Rad 3 week 7-10

What is the term for AVN of the scaphoid?

Preiser disease*

What is the term for AVN of the lunate?

Keinbock disease*

What is the term for AVN of the capitulum?

Panner disease

What is the term for TRUE AVN of the vertebral body?

Kummel disease

What is the term for AVN of the femoral head in children?

Legg-Calve perthes disease*

What is the term for AVN of the femoral head in adults?

Chandler's disease*

What is the term for AVN of the talus?

Diaz Disease

What is the term for AVN of the calcaneus?

Sever disease

T or F: A sclerotic calcaneal apophysis is a normal finding of aging

True

What demographic is most affected by severs disease?

Young athletes (particularly soccer)

What is the term for AVN of the navicular?

Kohler disease

What is the term for AVN of the metatarsal head?

Freidberg disease

What is the term for AVN of the proximal humeral epiphysis?

Hass disease

What is the term for AVN of the proximal medial tibia?

Blount disease

What is the term for AVN of the inferior pole of the patella?

Sinding-larson-johannson disease

What are the AKAs of avascular necrosis?

Bone infarct

Osteonecrosis

Aspectic necrosis

What part of a long bone is most commonly affected by AVN?

Epiphysis

T or F: Metaphyseal or diaphyseal infarcts are particularly pain-producing

False (typically completely asymptomatic)

What are the predisposing factors for AVN?

Truama

Hemoglobinopathy

Caisson disease

Corticosteroids

Collagen disease

Radiation

Alcoholism

Gaucher's disease

Pancreatitis

Gout

(PLASTIC RAGS / STARS)

What does STARS stand for?

steroids

trauma

alcohol/autoimmune

radiation/rheymatoid

sickle cell anemia

What is the most common cause of AVN in children?

Trauma

What is the gold standard for AVN diagnosis?

MRI

What is the most common cause of AVN in adults?

Corticosteroids

(2nd is alcohol)

What age group are AVNs self-limiting past?

2-8 years old

What are the 4 phases of AVN in the epiphysis?

Avascular

Revascularization

Repair

Deformity

What are the 3 phases of AVN in the metaphysis/diaphysis?

Absorption

Bone deposition

Periostitis

What are the findings of AVN in the medullary cavity?

Central area necrosis surrounded by a peripheral wall of ischemic and healing tissue

What are the findings of AVN of the epiphysis?

Sclerosis

Mottled trabecular pattern

Subchondral fracture

Collapse of articular cortex

Subchondral cysts

What is the name sign of subchondral fracture of the epiphysis due to AVN?

Crescent sign

What is the finding of cortical AVN. particularly in small bone of the hands and feet?

Periostitis and patchy loss of density

T or F: In the late phase of medially and metaphyseal/diaphyseal infarcts, there is patch moth eaten destruction

False (There is in the early phase)

What is the finding of AVN on MRI?

Diffuse edema (low on T1, high on T2)

Fatty center (high on T1)

What is the term for a bright line on T2 MRI next to the dark necrotic center in AVN?

Double line sign

What is the ending of late lesions of AVN?

Elongated with a wavy serpiginous external contour

What bones are serpiginous elongated lesions found in with AVN?

Distal femur

Proximal tibia

Proximal humerus

T or F: AVN has decreased uptake on isotopic bone scan

False (increased uptake)

What is the most common demographic of chandler's disease?

Males (4x) 40-60 yo

What % of chandler's disease is bilateral?

50%

What is the x-ray appearance of chandler's disease?

Necrotic wedge at the anterosuperior aspect of the femoral head, separated by fibrous tissue and sclerotic margin of adjacent normal bone

Which vessels are occluded in chandler's disease?

Lateral epiphyseal

Superior retinacular

What views are used to see chandler's disease?

AP Hip

Frog Leg

What aspect of the femur is most affected by chandler's disease?

Anterosuperior aspect of the femur head

What is the term for subchondral fracture in chandler's disease?

Crescent sign

Rim sign

What does crescent sign indicate?

Impending collapse

what is the term for articular cortical collapse in chandler's disease?

Step sign

What is the term for curvilinear semilunar wedged configuration of the femoral head in chandler's disease?

Bite sign

What is the term for trabecular alteration in chandler's disease on CT scan?

Asterisk sign

What other x-ray findings are seen in chandler's disease?

Cystic radiolucencies ands clerosis

Fragmentation

Degenerative joint changes

What is the finding of chandler's disease on both T1 and T2 MRI?

Diminished signal

What demographic is most affected by legg-calve-perthes disease?

Males (5x) 3-12 yo

What % of legg-calve-perthes disease is bilateral?

10%

What are the history findings of legg-calve-perthes disease?

Painful limp

Reduced mobility

Muscle atrophy

Which ortho is positive for legg-calve-perthes disease?

Trendelenburg test

What is the most vulnerable vascular period of the femoral ear due to solitary epiphyseal blood supply?

4-7 yo

T or F: The cartilage dies in legg-calve-perthes disease

False (cartilage is unaffected)

How long does the process of legg-calve-perthes disease take?

2-8 years

What are the x-ray findings of legg-calve-perthes disease during the avascular phase (0-12 months)?

Distention of the capsule

Increased joint space

Waldenstrom's sign

Small epiphysis

What are the x-ray findings of legg-calve-perthes disease during the revascularization phase (6 months - 4 years)

Flattened, small epiphysis

Subchondral fracture (crescent sign)

Fragmentation of the epiphysis

Homogenous sclerosis (snowcap sign)

Metaphtseal cysts

Increased cortical density

Wide, short femoral neck

What is the name sign of homogenous sclerosis in legg-calve-perthes disease?

Snowcap sign

What causes snowcap sign?

Increased density due to osteoid repair

What are the findings of legg-calve-perthes disease during the repair and remodelling phase (1-2 years)?

Gradual reconstitution of normal density

What are the findings of legg-calve-perthes disease during the deformity phase?

Coxa vara

Enlarged head (coxa magna)

Flattened head (mushroom deformity/coxa plana)

Large greater trochanter

Sagging rope sign

What is the term for an enlarged femoral head in legg-calve-perthes disease?

Coxa magna

What is the term for a flattened femoral head in legg-calve-perthes disease?

Mushroom deformity

Coxa plana

What is the term for concave curvilinear radiopaque line visible superimposing the metaphysis?

Sagging rope sign

T or F: legg-calve-perthes disease in older patients has a better prognosis

False (better prognosis in younger patients)

T or F: Female patients with legg-calve-perthes disease have more complications

True

Which metatarsal is freidberg disease most common in?

2nd metatarsal head

What demographic is freidberg disease most common in?

Females (5x) 13-18 yo

What are the main causes of freidberg disease?

Trauma or increased stress

What are the radiographic features of freidberg disease?

Flattened and collapsed cortex

Sclerosis

Lucency

Widened joint space

thickened metatarsal cortex

Enlarged head and narrow joint space (late findings)

What predisposes people to haave friedberg disease

dancer

high heels

What demographic is most affected by keinboch's disease?

Males (9x) 20-40 yo

What physical anomaly predisposes someone to keinboch's disease?

Negative ulnar variance

What are the radiographic features of keinboch's disease?

Increased density

Lucent areas

articular collapse

decreased size of lunate

What is the term for AVN of the tibial tuberosity?

Osgood-schlatter's disease

What demographic is most affected by osgood schlatter's disease?

Males 11-15 yo

What history findings suggest osgood-schlatter's disease?

History of a single violent injury or repetitive flexion-extension movements (jumping and kicking

Pain, swelling and tenderness over tibial tuberosity

What views must be used to view osgood schlatter's disease?

Bilateral views with slight medial rotation using both high and low kVp

What are the x-ray findings of osgood schlatter's of the skin contour?

Displaced

What are the x-ray findings of osgood schlatter's of the patellar ligament?

Thickened and indistinct

What are the x-ray findings of osgood schlatter's of the infrapatellar fat?

Blurred and opacified

What are the x-ray findings of osgood schlatter's of the tuberosity?

Anterior surface irregularities (with isolated irregular ossicles)

What part of the vertebra is affected by scheuermann's disease?

Vertebral ring apophyses

What are the AKAs of scheurmann's disease?

Juvenile kyphosis

Vertebral epiphysitis

What demographic is most affected by scheurmann's disease?

Males, 13-17 yo

What part of the spine is most commonly affected by scheurmann's disease?

Middle and lower thoracic regions

T or F: Neurologic deficits are common in scheurmann's disease due to spine deformity

False (rare)

What are the main radiologic findings of scheurmann's disease?

At least three contiguous vertebra wedged at least 5 degrees

Irregular endplates

Decreased disc height

Increased kyphosis

What are the additional findings of scheurmann's disease?

Accentuated lumbar and cervical lordosis

Mild scoliosis (25%)

limbus bones

schmorl nodes

persistent venous channels

premature degenerative changes

What is the treatment for scheurmann's disease?

<50 degrees = conservative, stretching postural changed

50-75 degrees = brace

>75 degrees = surgery

What is the term for a disorder of adolescence in which a small segment of subchondral bone undergoes ischemic necrosis secondary to trauma or a primary vascular occlusion?

Osteochondritis dissecans

What demographic is OCD most common in?

Males 11-20 yo

What is the most common location of OCD?

Knee

Ankle

Lateral aspect of the medial femoral condyle most common

What are the possible symptoms of OCD?

Asymptomatic

Acute pain

Swelling

Locking

What part of the talus is most commonly affected by OCD?

Medial surface

What part of the hip is affected by OCD?

Superior weight-bearing surface following legg-calve-perthes

What part of the patella is affected by OCD?

Medial facet

What part of the foot is affected by OCD?

first and second metatarsal heads

What part of the shoulder is affected by OCD?

Humeral head