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SKELETAL SYSTEM

CONGENITAL/ HEREDITARY DISEASE A. OSTEOGENESIS IMPERFECTA - a serious autosomal dominant , congenital disease that affects the newborn skeletal system. Due to its abnormal fragile bone, infants afflicted are born with multiple fracture. It results in limb deformities and dwarfism. In some cases, a hearing disorder might occur due to the abnormal connective tissues around the auditory ossicles. Also called Brittle bone disease. B. ACHONDROPLASIA - it is the most common inherited disorder that results in malformation and dwarfism. This is due to the cartilage located in the epiphyses of long bones that does not convert to a bone. Patients with such condition present a normal size trunk but with shortened extremities. Other manifestations include lumbar spine lordosis ,bow leg and bulky forehead. C. OSTEOPETROSIS - including Marble Bone are term characterizing various disorders that involves increase in bone density and defective bone contour (Skeletal Modeling). - Albers-Schonberg is a common form of osteosclerotic osteopetrosis that is considered as a benign skeletal anomaly involving bone density. Patients with such condition are asymptomatic. Not radiographically visible at birth but as the individual ages, manifestations become visible especially at the cranium and spine. D. HAND AND FOOT MALFORMATIONS - Failure of the fingers or toes to separate is Syndactyly that gives a physical appearance of a webbed digit. Polydactyly is the presence of extra digits. Clubfoot prevents a normal weight-bearing. Found to turn inward at the ankle, common in males and occurs bilaterally.

E. CONGENITAL DISLOCATION OF THE HIP - It is a malformation of the acetabulum due to incomplete formation resulting in displacement of the head of the femur. Very common in females and can be treated through casting or splinting of the affected hip. F. VERTEBRAL ANOMALIES SCOLIOSIS - is an abnormal lateral curvature of the spine that tends to affect females more frequently. This does not generally become apparent until adolescent stage. Such curve can either be convex to the right in the thoracic region or to the left in the lumbar region. Can be corrected surgically or by placing a brace or body cast. SPINA BIFIDA - an incomplete closure of the vertebral canal particularly in the lumbosacral area which results in failure of bony fusion of the 2 laminae that is visible radiographically. In severe cases it affects the spinal cord resulting in paralysis. G. CRANIAL ANOMALIES CRANIOSYNOSTOSES - premature or early closure of any of the cranial sutures. This causes an overgrowth in the fused sutures allowing the brain to grow, thus altering the shape of the head. ANENCEPHALY - results in no formation of the brain and cranial vault leaving only the facial bones to be formed. This results in death and can be diagnosed by sonography and radiography. INFLAMMATORY DISEASE A. OSTEOMYELITIS - an infection of the bone and bone marrow resulting from a direct infection such as an open fracture. Generally affected are the infants and children because of low resistance combined with the virulence of the organism. In adults, it affects the ends of the long bones of the lower limbs.

B. TUBERCULOSIS - a chronic inflammatory disease affecting the ends of long bones or of the spine. Radiographically displays a wormeaten appearance infecting the joint spaces POTTS DISEASE the tuberculosis of the spine causing softening and eventual collapse of the vertebrae resulting in abscess formation and pressure in spinal cord. C. ARTHRITIS - defined as inflammation of the joints ACUTE ARTHRITIS Commonly called Pyogenic Arthritis caused by staphylocci, streptococci and gonococci. Symptoms are pain, redness, swelling of the affected joint accompanied by fever. RHEUMATOID ARTHRITIS chronic inflammatory disorder affecting the synovial joints. common in women aged 20 to 50. it is manifested as having pain, swelling,stiffness, fatigue, weight-loss, fever,anorexia, etc. ANKYLOSING SPONDYLITIS a progressive form of arthritis that is a chronic condition affecting the spine and sacroiliac joints of males aged 10 to 30 years. it leads to rigidity and fixation making the spine a rigid block of bone referred to as bamboo spine resulting in bone fusion (ankylosis) OSTEOARTHRITIS the most common type of arthritis known for as degenerative joint disease. affects male and female equally resulting from a noninflammatory deterioration of the joint cartilage that occurs with the normal wear and tear of aging. it is also secondary to bone stress associated with trauma. This condition affects mainly the large, weight-bearing joints and interphalangeal joints of the fingers.

radiographically, presence of bone spurs or known as

osteophytes are seen visible which is due to the loss of articular cartilage. INFLAMMATION OF ASSOCIATED JOINT STRUCTURES Tendonitis - inflammation of the tendons (connective tissues attaching the muscles to the bones, enclosed in a sheath) Bursitis - an inflammation of the bursa (bursea) which are surrounded with synovial membrane. GOUTY ARTHRITIS inherited metabolic disorder with excess amounts of uric acid. common in males affecting the metatarsophalangeal joint of the big toe. its complication leads to kidney stone formation due to increase excretion of uric acid by the kidneys. METABOLIC DISEASE A. OSTEOPOROSIS A metabolic bone disorder common in women past menopause. There is an abnormal decrease in bone density. In postmenopausal women, hormone estrogen is decreased or lost causing the bones to become porous. Its severity leads to a compression fracture. Treatment includes increase in intake of calcium, vitamin D and sex hormone supplements. B. OSTEOMALACIA Metabolic condition due to lack of calcium in the tissues and a failure of bone to calcify. Results from inadequate intake of calcium, phosphorus,or vitamin D. RICKETS is caused by vitamin D deficiency in children. C. PAGETS DISEASE It is the most common in elderly of unknown etiology. Affects the pelvis, spine, skull and the long bones. Complications may lead to hearing and vision disturbances and even to a malignant neoplastic disease of the skeletal system, OSTEOGENIC SARCOMA.

D. HYPERTHYROIDISM A fairly common disease of the endocrine system, often very mild and may go undetected for a long time, Since the skeletal system is involved in balancing calcium and phosphorus levels, such condition disrupts the normal calcium-phosphorus ratio leading to bone destruction. E. ACROMEGALY Also an endocrine disorder due to disturbance of the PITUITARY GLAND. It is a slowly progressive disease in which there is an increase in growth of the hormone that will thicken and make the bone coarse because of the epiphyses closing and bone that does not grow in length anymore. Radiographically, it will show an increase in size of SELLA TURCICA and some changes in the skull People with acromegaly present forehead & jaw, widened teeth, and a large spade-like hand. TRAUMATIC DISEASE FRACTURES A discontinuity of bone caused by mechanical forces either applied to the bone or transmitted directly along the line of a bone CLASSIFICATION OF FRACTURES 1. Open or Compound fracture - one in which the bone has penetrate the skin. 2. Closed Fracture - one in which the skin is not penetrated, thus reducing the chance of infection 3. Complete, Non comminuted Fracture - those in which the bone has separated into two fragments 4. Incomplete - those in which only part of the bony structure gives way, with little or no displacement

TYPES OF FRACTURES 1. Transverse - complete fractures that are at right angles to the long axis of the bone 2. Fissure - a type of incomplete fracture that extends from the surface into but not all the way through a long bone 3. Oblique - the axis of the fracture is neither parallel nor perpendicular to the bone. The length and angle of the fracture depend on the rotational stress 4. Spiral - the bone appears to be twisted apart - this is very common in the humerus, and especially the tibia of skiers 5. Longitudinal - a lengthwise break in a bone 6. Impacted - one bone fragment is driven into another 7. Torus - a type of impacted facture that is especially common in the distal radius of children 8. Comminuted - the bone is separated into two or more and often numerous fragments 9. Double - fracture of a bone in two district places 10. Avulsion - occur when a fragment of bone is pulled away from the shaft

11. Stress / Fatigue - fractures that usually occur as a result of a strong, violent force - occur at sites of maximal strain on a bone,usually in connection with unaccustomed activity 12. Pathologic - commonly a transverse fracture occurring in abnormal bone that is weakened by various diseases COMMON FRACTURES 1. Bennett's Fracture - a fractures of the base of the first metacarpal with involvement of the first carpometacarpal joint 2. Colles - a fracture through the distal one-inch of the radius 3. Smiths - a reverse Colles fracture with displacement toward the palmar aspect of the hand 4. Supracondylar - a common pediatric fracture in which there is an alteration in the alignment of the condyles may come to lie directly under the shaft of the humerus 5. Carpal-Navicular Fracture - usually caused by falling on ones hand 6. Potts - involves both malleoli, with dislocation of the ankle joint 7. Hip Fractures - the exact location and severity of a hip fracture depend on the direction of the forces involved - the most common types of hip fractures include subcapital, transcervical and intertrochanteric

8. Bimalleolar Fracture - a fracture of the lateral and medial malleolus 9. Trimalleolar Fracture - has three components: the medial and lateral malleolus and the posterior distal tibia 10.Fracture of the Base of the Fifth Metatarsal - a common transverse fracture that occurs when the foot is suddenly twisted when the ankle pronates 11. Stellate Fracture - occurs when a person falls directly on the patella, shattering it. 12. Butterfly - a comminuted fracture in which there are one or more butterfly wing or wedge-shaped fragments split off from the main fragments 13. Greenstick - in which the cortex breaks on one side without separation or breaking of the opposing cortex. - found almost exclusively in infants and children because of the softness of the cancellous bone 14. Multiple - another type of complete, noncomminuted fracture in which two or more complete fractures occur involving the shaft of a single bone 15. Chip - an avulsion fracture of a small fragment or chip of bone from the corner of a phalanx or other long bone 16. Penetrating - type of incomplete fracture resulting from penetration by a sharp object such a bullet or a knife

17. Boxers - occurs when the fifth metacarpal fractures as a result of a blow to or with the hand 18. Monteggia - one of the proximal third of the ulna shaft, with anterior dislocation of the radial head CEREBRAL CRANIAL FRACTURES 1. Linear - appear as straight, sharply defined, nonbranching lines and are intensely radioluscent 2. Depressed - appears as a curvilinear density because the fracture edges are overlapped 3. Basilar Skull Fractures - very difficult to demonstrate radiographically - air-fluid levels in the sphenoid sinus and/or clouding of the mastoid air cells are often the only radiographic finding suggesting a fracture VISCERAL CRANIAL FRACTURE 1. Facial Bone - generally result from a blow to the face 2. Zygomatic Arch Fracture - maybe difficult to recognize initially because of the edema - may be indicated by clinical signs, which include black eyes, flattening of the cheek, and/or a restriction of the movement of the mandible 3. Mandibular Fractures - generally detected by the patients inability to open the mouth and pain when moving the mandible - these fracture also cause a misalignment of the patients teeth 4. Fractures of the Maxilla - serious because of the adjacent nasal cavity, paranasal sinuses, orbit and close proximity of the brain

5. Blow-out - results from a direct blow to the front of the orbit, thus transferring the force to the orbital walls and floor - occurs in the thinnest, weakest portion of the orbit, i.e., the orbital floor just above the maxillary sinuses 6. Tripod - occurs when the zygomatic or malar bone is fractured at all three suture: frontal,temporal, and maxillary 7. Nasal Bone Fracture - may be accompanied by a fracture of the ascending process of the maxillae and/or the nasal septum, which is composed of the vomer and the perpendicular plate of the ethmoid bone DISLOCATIONS Dislocations implies that a bone is out of its joint and not in contact with its normal articulation. Subluxation is a partial dislocation, often occurring with a fracture. BATTERED CHILD SYNDROME A term associated with a physical form of child abuse. Physical child abuse often co-exists with both emotional and sexual abuse. Physical signs of battered child syndrome include bruises, burns, abrasions, and fractures in various stages of healing. Radiographic signs of child abuse include hematomas, and single or multiple fractures of varying ages, especially in areas where it is difficult for the child to self-inflict the injury. LEGG-PERTHES DISEASE A term associated with ischemic necrosis of bone. The etiology of this disorder is unknown and the disease process is fairly quiet. Perthes refers specifically to ischemic necrosis of the head of the femur. It tends to occur in males between the ages of 5 to 10 years and often follows injury or trauma to the affected hip. Clinically these patients present with a limp that is accompanied by little or no pain. Radiographically the bone in the center of the epiphysis is fragmented and the head of the femur is flattened

VERTEBRAL COLUMN INJURIES The causes of vertebral column injuries include direct trauma, hyperextension-flexion injuries (whiplash), osteoporosis or metastatic destruction. Perhaps the most common condition of the vertebral column is generalized back pain, typically in the lumbar area. Such back pain may not always result from bony involvement. Disk disease can cause muscle spasm with pain referral throughout the back. Finally, back pain may be secondary to referred pain from the hip. Compression fractures are the most frequent type of injury involving a vertebral body. Hangmans fracture is a fracture of the arch of the second cervical vertebrae and is usually accompanied by anterior subluxation of the second cervical vertebrae or the third cervical vertebrae Spondylolysis exists when there is a cleft or breaking down, of the body of a vertebra between the superior and inferior articular processes (pars interarticularis). Typically this occurs in the arch of the fifth lumbar vertebrae and appears radiographically as a collar or broken neck on the Scotty dog appearance and is demonstrated on an oblique projection of the lumbar spine. When forward slippage of the vertebral column off a vertebra occurs because of spondylolysis, it is known as spondylolisthesis. The patient with this condition may present symptoms identical to those of a herniated disk. NEOPLASTIC DISEASE OSTEOCHONDROMA The most common benign bone tumor, which arises from the growth zone between the epiphysis and diaphysis of long bones, also called the metaphysis. Most commonly it involves the lower femur or upper tibia and is capped by growing cartilage. Many times osteochondromas are asymptomatic unless the affected long bone is traumatized, which results in a pathologic fracture of the diseased bone.

OSTEOMA An osteoma is a fairly rare growth most commonly located in the skull. These lesions are composed of very dense, wellcircumscribe, normal bone tissue that usually projects into the orbits or paranasal sinuses. Another term associated with osteoma of the skull is hyperostosis frontalis interna. ENDOCHONDROMA An endochondroma is a slow-growing benign tumor composed of cartilage. It grows in the marrow space and most commonly affects the small bones of the hands and feet in individuals between the ages of 10 and 30 years. Multiple growths termed endochondromatosis, may also occur in childhood and like multiple osteochondromas may undergo malignant transformation SIMPLE BONE CYST A simple bone cyst is a wall of fibrous tissue filled with fluid. These frequently occur in the long bones of children, most commonly in the humerus and knee. The cyst is usually first noticed when the patient presents with pain caused by the increased tumor growth or as a result of a pathologic fracture. OSTEOID OSTEOMA Another common benign tumor of the skeletal system is the osteoid osteoma. These fibrous tumors occur twice as often in males compared with females and almost always develop before the age of 30 years. Osteoid osteomas are most commonly found in the femur, tibia or spine of the young adult. OSTEOCLASTOMA (GIANT CELL TUMOR) Refers to a group of tumors characterized by the presence of numerous, multinucleated, osteoclastic giant cells. This neoplasms affects the sexes equally and is found in individuals between the ages of 20 to 30 years. Anatomically this disease tends to affect the ends of epiphyses of long bones, especially the lower femur, upper tibia, and lower radius Clinical signs and symptoms of an osteoclastoma are nonspecific and include pain, tenderness, an occasional palpable mass, or an occasional pathologic fracture

OSTEOSARCOMA (OSTEOGENIC SARCOMA) Except for myeloma, the most common primary malignancy of the skeleton is the osteosarcoma, which arises from osteoblasts. This neoplasm is most frequently found in the metaphyses of long bones, with approximately 50% affecting the knee. Osteosarcoma can occur at any age but predominantly affects young males between the ages of 10 to 20 years and is rarely seen after the age of 50 years. Osteosarcoma is a highly malignant disease with a poor prognosis because lung metastasis almost always occurs via blood stream. EWINGS SARCOMA Another primary malignant bone tumor is a Ewings sarcoma. This neoplasm occurs at a younger age than any other primary malignant bone neoplasm, usually between the ages of 5 to 15 years and rarely occurs after the age of 30 years. Unlike osteosarcoma, Ewings sarcoma arises from the medullary canal and involves the bone more diffusely, giving rise to uniform thickening of the bone. Ewings sarcoma does not begin at the end of a long bone. It does however tend to affect the extremities and pelvis. Clinical symptoms are non-specific and include pain and tenderness of the affected area. CHONDROSARCOMA A chondrosarcoma is a malignant tumor of cartilaginous origin and is composed of atypical cartilage. It is about half as common as osteosarcoma and comprises approximately 10% of all malignant tumors of the skeletal system. Males are three times as likely as females to develop chondrosarcoma and it is more common in older adults METASTASES FROM OTHER SITES Any type of cancer can metastasize to bone, but metastatic disease from carcinomas are the most common malignant tumor of the skeleton, with secondary bone tumors of any origin far outnumbering primary bone tumors. The bones of the skeletal system that contain red bone marrow are the major

bones affected by metastatic disease because of their good vascularization. The most common primary sites for metastatic bone cancer are the breast, lung, prostate, kidney and thyroid gland with the tumor spreading via proximity, the blood stream or the lymphatic system

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