Bone PresentationA

7/31/2019 Bone PresentationA

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EnchondralOssification

1. Mesenchyme to differentiate in to cartilage

with a surrounding membrane (perichondrium)

2. Maturation and vacuolation with secretion

of phophatase of cartilage cells


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3. Intra cellular calcification of cartilagenous

matrix

4. Cartilage cells die & fragmented of calcified

intra cellular matrix

5. Perichondrium derive blood vessels &

osteogenic cells invade calcific area


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6. Osteogenic cells lay down a layer of osteoid arround

the calcific foci

7. Ostoeid become calcified forming bonytrabeculae

Perichondrium transformed to periosteum and center

of chondrification has become a center for

ossification


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8. Gradual replacement of chondrified anlage By bloodvessels, osteoid, osteoblast and new bone formation,

until epiphyseal plate/disk is reached


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In the metaphysis occurs a

moulding process, by

resorbing some bone &

laying down new bone, gives

the metaphysis its proper

tapered appearance


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Chondrification precedes ossification in balanced

fashion until chondrification ceases, and epiphyseal

plate itself became ossified

Center of ossification has appeared ini epiphyses and

growth has precedes toward the distal end of the bone

or toward the adjoining joint

Blood supply :

1. Nutrient artery

2. Metaphyseal and epiphyseal vessels

3. Periosted vessels


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Bone composition :

Water 25% Organic substance (oroteins) 30%

Inorganic substance 45%

CaPO4 85% CaCO3 10.5%

Other substance 4.5%


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Osteoblast is capable of excrecting albumin andforming osteoid

Osteoid is a cartilage substance whichcontains specific binding sites for bone

minerals


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FACTORS AFFECTING BONE FORMATION

Phosphatase

Calcitonin

Parathyroid hormone

Vitamin D


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Active in new bone formation or osteolysis

In acid medium : splits bone salts & return the salt into the solution

In alkaline medium : promote osteiogenensis by liberating

phosphat ion & precipitating calcium salts


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Secreted to hypercalcaemia

Depressed serum calcium levels by

inhibiting bone resorption


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Maintenance of a proper level of calcium in the blood by

mobilization of calcium, with :

1. Inhibition of phophate resorbtion at the renal tubular level

2. Promotion of absorbtion of calcium & phosphorus out the intestinal

mucous level

3. Direct stimulation of osteoclasts in bones to mobilize calcium


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1. Absorbtion of calcium from the ileum

2. Promotion of tubular phosphat secretion

3. Direct action on bone by potentiating the osteoclastsactivity


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Methods of Roentgen Analysis of

Bones1. Always have at least two perpendicular view and one

joint view

2. Determine wether or not single or multiple foci areinvolve by a bone survey :

Two views of skull

Two views of lumbar or thoracic spine AP view of pelvis AP view of arms and thighs

3 Make comparison studies of the two


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3. Make comparison studies of the twocomparable sides of the body when

appropriate

4. Know age and sex of patient5. Know hereditary factors, occupationalhistory, and whenever possible clinical andlaboratory data

6. Study bone in following sequences : soft tissue adjoining

periostal region

cortex

medulla

joint capsule


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subarticular bone

epiphysis, epiphyseal plate, metaphysis

systematic review general roentgenpathology, such as alteration inposition, size,contour, density,

architecture, (internal and marginal),

number, function, change occuring overa period of time, and changes resulting fromtreatment


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7. Classify objective roentgen signs in respect to :

Monostotic vs polyostotic Increased density vs hyperluscent

Overgrowth vs undergrowth

Architecture of lesion or lesions (1)internal and (2) marginal

Soft tissue and/or periosteal involvement

Joint involvement


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Categorization of BoneAbnormalities by Tissue of Origin

(Edling 1968)


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1. Fibrous2. Chondromatous

3. Osseus4. Granulation

5. Avascular

6. Fat marrow7. Fibrous marrow

8. Vasculocellular

9. Hemangiomateus

10. Reticuloendothelial

11. Cellular


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1. Radiographs must be made in a minimum of twoplane at ringht angles to each other2. The area must be large enough to include at least one

joint and preferable two joints if the bone in question

lies between two joints3. The mechanism of trauma or injury must beunderstood


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1. The degree of apposition of the fragments

2. The alignment of the fragment with respect to theline of weight bearing and movement of joints

3. The degree of torsion of the fragments with respectto one another

4. The degree of shortening of the bone as a whole


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1. Post reduction and post immobilization

2. One or two weeks later, if position has changed3. After approximately six or eight weeks for primary callus

4. After each plaster cast or traction change

5. Before final discharge of the patient


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TYPES OFFRACTURES


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1. Formation of hematoma

2. Organization of hematoma

3. Formation of fibrous callus

4. Replacement of fibrous callus by primary bone callus

5. Absorbtion of primary bony callus and transformation graduallyto secondary bony callus

6. Functional reconstruction of the bone in accordance with line ofstress and adaptation by bone modelling


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1. Metastatic bone tumor, including multiple myeloma2. The histiocytosis or reticuloendotheliosis including the

lipoid storage disease

3. Hyperparathyroidism with osteitis fibrosa cystica

4. Widely disseminated inflammatory disease of bones,both acute and chronic


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1. Hemolytic anemia- Thalassemia

- Spherocytic anemia

- Sickle cell anemia

2.Leukemias, lymphomas

3.Chronic poisoning or hormonal


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1. Acute leukemia

2. Hypervitaminosis A

3. Hypervitaminosis B

4. Renal Rickets & hypovitaminosis D5. Scurvy

6. Syphilis (congenital)

7. Hypophosphatase

8. Phenylketonuria

9. Congenital Rubella syndrome


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1. The epiphysis primarily

2. Both the metaphysis and epiphysis3. The metaphysis primarily with thick or thin marginal

sclerosis

4. The metaphysis without marginal sclerosis

5. Diaphyseal corticoperiosteal lesions


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1. Transverse bands, usually at the metaphysis2. Longitudinal reticules bands, roughly parallel to the

cortex, which may be asymmetrical and corticoperiosteal

3. Indiscriminate, patchy foci of luscen or sclerotic : thosemay be localized to epiphyses, metaphyses or diaphysealpredominantly


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1. Osteopetrosis or marble bone disease2. Engelmanns disease3. Fluorine poisoning4. Juvenile and tertiary syphilis5. Urticaria pigmentosa (mastocytosis)6. Myelofibrosis


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1. Hypoparathyroidism

2. Hypervitaminosis A & D

3. Pagets disease (osteitis deformans)

4. Idiopathic hypercalcemia of infancy


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1. Anemias, lymphomas

2. Metastases (carcinoma of prostat and others)

3. Myelofibrosis or myelosclerosis

4. Carcinoid metastases or carcinoid syndrome


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1. Heavy metal poisoning, phospharus osteopathy2. Cretinism (hypothyroidism)3. Congenital syphilis4. Recovery period following debilitating disease5. Hypervitaminosis A and D6. Acute leukemia7. Scurvy (hypervitaminosis C)8. Idiopatic hypercalcemia of infancy (hypervitaminosis

D)


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1. Meborheostosis leri2. Juvenile or tertiary

syphilis

3. Infantile corticalhyperostosis of Caffey-Silverman

4. Hypertrophicpulmonary osteoarthropathy

5. Blood dyscrasias :lymphoma & leukemias

6. Chronic fungusosteomyelitus

7. Osteosis eburnians

unilateralis8. Neuroblastoma9. Ewings tumor10. Fibrous dysplacia

11. Meningioma12. Hyperostosis frontalisinterna

13. New bone formation inthe collagen diseases


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1. Sclerotic bone islands2. Osteopoikilosis3. Pagets disease (osteitis deformans)

4. Osteosclerotic tumor metastasis5. Occasional multiple myeloma6. Mastocytosis7. Osteopatia striata (voorhoeve)

8. Osteosclerosis with parathyroid adenoma + chronicrenal failure9. Tuberous sclerosis


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1. Bone infarction2. Osteitis candensons ilei3. Osteomyelitis of Garre

4. Brodies abscess5. Osteoid osteoma


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1. Single bone

2. Several or many growth


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a) Multiple osteochondromas, diaphyseal aclasisb) Pituitary gigantismc) Acromegalyd) Arachnoidoctyly (marfans syndrome)e) Engelmanns diseasef) Erlenmeyer flask type failure of bone

modelling : Gauchets disease, marble banddisease or osteopetrosisg) Pyles disease


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1. Proliferative or reactive processes, amanifestation of reparative proliferation

2. Hamartomatous inclusion3. A non maturating hyperplasia or

multiplication of cells

neoplasia

:


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1. Benigna

2. Malignant

1. Mesoderm Fibroblast : 1. Osteogenic groups 2. Chondrogenic groups

3. Collagenic groups

Reticulum : myelogenic groups

2. Neuronous tissue elements


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Bone PresentationA

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