Download - ALL ABOUT Orthopaedic Pathology
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(Medical Student Education Series: Core Orthopaedics)
ALL ABOUT
Orthopaedic
Pathologycopyright 2008 eugene [sic] with Conor
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Pagets disease
Pagets(osteitis deformans) is probably a viralinfection of bone where there is disorderedformation of bone resulting in deformity, weakened
bone and 2 OA.It is common in the UK, Australia and NZ. Patientsmay also develop cardiac problems and nerveentrapment.
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Pagets disease(51M, pain and stiffness for years)
Large head, 2 OA,coarse trabeculae,
ossification psoasTHR
LARGE HEAD, 2OA, COARSETRABECULATION, OSSIFICATIONOF PSOAS.
BROAD TRABECULAR, ACTIVEOSTEOBLASTS, CEMENT LINES &FIBROUS VASC. TISSUE.
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Infection
Infections in orthopaedics can be devastating. Theinfection maybe of bone(osteomyelitis,OM-1/haematogenous or 2-post trauma /ORIF) or in jointsseptic arthritis).XR changes of OM are soft tissueswelling,demineralization,sequestra(dead bone) andinvolucrum(periosteal new bone). Treatment is rest,hydration, identifying the causative organism andsurgery.
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Osteomyelitis (with sequestrum)(21M , post MVA, open tibia #)
SEQUESTRUM,DEAD BONE
OPEN # TIBIA
OPEN # TIBIA
OPEN REDN &EXT FIX.
POST-OPINFECTION
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Gout
Gout is a disorder of metabolismwhereby there is hyperuricemiaresulting in deposition of uric acidcrystals in soft tissue olecranonbursitis) and in/around joints.
XR changes of punched-out erosionsare typical.
Punched out erosions
Pseudo gout crystalsin knee
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Gouty olecranon bursitis
Picture5
Picture7
43 yo NZ Maori
P icture 10 P icture 12
TophusExcising gout tophus
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Loose bodies in joint(70F, pain and locking of knee)
Picture3
Picture4
xx LOOSEBODIES
OA KNEEPicture7
Removing LBat arthroscopy
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Mortons
metatarsalgia/neuromaIs from repetitive microtrauma to foot digital nerves.
Usually the common digital nerve to the 3 rd webspace.
Patient has forefoot pain, feels walking on pebble.
Treatment is better shoes and maybesurgery/neurectomy.
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Mortons(Betts) metatarsalgia(33F, pain in 2/3 space)
EXCISED NEUROMAPAIN USUALSPACE
EXCISION,Dorsal appr
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Freibergs disease foot(78F, pain over 2nd metatarsal head)
Excised 2 nd metatarsalhead
Sclerosis 2 nd met head &collapse joint surface. Arrow
Stress overload to 2nd metatarsal head. Can be extremely painful. May need to be excised .
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Dupuytrens disease An autosomal dominance disease characterized by
abnormal proliferation of myofibroblasts andfibroblasts resulting in contractures of the
hands/digits,feet and penis.Treatment is largely surgery(fasciectomy and rarely amputation).
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Dupuytrens-straighten but if toodeformed then amputate.
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Osteoarthritis(OA)OA is a loss of the articular
cartilage. Often the longterm result of damage ( egtrauma).
It maybe 1 or 2.2 from abnormal cartilage(e.g. ochronosis),abnormalbone ( e.g.radionecrosis,AVN) or abnormal loads( egdeformity from childhood-Perthes, SUFE, DDH andPagets).The XR changes are loss of
joint space, sclerosis andosteophytes.
Knee replacement
OA=loss articular cartilage;seen at arthroscopy
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OA-causes
DDH. 36F.PAINFUL HIPS.Childhood surgery.2OA. Bil THR.
Bil 2 OA
PERTHES.LARGE DEFORMED HEAD.2OA. Needed THR.
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OA-causesRADIONECROSIS. 64m post-radiotherapy for testicular Ca.Needed THR.
SEGMENTALAVN post slidingscrew plate for #NOF. 35M.Needed THR.
DERMATOMYOSITIS 43F with painful hip. 2OA. Needed THR.
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OA-causes
SUFE
2 OA as adult.Needed THR
SUFE, left side, aschild
Pin-in-situ; but still wentonto 2OA as adult
pistol-gripshape
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AVN hip(42F,on steroids for pemphigus, to THR)
LARGE FLAP HIP FLAP IS CARTILAGE & BONE
COLLAPSE OF SURFACEWITH 2 OA
THR
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Meniscus
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=Left meniscus(with permission JBJS(B). Fig 1, p 1550, Dec., 2006)
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Ochronosis/alkaptonuria(68F, pain and stiff knee)
Black staining fromxx homogentisic acid deposits
Black colouration of knee from xx homogentisicacid acid deposits into joint.
2 OA