Where do metaphyseal/diaphyseal infarcts usually occur?
the medullary of the distal femur, proximal tibia, and proximal humerus
What do metaphyseal/diaphyseal infarcts look like?
serpent-like configuration with central sclerosis
What is Chandler’s Disease and who gets it typically?
AVN of femoral head in adults, usualy males aged 30-70
“bilateral but asymmetric 50% of the time”
AVN of the adult femoral head
What is the “bite sign?”
a semi-lunar or wedged necrotic area involving the superior margin of the femoral head
Snow Cap Sign, crescent/rim sign, mushroom deformity, and hanging rope sign all indicate what?
AVN
What is the term for an arc like radioucency beneath the superior weight bearing surface of the femoral head which is associated with AVN?
subchondral fracture (rim or crescent sign)
T/F: Once AVN heals, it is typically the beginning of DJD.
True
Why might a person with lupus develop AVN?
Steroids are often prescribed for lupus
What disease affects mostly boys, is sometimes bilateral, causes groin pain, and involves AVN of the femoral capital epiphysis before closure?
Legg-Calve-Perthes disease
What are the 4 stages of Legg-Calve-Perthes Disease?
avascular stage (0-12 months) revascularization stage (6 months-4 years) repair and remodeling (1-2 years)
What are 3 common soft tissue signs of hip joint disease?
capsular swelling, small obturator (hip flexion), and increased TDD
What condition represents a focal subchondral infarction of sub-articular bone where the necrotic bone may heal spontaneously or become a free floating fragment separated from the parent bone?
Osteochondritis dissecans
Who typically gets osteochondritis dissecans? where do they get it?
males aged 11-20;
knee is mc location, especialy medial femoral condyle
What are the typical symptoms of osteochondritis dissecans?
may be asymptomatic or have vague symptoms such as, clicking, locking, limitation of movement, swelling, or pain aggravated by movement.
What condition doe osteochondritis dissecans predispose the patient to?
DJD
Other than the knee where might a patient have osteochondritis dissecans?
humeral head, capitellum of the elbow, or the medial surface of the talus.
What is a joint mouse?
osteochondral fragment that has detached
What is SONK?
spontaneous osteonecrosis of the knee - idiopathic (aged) AVN of the knee
T/F: SONK is associated with lateral meniscal lesions.
False; associated with medial meniscal lesions
What is the term for the fragmentation of the apophysis of the tibial tuberosity often seen in young, teenage males which typically is asymptomatic by age 18?
Osgood Schlatter’s Disease
What is the difference between Osgood Schlatters’s and Sindig-Larsen-Johanssen disease?
SLJ disease involves the inferior pole of the patella rather than the tibial tuberosity
What is the name for AVN of the metatarsal head, usually the second, which affects females more often possibly due to wearing heels?
Freiberg’s Disease
What condition involves AVN of the lunate in males aged 20-40 y/o who are involved in manual labor?
Kienbock’s Disease aka Drillers disease
What bone is involved in Kohler’s Disease?
Navicular (tarsal)
What disease most commonly affects teens, has irregular end plates, affects 3 contiguous vertebrae, may display schmorl’s nodes, and is aka Juvenile Discogenic Disease?
Scheuermann’s Disease
The primary etiology of this disease appears to be failure of embryologic vascular channels, centrum defects, and notochord clefts to disappear leaving endplate defects. What is this disease?
Juvenile Discogenic Disease (Scheuermann’s)
T/F: Severs Disease is a necrosis and fragmentation of the calcaneal apophysis.
False; Sever disease is not a necrosis but a sclerosis and fragmentation of the calcaneal apophysis
What is the term for serpiginous regions of calcification within the bone medulla, usually associated with arteriosclerosis, which look similar to enchondromas/chondrosarcomas?
Calcified medullary infarct
What is the most common hemolytic anemia?
Sickle cell anemia
T/F: In addition to “hands and feet syndrome” (pain/swelling), patients with sickle cell anemia also have a predisposition to salmonella osteomyelitis
True
Hair-on-end skull, H-vertebrae, marrow hyperplasia, and long bone undertubulation are all associated with what disease?
Sickle cell anemia
What disease other than Sickle cell anemia may also display hair-on-end skull? and how do you tell the difference?
thalassemia;
only sickle cell will also affect the spine
This group of genetic blood disorders affects people of mediterranean origin, creates abnormal hemoglobin, and is aka Cooley’s anemia.
What is Thalassemia
With what condition might you find splenomegaly, cardiomegaly, fatigue, and rodent facies?
Thalassemia
What is the term for undertubulation at the metaphyseal/diaphyseal junction commonly seen with Thalassemia?
Erlenmeyer Flask Deformity
What appearance will trabeculation take on with severe Thalassemia?
honeycomb (coarsened trabeculation)
What X chromosome linked bleeding disorder is typically carried by females but manifested in males? It may produce intra-articular tissue swelling, osteopenia, and joint pain.
Hemophilia
What malignant proliferation of WBCs produces radiolucent submetaphyseal bands on xrays, osteopenia, periosteal reactions, and osteolytic destruction of long bone metaphysis and diaphysis?
Leukemia
What is the clinical presentation of a patient with Leukemia?
fever, malaise, joint pain, easily bruised, and spontaneous bleeds