Transcript The Roasting of D. r. Kessler

UNC MSK Course Day 1 Lab XR
UNKNOWNS
(for self study)
Pathology?
Old fracture
of radius
with growth
arrest of
distal radial
physis.
Relative
overgrowth
with distal
and dorsal
dislocation
of distal
ulna
Pathology?
Pathology?
Pathology?
Slipped
Capital
Femoral
Epiphysis
(SCFE)
Note that it
has slipped
more
posteriorly
than
anteriorly
Slipped
Capital
Femoral
Epiphysis
(SCFE)
Note that a
line drawn
along the
anterior
femoral neck
intersects the
head on the R
but not on the
L.
Slipped
Capital
Femoral
Epiphysis
(SCFE)
A screw has
been placed
on the L to
prevent
further slip.
Pathology?
Polydactyly
Inheritance?
Polydactyly
Inheritance for
postaxial
polydactyly is
frequently
autosomal
dominant,
whereas
preaxial
(duplicate
thumb) is
usually
spontaneous.
Pathology?
Hemihypertrophy
Note: all structures
slightly enlarged
on the right.
Pathology?
Osteochondromatosis
(Multiple hereditary
exotoses)
Inheritance?
Osteochondromatosis
(Multiple hereditary
exotoses)
Typically autosomal
dominant inheritance.
Bones often deformed
due to pressure or
growth abnomalities
Pathology?
Osteopetrosis
Inheritance?
Osteopetrosis
(Multifactorial
and there are
autosomal
dominant and
recessive forms)
Note: Bone is
dense, marrow
space is
decreased –
Why?
Osteopetrosis
Note: Bone is
dense, marrow
space is
decreased because
osteoclasts are
not removing
bone to
enlarge
marrow canal.
Pathology?
Hypophosphatemic
(Vitamin D Resistant)
Rickets
(May be difficult to
differentiate from other
causes of bowing on
basis of X-ray alone.)
Inheritance?
Wide physis better seen here
Hypophosphatemic
(Vitamin D Resistant)
Rickets
(May be difficult to
differentiate from
other causes of
bowing on basis of
X-ray alone.)
(Sex linked dominant
trait)
Pathology?
Osteogenesis
Imperfecta
Severe
Inheritance?
Mild
Moderate
Osteogenesis
Imperfecta
Severe
(Autosomal
dominant or
recessive)
Many degrees
of severity.
Associated
with what
external
finding?
Mild
Moderate
Osteogenesis
Imperfecta
Severe
(Autosomal
dominant or
recessive)
Many degrees
of severity.
Associated
with blue
sclera.
Mild
Pathology?
Bladder
extrophy
Note: Wide
pubic
symphysis
resulting from
abnormal
development of
the cloaca.
Pathology?
Congenital
scoliosis
How do you
know it isn’t
“idiopathic
scoliosis”?
Congenital
scoliosis
Note:
Presence of
hemivertebra
Congenital
scoliosis
Note:
Presence of
hemivertebra
Pathology?
Spina Bifida
L4-sacrum
Note: Wide
pedicles and
absence of
spinous
processes.
Spina Bifida
L4-sacrum
Note: Wide
pedicles and
absence of
spinous
processes.
Inheritance?
Spina Bifida
L4-sacrum
Note: Wide
pedicles and
absence of
spinous
processes.
Multifactorial –
genetic plus
intrauterine
influences
especially
prenatal folic
acid deficiency
Pathology?
Proximal
Femoral
Focal
Deficiency
(PFFD)
Pathology?
Pathology?
“Scanogram” of another patient with the same condition, shows x-rays of the
hips, knees and ankles all shot over a ruler to allow measurement of the leg
length discrepancy which is often present
Fibular
Hemimelia
(congenital
absence of
fibula)
(Can be
familial)
Pathology?
Radial
hemimelia
(Radial Club
Hand)
Not the same patient, note
absence of thumb in this case.
Pathology?
Pathology?
Madelung’s Deformity
Note the "V" shaped
proximal carpal row.
Congenital
Madelung’s may be
due to an abnormal
fibrous band tethering
the sigmoid notch of
the radius proximally
to the ulna and
slowing the growth.
Traumatic
Madelung's may
follow partial growth
arrest of the distal
radius (seen earlier).
Pathology?
Spondyloepiphyseal
dysplasia
Note: Platyspondyly
or “flat vertebrae.”
Pathology?
Developmental
dysplasia of the
hip (DDH)
Note: Absence of
ossification center
L femoral head
Inheritance?
Developmental
dysplasia of the
hip (DDH)
Note: Absence of
ossification center
L femoral head
Inheritance –
multifactorial
including
intrauterine and
post natal
positioning
influences.
Developmental
dysplasia of the
hip (DDH)
Note: Break in
Shenton’s line on
L with small
ossific nucleus
Developmental
dysplasia of the
hip (DDH)
Note: Break in
Shenton’s line on
L with small
ossific nucleus
Break
Shenton’s
line
Developmental
dysplasia of the hip
(DDH)
Note: Acetabular
angle should be less
than 30 degrees at
birth and less than
20 degrees by age 2
years. The ossific
nucleus should be in
the inner lower
quadrant of the
crossing of
Hilgenreiner’s line
(through the
triradiate cartilages)
and a perpendicular
line through the
AIIS.
Alaska