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UNC MSK Course Day 1 Lab XR UNKNOWNS (for self study). Pathology?. Old fracture of radius with growth arrest of distal radial physis. Relative overgrowth with distal and dorsal dislocation of distal ulna. Pathology?. Pathology?. Pathology?. Slipped Capital Femoral Epiphysis (SCFE) - PowerPoint PPT Presentation
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Old fracture of radius with growth arrest of distal radial physis.
Relative overgrowth with distal and dorsal dislocation of distal ulna
Slipped Capital Femoral Epiphysis
(SCFE)
Note that a line drawn along the anterior femoral neck intersects the head on the R but not on the L.
Polydactyly
Inheritance for postaxial polydactyly is frequently autosomal dominant, whereas preaxial (duplicate thumb) is usually spontaneous.
Osteochondromatosis
(Multiple hereditary exotoses)
Typically autosomal dominant inheritance.
Bones often deformed due to pressure or growth abnomalities
Osteopetrosis
(Multifactorial and there are autosomal dominant and recessive forms)
Note: Bone is dense, marrow space is decreased – Why?
Osteopetrosis
Note: Bone is dense, marrow space is decreased - because osteoclasts are not removing bone to enlarge marrow canal.
Hypophosphatemic (Vitamin D Resistant) Rickets
(May be difficult to differentiate from other causes of bowing on basis of X-ray alone.)
Inheritance?
Wide physis better seen here
Hypophosphatemic (Vitamin D Resistant) Rickets
(May be difficult to differentiate from other causes of bowing on basis of X-ray alone.)
(Sex linked dominant trait)
Osteogenesis Imperfecta
(Autosomal dominant or recessive)
Many degrees of severity.
Associated with what external finding?
Severe
Moderate
Mild
Osteogenesis Imperfecta
(Autosomal dominant or recessive)
Many degrees of severity.
Associated with blue sclera.
Severe
Mild
Spina Bifida
L4-sacrum
Note: Wide pedicles and absence of spinous processes.
Multifactorial – genetic plus intrauterine influences especially prenatal folic acid deficiency
Pathology?
“Scanogram” of another patient with the same condition, shows x-rays of the hips, knees and ankles all shot over a ruler to allow measurement of the leg length discrepancy which is often present
Madelung’s Deformity
Note the "V" shaped proximal carpal row. Congenital Madelung’s may be due to an abnormal fibrous band tethering the sigmoid notch of the radius proximally to the ulna and slowing the growth. Traumatic Madelung's may follow partial growth arrest of the distal radius (seen earlier).
Developmental dysplasia of the hip (DDH)
Note: Absence of ossification center L femoral head
Inheritance?
Developmental dysplasia of the hip (DDH)
Note: Absence of ossification center L femoral head
Inheritance – multifactorial including intrauterine and post natal positioning influences.
Developmental dysplasia of the hip (DDH)
Note: Break in Shenton’s line on L with small ossific nucleus
Developmental dysplasia of the hip (DDH)
Note: Break in Shenton’s line on L with small ossific nucleus
Break
Shenton’s line
Developmental dysplasia of the hip (DDH)
Note: Acetabular angle should be less than 30 degrees at birth and less than 20 degrees by age 2 years. The ossific nucleus should be in the inner lower quadrant of the crossing of Hilgenreiner’s line (through the triradiate cartilages) and a perpendicular line through the AIIS.