chapter 7 pathology for proximal femur and pelvic girdle

ankylosing spondylitis

the first effect demonstrated is fusion of the sacroiliac joints. This disease causes extensive calcification of anterior longitudinal ligament of the spinal column. It is progressive, working up the vertebral column and creating a radiographic characteristic known as bamboo spine. Males are most often affected

avulsion fractures of the pelvis

these fractures cause extreme pain and are difficult to diagnose if not imaged properly. Occur in adolescent athletes who experience sudden, forceful, or unbalanced contraction of the tendinous and muscular attachments, such as might occur while running hurdles. The force of the tendons and muscles sliding over the tuberosities, ASIS, anterior inferior iliac spine (AIIS), superior corner of the symphysis pubis, and iliac crest may cause it

chrondrosarcoma

a malignant tumor of the cartilage, it usually occurs in the pelvis and long bones of men older than 45 years. May be completely removed surgically if it does not respond to radiation or chemotherapy

developmental dysplasia of the hip (DDH)

older term is congenital dislocation of the hip (CDH); these hip dislocations are caused by conditions present at birth and may require frequent hip radiographs

femoroacetabular impingement (FAI)

defect of the femoral head and/or acetabulum reducing smooth articulation of the hip joint and producing pain. There are 3 forms:

1. pincer: abnormal bony growth of along the lateral aspect of the acetabulum

2. cam: irregular shape of femoral head, which may be caused by congenital defect or degenerative disease (osteoarthritis)

3. combined: both pincer and cam defects present producing impingement

legg-calve-perthes disease

most common type of aseptic or ischemic necrosis. Lesions typically involve only one hip (head/neck of femur). This disease occurs predominantly in 5 to 10 year old boys, and a limp is usually the first clinical sign. Radiographs demonstrate a flattened femoral head that later can appear fragmented

metastatic carcinoma

malignancy spreads to bone via circulatory system or lymphatic system, or by direct invasion. Metastatic tumors of the bone are much more common than primary malignancies. Bones that contain red bone marrow are the more common metastatic sites (skull, ribs, pelvis, pine, and femora)

osteoarthritis

condition known as a degenerative joint disease (DJD), with degeneration of joint cartilage and adjacent bone causing pain and stiffness. It is the most common type of arthritis and may be considered a normal part of aging process. Common in weight-bearing joints such as hips, and first evidence is seen on radiographic images of joints such as the hip before symptoms develop, in many persons by age 40. As condition worsens, joints become less mobile, and new growths of cartilage and bone are seen as osteophytes (bony outgrowths)

pelvic ring fracture

because of the closed ring structure of the pelvis, a severe blow or trauma to one side of the pelvis may result in a fracture opposite from the site of primary trauma, thus requiring clear radiographic visualization of the entire pelvis. This type of fracture is referred to as a contrecoup injury.

proximal femur (hip) fractures

these fractures are most common in older adult or geriatric patients with osteoporosis or avascular necrosis. Both osteoporosis (loss of bone mass from metabolic or other factors) and avascular (loss of blood circulation) necrosis (cell death) frequently lead to weakening or collapse of weigh-bearing joints such as the hip joint; fractures occur with only minimal trauma

slipper capital femoral epiphysis (SCFE)

condition usually occurs in 10 to 16 year olds during rapid growth, when even minor trauma can precipitate its development. The epiphysis appear shorter and the epiphyseal plate wider, with smaller margins