Musculoskeletal
Vincent Helyar, Aidan Shaw in The Final FRCR, 2017
This chapter examines various musculoskeletal concepts. Adhesive capsulitis is also known as 'frozen shoulder'—more common in females and between 40 and 70 years of age. Interruption of blood supply causes the cell death of the bone constituents, mostly due to an arterial problem. It can affect any bone, but the hip is most commonly affected. Slipped upper femoral epiphysis (SUFE) is the most common hip abnormality affecting adolescents aged 10–16 years. Bone infarct refers to infarction occurring in the diaphysis or metaphysis. Infarction occurring in the epiphysis is known as avascular necrosis (AVN). Musculoskeletal abnormalities may be due to the effects of chronic anaemia. Aneurysmal bone cyst (ABC) is a lucent, expansile lesion containing multiple thin-walled, blood-filled cavities. The brown tumour is a focus of bone resorption replaced by vascular fibrous tissue. It mimics metastases and myeloma. Multiple myeloma is a cancer of the plasma cells found in bone marrow.
Diaphyseal bone loss
Benjamin Joseph, Selvadurai Nayagam, Randall Loder, Ian Torode in Paediatric Orthopaedics, 2016
Loss of a segment of the diaphysis of a long bone in children can occur following trauma, infection or after surgical resection of bone tumours. Rarer causes include resorption of bone in osteogenesis imperfecta and massive osteolysis. Instability at the site of the defect will preclude normal function of the limb. Shortening may be present if the problem has been longstanding and is frequently encountered in children with bone defects following infection in infancy. Deformity is often seen in limbs with defects secondary to infection and this would need to be corrected in addition to restoring continuity of the bone. Scarring and fibrosis of soft tissue around the bone defect occurs following infection and trauma or following radiotherapy to the area. This may preclude some forms of treatment; particularly those that entail vascular anastomosis. Autogenous non-vascularised bone graft is often effective in bridging diaphyseal defects in children and the fibula is frequently the chosen graft.
Bone Changes
C. Alan B. Clemetson in Vitamin C, 1989
The consequences are most serious at the time of most rapid bone growth — in infancy; the infant with scurvy tends to lie still on its back in the frog-leg position with its legs flexed at the knees and the hips and its thighs abducted and externally rotated. K. A. L. Aschoff and W. Koch made a detailed study of the bone pathology in human scurvy, as seen in soldiers who died of the disease during the World War I. Particular attention was paid to changes in the bone and cartilage at the costochondral junctions and also at the junction of the diaphysis and the epiphysis of the long bones. Scurvy affects growing bones, so X-ray changes are seen most frequently in infants and young children and most notably at the ends of the long bones. Slipped epiphyses occur both in infants and in older children; osteoporosis and fractures have often been reported in adults with scurvy.
An Unusual Cause of Enthesopathy of the Bicipital Tuberositas of the Radius: Screw Irritation
Published in Journal of Musculoskeletal Pain, 2013
Cengiz Isik, Husamettin Cakici, Kamil Cagri Kose, Fuat Akpinar
Background: A 36-year-old woman was suffering from a right forearm ulna-radius diaphysis displaced fracture and a non-displaced fracture of the radius neck. Open reduction and internal fixation with screws and a plate for the ulna and radius diaphysis fractures and a long-arm plaster splint treatment was performed. Findings: Four months later, the patient presented with pain, swelling, and restricted mobility on the antecubital side of the right forearm. Radiography showed that the screw which was used for ulna fixation caused enthesopathy of the neighboring bicipital tuberosity of the radius. Removal of the screw improved the symptoms and angular degree of pronation-supination movements from 20° to 70°. Two years after screw removal, radiography showed resolution of enthesopathy of the radius bicipital tuberosity. Conclusions: When inserting a screw for ulna and radius diaphysis fractures, maximum care must be taken to avoid screw irritation of the bicipital tendon enthesis. When this complication does occur, removal of the causative screw may completely solve the problem.
Towards automatic measurement of anteversion and neck–shaft angles in human femurs using CT images
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2014
Mariano E. Casciaro, Damian Craiem
Automatic assessment of human femur morphology may provide useful clinical information with regard to hip and knee surgery, prosthesis design and management of hip instability. To this end, neck–shaft and anteversion angles are usually used. We propose a full automatic method to estimate these angles in human femurs. Multislice CT images from 18 dried bones were analysed. The algorithm fits 3D cylinders to different regions of the bone to estimate the angles. A manual segmentation and a conventional angle assessment were used for validation. We found anteversion angle as 20 ± 7° and neck–shaft angle as 130 ± 9°. Mean distances from femur surface to cylinders were 5.5 ± 0.6, 3.5 ± 0.6 and 2.4 ± 0.4 mm for condyles, diaphysis and neck regions, respectively. Automatic and conventional angles were positively correlated (r2>0.85). Manual and automatic segmentations did not differ. The method was fast and 100% reproducible. A robust in vivo segmentation algorithm should be integrated to advance towards a clinically compliant methodology.
Bone remodelling analysis of a bovine femur for a veterinary implant design
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2009
L.B. Rodrigues, D.S. Lopes, J. Folgado, P.R. Fernandes, E.B. Pires, E.B. Las Casas, R.R. Faleiros
The response of bovine bone to the presence of an implant is analysed with the aim of simulating bone remodelling in a developing model of a polymeric intramedullary interlocking nail for veterinary use. A 3-D finite element model of the femur diaphysis is built based on computed tomography images and using a CAD-based modelling pipeline. The bone remodelling process after the surgery is analysed and compared with the healthy bone. The remodelling law assumes that bone adapts to the mechanical environment. For the analyses a consistent set of loads is determined for the bovine walk cycle. The remodelling results reproduce the morphologic features of bone and provide evidence of the difference on the bone behaviour when comparing metallic and polymeric nails. Our findings indicate that an intramedullary polymeric nail has the advantage over the metallic one of improving long-term bone healing and possibly avoiding the need of the implant removal.
Related Knowledge Centers
- Bone Matrix
- Osteoblasts
- Osteoclasts
- Osteocytes
- Connective Tissue
- Bone & Bones
- Fibrillar Collagens