A lump in the leg

Quiz

2004 past exam Q

• Name the characteristic features of a synovial joint

1. Joint capsule2. Synovial membrane3. Synovial fluid / joint

cavity4. Articular cartilage5. Bone

This is a radiograph of the knee of a patient who has been involved in a motor vehicle accident.

List three (3) structures whose integrity you must test prior to treating this injury.

• Popliteal artery• Tibial nerve• Peroneal nerve• ?? others

2004 past exam Q

Osteogenesis imperfecta is a disorder of defective synthesis of collagen type I. True

Metastases in bone usually cause a periosteal reaction. False

Most osteosarcomas occur before the age of thirty (30) years. TrueOsteosarcomas are aggressive tumours. TrueSclerotic bone around the edge of a lesion in a bone, is a poor

prognostic sign. FalseGiant cell tumours (osteoclastoma) are usually benign. True

2004 past exam Q’s – TRUE or FALSE

2004 past exam Q – describe the abormality.

Feedback:- November 2004 Many students confused film exposure with osteoporosis � Confusion of the growth plates and sutures as fractures � Many stated that the x-ray was of degenerative changes despite being from �

a young child ie osteoporosis and osteoarthritis giving fractures. (How many could tell this was a child’s x-ray?)

Confusion of fovea capitis with an abnormality � Confusion of ileum and ilium � Confusion of hip joint with sacroilac joint � Some students couldn’t tell left from right despite it being written on the �

radiograph. One student claimed a diagnosis of hepatitis, although osteoporosis and �

fractures and malignancies were commonest. Common Errors:- Lack of knowledge in interpreting radiographs. The

majority didn’t realise it was a child’s x-ray or didn’t actually notice the growth plate lucencies, then they decided that it was osteoarthritis/osteoporosis and then went looking for evidence to support their ideas.

Knee examination – Mix & Match

Collateral ligaments

Cruciate ligaments

Meniscuses

Osteochondroma

Enchondroma

Simple bone cyst

Osteosarcoma

Osteoid osteoma

Chondroblastoma

Giant cell tumor

Ewing’s tumorC

H

FB

A

D

G

E

Tumours of bone and cartilage

• Malignant, 15-30yo, around the knee, sunburst

periosteal reaction

• Usually benign. Giant multinucleated cells.

• Small sclerotic central nidus

• Benign cartilage cyst in bone marrow

• Small round blue cells

• Rare, malignant, notochord remnant

• Cartilage-capped exostosis (bony outgrowth)

Giant cell tumour

Osteoid osteoma

Osteosarcoma

Enchondroma

Ewing’s sarcoma

Chordoma

Osteochondroma

OsteomyelitisA patient presents with dull unilateral hip pain,

progressing over a week.If this is a case of osteomyelitis, what local and

systemic signs and symptoms might you expect?Tenderness, warmth, erythema, swelling, fever

and rigor may also be present. However, patients with osteomyelitis involving sites such as the hip, vertebrae, or pelvis tend to manifest few signs or symptoms other than pain

OsteomyelitisThe risk of osteomyeletis spreading from the

bone shaft to the bone end and the into a joint depends on age. Considering infants, children, and adults, which groups are at higher risk and why?

Infants have capillaries bridging the growth plate.

Adults have the growth plate resorbed.