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B&jJJJJJjjjj Final

Bone and Joint Final

Who's predisposed to infections>? immunocompromised, alcoholics, newborns, intravenous drug users, diabetics, hemodialysis, post-surgery
What organisms can cause acute suppurative osteomyelitis? Staph aureus (90%), e. coli, H. influenzae, Klebsiella, Strept B
What is the MC way of spread of acute suppurative osteomyelitis? hematogenous
What are 4 ways in which acute suppurative osteomyelitis is spread? hematogenous, contiguous source, direct implantation, postoperative.
What is the mc age group of acute suppurative osteomyelitis? 2-12 years
what are early signs of acute suppurative osteomyelitis? soft tis swelling, bone destruction, periosteal rxn
opening from the soft tissues to the hollow viscerals or outside the skin sinus tract
periosteal new bone formation in osteomyelitis? involucrum
discitis in child, first site of involvment vs adult? child: disc first, adult: Anterior vert endplate, then vert destruction and secondary disc involvement
in osteomyelitis disc invovlement is..... (if in spine) early
in TB disc involvement is..... late
what are the TXs of suppurative osteomyelitis? and prognosis? antibiotics, brace, surgical debridement late. Prognosis good if dxed early
what is a localized aborted form of suppurative osteomyeltiis? brodies abcess
biopsy of brodies abcess may be..? sterile
mc bone affected by brodies abcess? tibia
location of brodies abcess usually? metaphysis of tubular bones, can cross physis!!!
septic arthritis affects ____ joint single
What are the Mc areas of septic arthritis? hip and knee
what are imaging findings of septic arhtritis? joint effusion which distorts fat pads, rapid loss of joint space, loss of subchondral white bone, motheaten bone destruction, later is boneeyyyy anklyosis
What does waldenstroms sign indicate? intracapsular effusion with infection, LCP, SCFE, Chandlers.
What are the measurements of waldenstroms sign? > 11 mm, or >2 mm difference from side to side
other findings of septic arthritis post fist fight//human bite injury joint space narrowing, periarticular osteopenia, periostitis
Where are the areas that undergo septic arthritis d/t pseudomonas in iv drug users? S JOINTS: spine, si, symphysis, sc, acromioclav
What is Marjolins ulcer? malig degeneration of chronic osteomyelitis into squamous cell carcinoma within the cloaca.
What is seen with chronic osteomyelitis? sclerosis, cortical thickening, periosteal new bone formation, osseous destruction, sequestrum, malig degen
What can chronic osteomyeltisis become with malig degen? fibroscarcoma, squamous cell carc (marjolins ulcer)
in what condition might you see gas gangrene? diabetic osteomyeltisi
primary stage tb? infects lungs, leads to granulomatous rxn, may stay silent for rest of pts life.
secondary (post-primary) stg tb? reactivation of the organism, spreads to other organs and bones via blood
what age is skeletal TB mc? 2-30
skeletal tb is rare in? first year of life
what are sx of skel tb insidious onset of pain, decreased rom, focal tenderness
50% of tb goes to? the spine, tuberculous spondylitis, Potts dz
where is mc location of tb in the spine? most common @ L1 - lower t-spine and upper l-spine
what is potts paraplegia? rare, collapse of multi vertebra with tb infection which leads to growth of granulation tissue which narrows spinal canal.
what are early imagining findings of tb? disc space loss, anterior vert body destruction, subligamentous spread
what are late potts findings? pathologic vert collapse, angular kyphosis (gibbus), retropharyngeal, paravert, psoas calcified abcesses.
TB can end with ____ ankylosis fibrous ( septic arthritis is boney)
What is Phemisters triad? With TB: progessive and slow joint space narrowing, juxta-artic osteoporosis, periph erosions of the articular surfaces
What is spina ventosa? AKA tuberculous dactylitis, d/t TB..... diaphyseal expansile lesion in hands and feet.
what is potts puffy tumor? TB of skull (frontal bone) with scalp abcess
what is weavers bottom? TB - subgluteal infective bursitis with direct extension to the ischium ... located on isch tube.
I say H vertebra and osteonecrosis and you say? sickle cell anemia
hair on end skull thalassemia
hemophilia, clotting factors?? 8 and 9
Three features of hemophilia hemarthroses, deformities, arthropathy
What are two growth abnormalities of hemophilia? early fusion of 2ndary ossification centers, and ballooning of epiphyses
hemophilia imaging findings growth abnormalities, osteopenia, arthropathy, pseudotumors (MC @ ilum)
where is the mc arthropathy of hemophilia? knee
what is seen with hemophilia arthropathy? bloody joint effusion, synovitis, OA, widening of intercondylar notch, squaring of patella (inf pole)
dif dx of hemophilia? JCA
what are radiographic findings of leukemia? osteopenia and radiolucent metaphyseal bands
location of bone infarcts metaphysis and diaphysis
location of AVNs epiphysis
pathogenesis of osteonecrosis? arterial rupture (trauma), arterial blockage (thrombus, emboli, vasculitis), and arterial compression (myeloproliferation)
what is unilateral osteonecrosis d/t? spontaneous, trauma, surgery, gout, infection
what is bilateral osteonecrosis dt? alcohol, corticosteroids (RA, sle), spontaneous, arteriosclerosis, caisson, cushings, hemoglobinopathy, hemophilia
what is the clinical latent period of osteonecrosis? few weeks to 1 year
sx of osteonecrosis? occur as articulating surface collapses, pain, atnalgia, painful rom, mm atrophy
What are the 4 phases of avn? avascular, revascularization, repair & remodeling, deformity
feature of avascular stg of avn? increase joint space, capsular swelling..... therefore in hip would see waldenstrums sign
what are features of revascularization phase of avn? subchondral cysts, sclerosis (bite sign, snowcap), subchondral fx (cresent sign), collapse, flattening of artic surface, fragmentation... EVERYTHING.
where and who does sonk occur in? med condyle, medial surface - wt bearing surface. in 40-60 yrs
where and who with ocd? under 20, med condyle, lat surface
group of epiphyseal/apophyseal conditions characterized by fragmentation, sclarosis and irreg artic surfaces osteochondroses
some osteochondroses are real.... avn, some a post-traumatic deformities, some are developmental variations
LCP aka? coxa plana
age of LCP? 3-12
males or females LCP? males more, 5:1
___% bilat LCP 10%
how long does LCP process take? 2-8 years
What is not affected in LCP? the cartilage
Early findings of LCP? soft tis swelling, wide medial joint space, small fem head, epiphyseal frag, cresent sign, sclerosis
Mushroom deformity? seen in remodeling of LCP
sagging rope sign? seen in remodeling of LCP
avn of metatarsal head freibergs dz
mc site of freibergs dz? 2nd metatarsal head
avn of lunate? kienbocks
avn of tibial tuberosity? osgood-schlatters dz (ebbets <3)
other names for scheuermanns dz? juvenille kyphosis, vertebral epiphysitis
mc area of scheuermanns dz? midthoracic, then thoracolumbar
what are the imaging findings of scheuermanns dz? Anterior wedgings ( more than 5 degrees, 3 contiguus segments 2. irreg endplates (schmorls nodes) 3. loss of disc ht, 4. kyphosis (more than 40 degrees)
avn of inf pole of patella? Jumpers knee (SLJ)
avn of vert body> kummels dz
what else is seen with kummels dz? intravertebral vacuum cleft sign
ischiopubic synchrondrosis? van necks dz
blounts dz? medial epiphysis is wedged or absent, and get adjacent metaphysis with a beak like protuberance - often medially orientated
mc site of avn? fem head
avn of talus? diaz dz
avn of humeral head? hass dz, 2nd mc site of avn
avn of navicular and patella? kohlers dz
avn of scaphoid? preisers dz
avn of capitellum? panners dz
avn of calcaneal apophysis? severs dz
three causes of mocnkebergs medial sclerosis? DM, SLE, HPT
what is monckebergs medial sclerosis? sclerosis of tunica media
MC deenerative arterila dz? atherosclerosis
where is the plaquing of atherosclerosis found within the bv intimal and subintimal layers
what arteries typically have atherosclerosis? aorta, iliac, subclav, carotid, coronary, femoral
poor correlation b/w amount of calcifcation and what in atherosclerosis? and % of narrowing of artieries
good correlation b/w amount of abdominal aorta calcifcation and what? risk of stroke
diameter greater than ___ is an AAA 3 cm
referral for ultrasonographic doppler @ ____ cm with an AAA 3.5-3.8 cm
best and 2nd best way to dx AAA? 1. ultrasonography 2. CT
what % of AAAs will calcify and show on film? 75%
If AAA 7 cm, ___% will rupture in 5 years 75%
RFs of AAA high BP, smoking, high cholesterol, obesity, emphysema, genetic facors, having a penis.
what % of males @ age 80 have an AAA? 7-9%
prophylactic surgery of AAA at ___ cm? 5.5 cm
TX of AAA? endovascular stent, vascular graft (such as Dacron)
reduction of bone quantity with normal quality of bone osteoporosis
reduction in quality of bone osteomalacia
osteopenia is not necessarily caused by? osteoporosis
poverty of bone, seen as increased radiolucency osteopenia
mc generalized osteoporosis? senile or post menopausal
congenital disorders with osteoporosis? OI and mucopolysaccharidoses
vascular disorders with osteoporosis? SC anemia, thalaseemia
nutritional disoders with osteoporosis scurvy, rickets, osteomalacia, hypervitamin A
metabolic and endocrine disoders with osteoporosis HPT, hyperthyroidism, cushings dz
neoplastic disorders with osteoporosis mult myeloma, lytic mets, leukemia
iatrogenic causes of osteoporosis corticosteroids, anticoagulants
2 other causes of osteoporosis generalized alcoholism and paralysis
F to male ratio of senile osteoporosis in 5th & 6th decades, and 7th and8th decades F:M 5th and 6th - 4:1, 7th and 8th is =
after 35 yrs, __% cortical and ___% medullary bone loss per year 1% cortical and 2% medullary
@ menopause ___% bone loss per year 3-6%
senile osteoporosis aka? senescent osteoporosis
MC location of senile osteoporosis? axial skel
where are fxs usually with senile osteoporosis? tl spine, hip, distal radius, prox humerus
____ hip fx annullay 240,000
___% die within year of fx (hip) 12-20%
pseudo-hemanigoma with what? senile osteoporosis
what is dexa? low dose xrays to quantify bone mass
cDXA vs pDXA? c = central, spine, hips p = periph, radius, calcaneus
what is the t-score? bone density compared with young adult of same gender, and gives risk of fx
what is z-score? bone density compared with other ppl of same age, size, and gender
what is a normal t-score reading? 0 to -1
what is a t-score of osteoporosis -2.5 or less
bone densitometry uses no? radiation
Mc cause of regional osteoprosis? disuse osteoporosis
What are the 3 patterns of disuse osteoporosis? generalized osteoporsis, band like metaphyseal or epiphyseal radiolucency, spotted radiolucency (permeative or moth eaten pattern of bone destruction loook)
What are the other names for complex regional pain syndrome? reflex sympathetic dystrophy syndrome, post-traumatic osteoporsis, sudecks atrophy, causalgia, shoulder-hand syndrome
Who and what age does transient osteoporosis of the hip occur in? males, 20-40
Sx of transient regional osteoporosis, and what about its recovery? sudden onset of pain antalgia, and limp..... self limiting: full recovery within 3-12 months
What are some causes of rickets? lake of vit D in diet, not enough UV light, intestinal malabsorption of vit d, kidney or liver dz, anticonvulsant medication (Dilatin, conveinently starts with a D..)
image findings of rickets Widened physis (failure of growth plates to ossify), generalized osteopenia, bowing deformities, irreg growth plates (paint brush metaphysis, cupping, fraying metaphysis), pseudofxs, path fxs
who gets cupping and fraying metaphyses? rickets
rachitic rosary seen in? rickets
4 clinical features of scurvy cutaneous petechiae, bleeding gums, joint swelling, irritability
scurvy dt? lack of vit c, chronic deficiency of ascorbic acid
image findings of scruvy? osteopenia, white line of frankel (dense zone of calcification), ring epiphysis of wimberger, pelkens spurs, scorbutic zone (trummerfeld zone)
90% of HPT dt? benign parathyroid adenoma
Lab tests of HPT? hypercalcemia, hypercalciuria, hypophosphatemia, hyperphosphaturia
lab findings of secondary hpt hypocalcemia, hypercalciruia, hyperphopsphatemia, hypophaturia
image findings of hpt? osteopenia, bone resorption (subperiosteal, subligamentous, subcondral, endosteal), fxs, soft tis and vasc calc, osteoclastomas (brown tumors)
hallmark of hpt? subperiosteal resorptions
salt and pepper skull? hpt
what is renal osteodystrophy? 2ndary hpt with osteomalacia/rickets
rugger jersey spine? 2ndary hpt
clinical features of acromegaly? malocclusion, prominent forehead, thickened tongue, borad large hands, headache, carpal tunnel syndrome, degen arthritis
measurements for sella turcica enlargement > 16 mm width, and > 12 mm ht
early acromegaly finding? widenened joint spcces
late acromegaly finding? accelerated degen arthritis
increased heel pad findings in males and females > 23 mm for F and >25 mm for M
mc congenital dwarfism? achondroplasia
what type of growth is abnormal in achondroplasia? enchondral growth and maturation, with normal intramembranous ossification
achondroplasia is an autosomal ____ disturbance dominant, with sporadic mutation in 80% of cases
achondroplasias have normal what? normal mentation and lifespan
what is average ht of achondroplasia? 50 inches
what are features of the head of an achondroplast? large head (prominent forehead), depressed nasal ridge, small foramen magnum (leads to hydrocephalus)
what are the clin features of the trunk of achondroplast? normal length spine, protuberant abdomen, prominet butt, hyperlordosis, tl kyphosis
what are the features of the spine with achondroplasia? spinal stenosis: post body scalloping, narrowed interpedicular distance, short thick pedicles. TL Gibbus: bullet vertebra
features of the pelvis with achondroplasia? champagne glass pelvic bowl, small pelvis, short flat ilia, horizontal acetabulum, short fem necks
feature of hand with achondroplasia? short, trident config
cleidocranial dysostosis d/t? autosomal dominant, mutation on chromosome 6
how common is celidocranial dysostosis? 5 per 1 million births
what type of ossification is faulty in cleidocranial dysostosis? intramembranous
what are some clin features of cleidocranial dysostosis? large head, and small face, abnormal teeth, drooping hypermobile shoulders, neural arch defects, hemivert, diastasis of symph pubis, reduced ht, narrow cone shaped thorax
what are the skull findings of cleidocranial dysostosis? multiple wormian bones, widened persistent metopic suture, widened diameter of sagittal and coronal sutures (hot cross bun appearance, bracycephaly), small face d/t underdeveloped facial bones
What are image findings of cleidocranial dysostosis in the thorax? absent (10%) or hypoplastic clavicles, pseduoarthrosis (mid portion missing), scapulae (small, winged, elevated), narrow coneshaped chest.
what are some image findings in the pelvis of cleidocranial dysostosis? small underdeveloped bones in pelvis, pubic symph diastasis, coxa vara or valga
what are findings in the spine with cleidocranial dysostosis? multi sbos, and hemiverts
What are some complications of cleidocranial dysostosis? hearing loss, severe dental probs, dislocations (hip and shoulder), resp distress in children, scolosis
What is the name of the autosomal dominant form of chondrodysplasia punctata? Conradi-hunermann syndrome
Which type of chondrodysplasia punctata is fatal in first few yrs of life? autosomal recessive
stippled calcifcation of multiple epyphyseal centers in the 1st yr of life is? chondrodysplasia punctata
what are clinical features of chondrodysplasia punctata? similar appearance to achondroplastic dwarfs
What are imaging features of conradi-hunermann syndrome? stippling at the end of long bones, can be seen at the endplates and ribs, can lead to asymmetric limb shortening
What is dysplasia epiphysealis hemimelica aka? trevors dz
what is focal osteocartilaginous overgrowth of a portion of the epiphysis? trevors dz/ dysplasia epiphysealis hemimelica
trevors dz can be what three things? monostotic, polyostotic, and gerenalized
where is the mc location of trevors dz? medial femoral condyle - get genu valga
when is trevors dz present? and does it affect males or females more? during first decade of life, affects males more 3:1
where does trevors dz typically affect? only one limb affected in the LE
What causes marfans syndrome? autosomal dominant - defect on chromosome 15.
marfans is a failure to produce? normal collagen
how common is marfans? 4-6 per 100,000 births
life expectancy with marfans? halved
systems involved with marfans? skeleteal (mainly extremities), ocular, cardiovasc
sex ratio of marfans =
Skeletal features of marfans arachnodactly, thin gracile bones, thin cortices, delicate trabecular pattern, scoliosis (>50%), acetabular protrusion (>50%), pectus excavatum or carinatum, joint lax and dislocs
ocular problem with marfans? >50% have disloc of lens
mc cardiovasc defect of marfans? atrial septal defect
marfans is ___% of congen heart dz? 33%
What cardiovasc problems are with marfans? aortic dissection and rupture, pulm artery rupture, aortic valve incompetence, ASD
What are imaging features of a Marfans spine? tall vert, kyphoscoliosis, doub major or RT thoracic scoliosis (early in childhood), widened spinal canal - 50%, post scalloping of bodies, thin pedicles
what are complications of marfans/ cardiac abnormalities, aneurysms, dental probs, SCFEs, transverse lig rupture
OI is a defect in what type of collagen? collagen type I
how is OI transmitted? autosomal dominant
What are the clinical diagnostic criteria of OI (4)? 1. osteoporosis and skel fragility, 2. blue sclerae, 3. abnormal denition (dentinogenesis imperfecta), 4. premature otosclerosis
do ppl with osteogenesis imperfecta tarda have a normal life expectancy? yes
male to fem ratio of OI? =
what % of OI tarda have blue sclera? 90%
features of OI tarda? less severe form, fxs following trivial trauma, kyphoscoliosis, deformities
Imaging features of OI diffuse osteopenia, pencilthin cortices, mult fxs, deformities
Resembles wax flowing down a lighted candle melorheostosis
what is the male to fem ratio of melorheostosis? =
when do sx occur in melorheostosis? late childhood, early adolescenes
what are sx of melorheostosis? pain, joint contractures and deformities, progessive hyperostosis, swelling, skin changes
Where is melorheostosis? LE
does melorhesotosis involve one or multiple limbs? usually one (monomelic)
what are the imaging features of melorheostosis? streaked or wavy cotrical thicekning, endosteal and periosteal bone production
What is osteopathia striata a variant of? osteopoikilosis
what is osteopathia striata? linear bands of dense bone in diaphysis and metaphysis of long bones and in pelvis ( usually bilat)
what appearance does osteopathia striata make in the pelvis? sunburst effect
How is osteopoikilosis spread? autosomonal dominant
location in bone of osteopoikilosis? epiphysis and metaphysis
1/4 of pts with osteopoikilosis have what? skin lesions
osteopetrosis is a lack of what? resorption of primitive osteochondral tissue
what does osteopetrosis inhibit? formation of normal meduallary canal and bone marrow
What is osteopetrosis aka? Albers-Schonberg dz, marble bones, chalk bones.
What are clinical features of severe forms of osteopetrosis? maybe still born or die in first 2 yrs, anemia, multi fxs of brittle bones, blindness and cranial nerve defects
What are clinical features of bengin forms of osteopetrosis? 50% asymptomatic, anemia, hepatosplenomegaly, facial palsises, deafness, dental caries (osteomyelitis of mandible)
What are lab findings with osteopetrosis? anemia (poor correlation with sclerosis), thrombocytopenia, serum calcium may be elevated
spine imaging features of osteopetrosis? diffuse sclerosis or striated bones, spondylolysis, spinal stenosis - cerivcal myelopathy
complications of osteopetrosis? path fxs esp in femur, hemorrhage, infection, blindness, deafness, leukemia and sarcoma
spondylolysis def interruption of pars interarticularis
Mc level of spondylolysis? L5 (90%)
If have SBOs __x more likely to have spondylolysis? 13 times
ethnicity most likely to have a spondylolysis? 28-40% eskimo (inuit)
etiologies of spondylolysis? stress/fatigue fx, congenital, acute fx
What is the name of the classification system of spondylolisthesis? Wiltse classification
Type I spondylolisthesis dysplastic
Type II spondylolistehesis isthmic (pars)
type III sondylolisthesis degenerative
type IV spondylolisthesis traumatic
type V spondylolisthesis pathologic
Dysplastic, type I spondylolisthesis is? congenital abnormality of post elements - NOT INCLUDING PARS
MC type of spondylolisthesis is? Type II, isthmic
types of isthmic spondylolisthesis? Stress fx of pars, Elongation of pars, Acute pars Fx
degen spondylolisthesis mc at what level? l4
degen spondylolistehesis commonalities fifty - over fifty, female - mc in females, 4 - l4, facet - severe facet arthrosis
type IV spondylolisthesis, trauma except for... except @ the pars!!!! (That'd be type II - acute or stress fx of pars)
Type II A fatigue stress fx of pars
Type II A, no correlation b/w pain and ___ degree of slippage
Most pts are ___ at the time of discovery of Type II A asymptomatic (inactive spondylolysis)
Active pars defects should be visualized where? on SPECT scan or MRI (sagittal STIR)
what is given to a pt to restrict LS extension with an active pars defect? orthosis (boston overlap brace) for 3-6 months
What are risk factors of displacement assoicated with Type II A ? SBO, trapezoidal shape of L5 body (back shorter than front), dome shape (rounding) of S1, high grade slip
What age does type II A displacement and instability occur? between 5 and 10-15
Good prognosis of Type II A with displacement when? butterssing, male, over age 18
A grade 5 spondylolisthesis is also called what? spondyloptosis
What are the clinical features of spondylolistehsis hyperlordosis, prominent buttocks, step defect, crepitus, tight hamstrings, pelvic waddle
Meyerding classifcations - %s of each 1: 0-25%, 2: 26-50% 3 - 51-75% 4: 76-100%, 5: >100%
When is Bowline of brailsford seen, and what are other names for it? Seen with grade 3 or greater, aka gendarmes cap, and inverted napoleons hat
Instability eval of spondylos? f/e, and compression traction - more than 4 mm translation, and more than 11 degrees of extensive angular motion is bad.
What is Wilkinson syndrome? sclerotic pedicle d/t unilateral spondylolysis
unilat spondylolysis outcome? may heal or progress to bilat defects
unilat spondylolysis is less common than _____, and has no ____ visualized less common than bilateraly, and has no spondylolistehsis visualized
What is management of stable/inactive Type II A? chiro manipulation (L4/L5, and SI joints), biomech eval -pelvis and LE
What is managment and of unstable Type II A? boston antilordotic brace (acute, and surgical arthrodesis (chronic)
Causes of cervical spondylolistehsis? congenital (MC), traumatic (dislocs, hangmans fx), degen
What is MC level of congen cerv spondylolistehsis? c6
features of congen cerv spondylolisthesis? SBO, hyoplastic pedicles and articular processes
dextroscolisos rt sided scolisos
double major scoliosis 2 curves of approx same degree in 2 dif spinal regions
double primary scoliosis 2 curves of approx same degree in same spinal region
levoscoliosis left sided scolisos
major curve largest curve
minor curve smallest curve
rib hump structural scoliosis
rotoscolosis coupled rotation with scoliosis, structural
end vertebra determines where scoliosis is
classification of structural scoliosis fails to correct on forward or lat bending, rib humps, large rotational component
non-struc/functional scoliosis classifications corrects itself on bending, diasppears when cause is removed, minimal rotation
structural scoliosis d/t? idiopathic, neuromm, myopathic, congenital, neurofibromatosis, trauma
non-struc scoliosis d/t? postural, limb length in=, hip contractures, antalgic (nerve root irritation, inflamm)
most common type of idiopathic scoliosis is? adolescent
most infantile idiopathic scoliosis will? resorb
age range of infantile scoliosis? and mc sex? 0-3, more in men
age range of juvenille idiopathic scoliosis? and avg age? and mc sex? 3-10, avg@ 7, and 4:1 f:m
age of adolescent idiopathic scoliosis? and mc sex? 10- skel maturity, F:M 9:1
most common curve pattern of adolescent idiopathic scoliosis? rt thoracic, then rt thoracolumbar, left lumbar, left lumbar and rt thoracic
what age is the critical time for progression of adolescent idiopathic scoliosis? 12-16
when is one skel mature? fusion of iliac apophysis
if one had adolec idiopath scoliosis degeneration in later life may lead to ____ increase of scoliosis 15 degrees on average
What is the incidence of congen heart dz when idiopathic curve is >20 degrees? 10 times greater
what is often reduced with adolescent idiopathic scoliosis? all the normal curves of the spine
what % of pts with idiopathic scholio have a fam member affected? 30%
What is the hueter-volkman principle? lateral wedge remodeling deformity of vert bodies (on concave side)
What are the causes of congenital scoliosis? hemivert, block vert, SBO, vertebral bars, rib fusion
what is the MC cause of congen scoliosis? hemivert
Congen scoliosis has a ___ C curve short C curve
congen scolisis may be ___ progressive rapidly
what anomalies are common with congen scoliosis? genitourinary
neuromuscular scoliosis has a ____ C curve long c curve
neuromuscular scoliosis runs from __ to ___ scarum to lower c spine, and is a severe curve
neuromusc scoliosis has ___ prgression from what age range? rapid from 12-18
what is the MC cause of neuropathic scoliosis? poliomyelitis
what are the causes of neuropathic scoliosis? poliomyelitis, cerebral palsy, syringomyelia, spinal cord tumor, trauma, dysautonomia.
What is the MC cause of myopathic scoliosis? duchenne msucular dystrophy
what the 3 causes of myopathic scoliosis? duchenne muscular dystrophy, arthrogryposis, and congen hypotonia
neuromusc scoliosis has <2% present to the ____ which are more likely to be assoicated with what? to the left, associated with underlying pathology
In a pt under 11 what degree of scoliosis should concern you of underlying patho? 15 degrees or more
scoliosis is mc bony abnormality in what inherited congenital disorder? neurofibromatosis
features of neurofibromatosis? hyperkyphosis, IVF enlargement, post vert scalloping, cafe-au-lait (coast of cali), fibroma mulluscum, intraspinal, intracrania and intercostal and soft tis neurofibromas
What dzs have post scalloping of vert bodies? ehlers danlos, acromegaly, marfans, achondroplasia, neurofibromastoais
What level of spine are post-traumatic scoliosis common in? thoracolumbar spine
what is post-traumatic scoliosis? lateral compression fxs, in osteoporotic pts
what side is the fx on in post-traumatic scoliosis? concave side
what side is most degen scoliosis on? concave side of longstanding curve
what is seen with degen scoliosis? asymmetric disc thinning, and apophyseal joint oA
what side of the scoliosis is osteoid osteoma found? concave side of pedicle
which dzes have rapidly progressing double thoracolumbar curves? Ehlers-danlos, and marfans
what two dzs may cause short leg syndrome? blounts dz, and SCFE
most cases of short leg syndrome are? idiopathic and asymptomatic
short leg syndrome should be measured with? orthoroetgenogram or scaogram (relative dif b/w legs)
short leg syndrome clinical significance of <__ cm discrepancy is debated 1 cm
non-tx comlications of scoliosis? cardiopulmonary, degeneration, progression, fatigue, joint dysfunction, radiation exposure (kids get 22 films), pregnancy
complications with tx of scoliosis? psychological, braces, skin irriation, nerve compression, instrument failure, infection
Avg pt with scoliosis gets how many films ? with an ___% increase in risk of breast cancer 22 films, 110% increase in breast cancer
What is the best method of scoliosis measurement? cobb-lippman
which method of scolio measurement takes in the apical vert? risser-ferguson
What is the most accepted assessment of rotation? pedicle method
What is the pedicle method aka? nash-moe method
how is the pedicle method graded? grade 0-4+
why not use the spinous method for rotation? many morphological variations, prone to errors
left hand and wrist method of skel maturity is compared with what? the greulich and pyle atlas
why left hand and wrist method works for skel maturity? dist radial epipysis closes @ the same time as the vert body epiphysis
fusion of what is the most accurate indicator of completed spinal growth? vert ring epiphysis
Iliac apophysis beings to cap ilium @ what age in girls and boys girls: 14, boys: 16
when does the iliac apophysis completely fuse in boys and girls? @ skel maturity: 18-19 boys, 16-17 girls (up to age 20 or more)
What rissers sign grade signals end of curve progression in females and males? females"4 and 5 in males
What are 4 indicators of likely prgoression of scolio? 1. age of onset (young), 2. onset of menarche (early), 3. rissers sign (absent, or early), 4. magnitude of curve (over 20 degrees)
what % of curves will progress? 25%
What are the most likely patterns of scoliosis to prgoress? 1. double primary, and 2. primary lumbar with compensatory thoracic
What are the 3 conventional managements of scoliosos? 1. observation 2. bracing 3. surgery
management of 0-20 degree curves 1. close observation 2. may progess rapidly 3. re-radiograph every 3 months until mature 4. more than 5 degrees between xray consider bracing 5. rotation and rib hump consider bracing
managment of 20-40 degree curves 1. bracing indicated in curves that are felxible, skel immature and prgressive 2. milwaukee brace common, 3. prevent profression
what is the thoraco-lumbo-sacral brace? boston brace
what is the cervico-thoraco-lumbo-sacral brace? milwaukee
what is the nightime brace/ charleston brace
surgical intervention of scolio when? rapid progression in immature spine, curve over 40 degrees, underlying abdnomality can be treated
what are the surgical procedures for curves 40-50 degrees or more? harrington rods, luque rods, dwyer procdure.
Created by: margaretrhager