Objectives
1. Define a fracture. Differentiate between open and closed fractures
in terms of initial injury, treatment and likely complications.
2. Define bursitis, gout, osteoporosis, malunion,
scoliosis,
kyphosis,
lordosis.
3. Distinguish between rheumatoid arthritis and osteoarthritis
(degenerative joint disease).
4. Know all underlined terms and all starred * questions.
SPECIMENS, MODELS AND ORTHOPEDIC DEVICES
Go to Specimen Photo Index
Vertebrae with Osteoarthritis (Degenerative Joint Disease) and Osteoporosis
Compare the diseased vertebrae with a normal vertebra. The surface of
the normal vertebra is smooth whereas the surface of the osteoarthritic
vertebrae is rough with protrusions of bone matrix called osteophytes.
This excess bone limits the range of movement and causes pain.(Fig. 70-2,
p. 1038)
39.
Vertebrae, degenerative osteoarthritis, gross
40.
Vertebrae, degenerative osteoarthritis, gross
Femoral
head, osteoarthritis, comparison of normal to abnormal articular cartilage,
gross [XRAY]
Osteoarthritis, of knee
radiograph [PATH]
Foot
with "hammer toes", gross
Foot,
degenerative osteoarthritis, gross [XRAY]
Osteoarthritis, hands,
radiograph [PATH]
Osteoarthritis, hand,
radiograph
Osteoarthritis, hand, with
joint subluxation, radiograph
Osteoarthritis, knee, with
joint subluxation, radiograph
In addition, note the eroded body (centrum) of one of the osteoarthritic
vertebrae. This damage is due to osteoporosis, a loss of bone density which
causes bones to become weak and easily fractured. This vertebra shows a
compression fracture, the centrum has collapsed under the normal weight
of the vertebral column.
Bone
density and osteoporosis, diagram [XRAY]
1.
Normal vertebral bone, gross.
2.
Normal vertebral bone, gross.
3.
Normal vertebral bone and marrow, low power microscopic.
*
4.
Normal vertebral bone, polarized, medium power microscopic.
*
5.
Vertebral bone with osteoporosis, gross.
6.
Vertebral bone with osteoporosis and compressed fracture, gross.
7.
Vertebral bone with osteoporosis, low power microscopic.
*
41.
Vertebrae, osteoporosis, gross
42.
Vertebrae, compressed fracture, gross [MRI]
* Osteoporosis is most common in older women. Why? (p. 963)
Malunions of the Femur and Fibula, (p. 1027-1028)
A malunion occurs when a fracture has healed in an inappropriate or twisted position. This can result from improper reduction (bone is not set properly) or abuse of the bone during the period of healing (inadequate retention of reduction). In many cases, such as the 2 bones here, excessive bone growth will occur at the fracture site. Compare the abnormal bones with their normal counterparts.
Herniated Disc - Model and Diagram (pp. 816-819)
In a herniated (or slipped) intervertebral disc, the jelly-like center ruptures through the fibrous capsule. Notice how the ruptured disc is pressing on a spinal nerve, which can cause severe back pain. This is one of the most common causes of back pain. It often occurs in later life because the fibrous capsule dries out and becomes more brittle with age.
What treatments are commonly used for a herniated disc? (pp. 818-819)
Herniated
intervertebral disc, sagittal view, MRI scan
Herniated
intervertebral disc, transverse MRI scan
Orthopedic Surgical Devices , Hip and Knee Chart (p. 1039)
Compression hip screw and hip nail are used to hold the head and shaft of a fractured femur in place (Top right of Hip and Knee Chart). Metal rods are used to support fractured diaphysis of long bones such as femur. Femoral-head replacement is used to substitute for an extensively damaged femoral head (Upper right of Hip and Knee Chart, see also the photo of a radiograph of a total hip replacement).
WALL CHART
Fractures of clavicle and acromion of scapula
These fractures are commonly caused by falls where much of the force from the weight of the body is applied to the shoulder. They heal rapidly and usually do not require a cast.
Normal bone
1.
Normal vertebral bone, gross.
2.
Normal vertebral bone, gross.
3.
Normal vertebral bone and marrow, low power microscopic.
*
4.
Normal vertebral bone, polarized, medium power microscopic.
*
Fractures
3.
Fracture with new woven bone, high power microscopic
*
4.
Fracture with new woven bone, medium power microscopic
*
5.
Fracture callus, high power microscopic
*
Pathologic
fracture of humerus, radiograph [CT, NM]
* What is a fracture? (p. 1025)
Osteomyelitis of Humerus
Osteomyelitis is an infection of a bone. It may result as a complication
from a fracture or from bacteria spreading to the bone from some other
area of the body.
Humerus,
compound fracture, gross [XRAY]
Osteomyelitis, foot,
radiograph
Osteomyelitis, great toe,
radiograph
Osteomyelitis, great toe,
nuclear medicine scan
Osteomyelitis, tibia,
radiograph
Osteomyelitis, vertebra,
MRI scan
Osteomyelitis, vertebra,
MRI scan
Osteomyelitis, vertebra,
MRI scan
6.
Chronic osteomyelitis, medium power microscopic
*
* Why is osteomyelitis a serious problem? (p. 1027)
Dislocation of shoulder, Torn shoulder capsule (pp. 1030)
Dislocation of the shoulder often accompanies fractures of the clavicle or acromion process because it too is caused by severe blows to the shoulder. Forces causing excessive movement of the upper arm beyond its normal range of motion are also common causes. Dislocation may be a serious injury since it can easily lead to complications such as damage to the nerves and blood vessels passing through the joint. These structures are vital to the health of the arm.
Another complication of shoulder dislocation is tearing of the shoulder
capsule. This capsule provides the main structural support for the shoulder
joint. Should it be damaged, surgical repair and artificial supports are
often needed.
Rotator
cuff injury, MRI scan
* What is the difference between dislocation and subluxation?
(p. 1028)
Osteoarthritis, hand, with
joint subluxation, radiograph
Osteoarthritis, knee, with
joint subluxation, radiograph
* What complications often occur after dislocation injuries? (p. 1028)
Bursitis of the shoulder
Bursitis is inflammation of a bursa (a fluid-filled sac between
soft tissues or between soft tissue and a bone). Bursae are often found
near joints where they serve to cushion and reduce friction.
Bursitis of elbow,
radiograph
Rheumatoid Arthritis and Osteoarthritis
Arthritis is a general term meaning inflammation of a joint. Note that in rheumatoid arthritis, the joint has swollen soft tissues while in osteoarthritis, excess bone tissue is present in the joints.
Rheumatoid
arthritis
46.
Hand, rheumatoid arthritis, gross
Rheumatoid arthritis,
hand, radiograph
47.
Elbow, rheumatoid nodule, gross
49.
Rheumatoid arthritis, rheumatoid nodule, microscopic
*
48.
Rheumatoid arthritis, pannus in joint, microscopic
*
Osteoarthritis
39.
Vertebrae, degenerative osteoarthritis, gross
40.
Vertebrae, degenerative osteoarthritis, gross
Vertebrae,
degenerative osteoarthritis, gross
Vertebrae,
degenerative osteoarthritis, gross
Femoral
head, osteoarthritis, comparison of normal to abnormal articular cartilage,
gross [XRAY]
Foot
with "hammer toes", gross
Foot,
degenerative osteoarthritis, gross [XRAY]
Hand,
degenerative osteoarthritis, gross [XRAY]
Osteoarthritis, hands,
radiograph [PATH]
Osteoarthritis, hand,
radiograph
Osteoarthritis, hand, with
joint subluxation, radiograph
Osteoarthritis, knee, with
joint subluxation, radiograph
* Which joints are most commonly affected by rheumatoid arthritis?
By osteoarthritis? (pp. 1037, 1041)
RADIOGRAPHS AND PHOTOGRAPHS
Go to X-ray Index
Go to Photo Index
Radiologic
images of lesions involving bone and joints
Fractures - radiographs # 1-10, 14, 15
Examine these radiographs and try to find the fracture(s) present in
each case.
Fracture and ORIF repair
of humerus, radiograph [PATH]
Fracture, femur at hip
joint with prosthesis, radiograph
Hip joint with prosthesis,
pelvic CT scan
Fracture-dislocation of
sacroiliac joint, pelvic CT scan
Fracture of 5th metacarpal
of hand, radiograph [PATH]
Linear fracture of skull,
radiograph [PATH]
Skull fractures, head CT
scan
Fracture, femur,
radiograph
Intertrochanteric
fracture, femur, radiograph
Comminuted fracture,
femur, radiograph [PATH]
Comminuted spiral
fracture, femur, radiograph
Comminuted spiral
fracture, tibia, radiograph
Tibia and fibula
fractures, healing, radiograph
Tibia, healing fracture,
CT scan
Fracture, healing, tibia,
radiograph
Hip Fractures and Treatment - radiographs # 11,12, & 13
First examine radiograph #12 of a normal hip. Notice the density of
the os coxae (hip bones) and the 2 femurs. (The denser the bone the lighter
it appears on X-ray). Next examine the fractured femur in rad. # 13; the
head of the femur is completely broken off. Note also the density of the
hip bone and femur by comparing this radiograph with #12.
* What disease is likely responsible for the decrease in density of the bones in rad. #13?
Now examine radiograph #11. The fractured femur has been repaired and stabilized with the insertion of pins into the head of the femur.
Note (on rad #11) the fracture on the opposite femur and the density
of these bones. This patient also has osteoporosis, which is common
in elderly patients and a common cause of hip fractures. Another method
of treating such fractures is by a "total hip replacement" in which the
head of the femur is replaced by a prosthesis (orthopedic device). Be sure
to examine these devices on display in today's lab and note the photograph
of a radiograph of a total hip replacement.
Femur, osteoporosis,
radiograph
Femur, osteoporosis,
radiograph [PATH]
Humerus, osteoporosis,
radiograph
Hand, osteoporosis,
radiograph
Curvatures of the Back - photographs and radiographs
Distinguish between scoliosis, kyphosis and lordosis
(p. 600 "Thoracic Cage DIsorders" and see lab photograph). Note the extreme curvature of the back in the patient
with kypho-scoliosis (radiograph). Note how this has altered the structure
of the thoracic cavity (compare with normal chest film). This condition
makes breathing very difficult for the patient. If diagnosed early (before
puberty), scoliosis may be treated effectively by a Milwaukee brace. This
brace is worn 23 hrs per day until the patient has stopped growing. If
treatment is not successful or if the diagnosis is not made until later
in life, scoliosis may be treated with surgical implantation of surgical
steel rods (as in the photograph).
Vertebral
abnormalities, table
Vertebrae,
scoliosis, gross [CT]
Scoliosis
of vertebral column, axial view, abdominal CT scan
Kyphosis
of vertebral column, lateral chest radiograph
Kyphosis
of vertebral column, chest CT scan
T-spine kyphosis with
compressed fractures, MRI scan [PATH]
Gout - photograph of foot and radiograph (pp. 1054-1056)
Notice the redness and swelling of the foot, especially of the big toe.
Note in the radiograph, the inflammatory reaction occurring within this
joint. This is a common site for gout to occur.
53.
Foot, gout, gross
Gout, big toe, radiograph
54.
Gouty arthritis, radiograph
Gout, hand, radiograph
55.
Gouty tophus in soft tissue, medium power microscopic
*
* What is responsible for gout? (pp. 1054-1056)
56.
Gouty arthritis, joint fluid, polarized, microscopic
*
8Copyright
2001 - Augustine G. DiGiovanna - All rights reserved.