types of Rheumatoid Arthritis

• Ankylosing Spondylitis or Rheumatoid Spondylitis
• Affects mainly the SI joins as well as the spine
• Radiographic Findings
• Fusing of the SI joints and Spine which is termed
  bamboo spine

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Types of Rheumatoid Arthritis

• Reiter Syndrome
• Effects mainly the lower extremities.
• Other complications include ulceration of the
  hands and soles of the feet
• Radiographic Findings
• Similar to classic rheumatoid arthritis

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Types of Rheumatoid Arthritis

• Psoriatic arthritis
• Rheumatoid like destructive process involving the
  distal joints rather that the proximal joints.
• Radiographic Findings
• Classis pencil-like destruction of the joint
  spaces

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Types of Arthritis

• Osteoarthritis (Degenerative Joint Disease)
• Non inflammatory deterioration of the articular
  cartilage with new bone forming at the surface of
  the joint
• Also called degenerative joint disease and
  hypertrophic arthritis
• Radiographic Findings
• sprruing
• Mild subluxation
• Loose bodies within the joint space
• Narrowed joint spaces

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Common Pathology that Accompanies Arthritis

• Bursitis
• An inflammation of the synovial bursa caused by
  excess stress on the joint
• Spondylolisthesis
• Forward displacement of the vertebra on top of
  another
• Usually at the L5 - S1 junction

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Common Pathology that Accompanies Arthritis

• Osteomyelitis
• An inflammation of the bone marrow caused by
  infections organisms that reach bone by
  Hematogenous spread
• Radiographic Findings
• Starts with the displacement of normal fat pads
  and progresses to a ragged,, moth-eaten
  appearance of the bone.

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Fractures

• A discontinuity of bone caused by force applied
  either directly or indirectly to the bone

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Types of Fractures

• Complete
• A fracture through the entire bone
• Incomplete
• Fracture of only the cortex
• Closed
• If the skin is not broken and a bone is broken

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Types of Fractures

• Open or compound
• The skin must be pierced by at least one end of
  the fractured bone
• Simple
• Divides the bone into two complete pieces
• Comminuted
• The bone is shattered into many pieces (3 or more)

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Common Fractures

• Transverse Tours
• Oblique Longitudinal
• Spiral Compression
• Comminuted Impacted
• Avulsion Pathologic
• Butterfly
• Segmental
• Greenstick
• Fatigue, march fracture or stress fracture

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Fracture Healing

• Malunion
• Healing of fragments of a fracture in a faulty
  position
• Delayed union
• Any fracture that takes longer to heal than the
  average fracture at that anatomic location
• Non-union
• The fracture healing process has completely
  stopped and the fragments will remain un-united
  even with prolonged immobilization

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Fracture Healing

• Pathological fractures
• Fractures occurring in the bone that has been
  weakened by a preexisting condition
• Stress fractures (fatigue fractures)
• Results of repeated stresses to a bone that would
  not be injured by isolated forces of the same
  magnitude
• Battered child syndrome
• Multiple repeated physically induced injuries in
  young children caused by parents or guardians

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Special Fractures

• Jefferson fracture
• Comminuted fracture of the ring of the atlas that
  involves both the anterior and posterior arches
  and causes displacement of the fragments
• Hangmans fracture
• The result of acute hyper extension of the head
  on the neck

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Special Fractures

• Clay shovelers fracture
• An avulsion fracture of a spinous process in the
  lower cervical or upper thoracic spine
• Seat belt fracture
• Transverse fracture of a lumbar vertebra that is
  often associated with significant visceral
  injuries.

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Special Fractures

• Colles fracture
• The distal radius fractures with the fragment
  being displaced posteriorly
• Smith fracture
• Forward displacement of the fragment of the
  distal radius

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Special Fractures

• Potts Fracture
• A fracture that involves both malleoli with a
  dislocation of the ankle joint.

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Common Pathologies of the Spine

• Spondylitis
• Inflammation of the spinal vertebrae
• Spondylosis
• Condition of the spine characterized by fixation
  and stiffness
• Disk herniation
• The fibrous ring of the disk degenerates to the
  point that the pulpy nucleus is forced out

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THE END