Plain X rays of Bones

15th Mai 2010

A patient presents to hospital with severe left arm pain, malaise and fever.

Acute osteomyelitis

The DD here are;•Cellulitis.• Acute suppurative arthritis.• Acute rheumatism.• Sickle cell crisis.• Gaucher’s disease

He was 15 years old

OsteomyelitisInflammation of bone caused by an infecting organism.

Commonest cause Staphylococcus spp. (aureus)*Other infecting organisms are E coli, S marcescens, and P aeruginosa.

In patients with sickle cell organism like Salmonella species and S aureus may be implicated.

Presentations may be acute, subacute, or chronic.On the basis of the route of infection, acute osteomyelitis can be classified as hematogenous or exogenous.

Hematogenous forms are predominantly seen in children and normally involves highly vascular bones. (In adults, hematogenous forms affects the vertzebral bodies).

Stages of diseaseThe disease process involves 5 stages:•Inflammation: inflammation with vascular congestion and increased intraosseous pressure. Obstruction to blood flow occurs with intravascular thrombosis.•Suppuration: Pus within the bones forces its way through the haversian system and forms a subperiosteal abscess (2-3 days).•Sequestrum: Increased pressure, vascular obstruction, and infective thrombus compromise the periosteal and endosteal blood supply, causing bone necrosis and sequestrum formation (7th day).•Involucrum: This is new bone formation from the stripped surface of periosteum.•Resolution : With antibiotics and surgical treatment early in the course of disease, may resolves +/- complications.

Risk Factors:•trauma•diabetes•suppressed immunity; hemodialysis•splenectomy

Abnormal trabeculation & lysis within distal tibial metaphysis due to periosteal reaction

Chronic osteomyelitis is a severe, persistent, form of osteomyelitis incapacitating infection of bone and bone marrow

Specific forms of chronic osteomyelitis•Brodie abscess•Tuberculous osteomyelitis•Congenital syphilis, and acquired syphilis.

•A Brodie abscess is a form of chronic osteomyelitis that occurs in the absence of a preceding episode of acute osteomyelitis. The lesion causes a localized abscess within the bone, often close to metaphysis.•Tuberculous osteomyelitis of the bone is secondary to the spread of infection from a primary source in the lung or GI tract.

chronic pyogenic osteomyelitis due to TB

Xteristic Plain radiographic features of a Brodie abscess •A central area of radiolucency with a surrounding thick rim of reactive bone sclerosis, which may persist for months.•Pathognomonic tortuous parallel lucent channels extending toward the growth plate.•A variable degree of periosteal new-bone formation.•Associated soft tissue swelling.

A 30-year-old man underwent internal fixation to his ulna fracture and now has features of toxaemia.

Marked extensive subcutaneous emphysema involving the entire forearm.

Anaerobic infection

DDAnaerobic cellulitis.Gas gangrene by myonecrosis

Commonest cause is the•Clostridium perfingens

Other causes may be•Staphylococcus aureus•Streptococcus pyogenes

Diagnosis of cellulitis is usually clinical.Palpation crepitations may be felt over the swollen area.

US appearance resembles oedema of subcutaneous fat, increased echogenicity of the subcutaneous fat with decreased acoustic transmission, blurring of tissue planes, progressing to hypoechoic strands between hyperechoic fatty lobules.This appearance is non specific & can not be differentiated from subcutaneous oedema

A young man who sustained injury from an automobile accident.

2-part anatomic neck fracture(Neel´s classification)

Humerus fracture – proximal (Neel´s classification)May occur due to fall onto the outstretched hand

3-part surgical neck and greater trochanter fracture

4-part fracture proximal humeral fracture with head split.Blood supply was distrupeted here

Thank you