Module 8 fase III muskuloskeletale sisteem Tema 4, Sessie 3 UITKOMSTE Na afloop van hierdie sessie behoort jy tot die volgende in staat te wees: 1... ACHILLES TENDON :TENDINITIS, TENDINOSIS AND RUPTURE WERNER HURTER SEPTEMBER 2000 INTRODUCTION The Achilles heel Hippocrates - first recorded descr... Fracture because of a cyst Treatment of pathological fracture through a simple cyst Most cysts will resolve if treated conservatively. Recommendat... Small or incidental simple bone cysts Not all require treatment Any procedure that decompresses the cyst will work * Steriod injection * Perforati... Recurrent cysts Require surgical treatment Query your initial diagnosis - May be an Aneurysmal bone cyst or malignant tumor Recommended management... Case B Previous Imaging Studies - suspected ostesarcoma The following studies are indicated Straight X-rays - AP and Lateral of lesion Chest X-ray... Case B Previous Blood Tests - suspected ostesarcoma Test Why Done ESR Raised in large (necrotic) tumor Full blood count Exclude sepsis, haematolog... Case B Previous Role of biopsy - suspected ostesarcoma Biopsy is done once the other tests are completed Open or needle biopsy can be done Techniq... Case B Previous Radioisotope Studies - suspected ostesarcoma Technecium whole body scan - The tumor area is warm The main reason for the scan is t... Instructional Course Lecture J Bone Joint Surg [Am] 2001; 83-A; 1878-90 Antibiotic Therapy for Musculoskeletal Infections AUTHOR(S): MADER, JON T.... 7MUSKULOSKELETALE INFEKSIES Gewrigs- en Sagteweefsel infeksies Beeninfeksie (osteomiëlitis) en Gewrigsinfeksie (arthritis) Predisponerende faktore... Reduced incidence of Septic Arthritis in children by Haempophillis influensae Type B vaccination: Implications for treatment AUTHOR(S): PELTOLA, H... ‹header› ‹date/time› Click to edit Master text styles Second level Third level Fourth level Fifth level ‹footer› ‹#› ‹header› ‹date/time› ‹footer› ‹#› Click to edit Master title style Click to edit Master text styles Second level Third level Fourth level Fifth level ‹date/time› ‹footer› ‹#›  Notes Slide Show Outline 1   2 INFECTIVE CONDITIONS OF THE MUSCULOSKELETAL SYSTEM THEME 4 PROF. JOHANN W SCHNEIDER DEPARTMENT OF ANATOMICAL PATHO... INFECTIVE CONDITIONS OF THE MUSCULOSKELETAL SYSTEM THEME 4 PROF. JOHANN W SCHNEIDER DEPARTMENT OF ANATOMICAL PATHOLOGY UNIVERSITY OF STELLENBOSCH ... Background knowledge •acute and chronic inflammation •cellulitis and erysipelas •necrotising inflammation •suppuration •abscess formation •granulo... Acute and chronic pyogenic (septic) OM Etiological agents •usually children + adolescents §especially S. aureus •receptors for bone matrix compone... Acute Pyogenic osteomyelitis Pathogenesis •Organisms reach capillaries in §metaphyseal marrow cavitiy §acute inflammation with neutrophils and sup... Osteomyelitis - concept •Inflammation of bone and bone marrow cavity •The term OM refers by convention to infective agents •OM can be acute or chr... Acute and chronic pyogenic (septic) OM  Etiological agents • •Organisms reach bone via: • §hematogenous dissemination (bacteria) – most common §di... Acute pyogenic osteomyelitis Pathogenesis •Central ischemia and necrosis of bone with suppuration and extention through cortical bone • •Infection... Pyogenic osteomyelitis Pathogenesis and complications •Progression of infection •Subperiosteal abscesses spread to §skin = draining sinusses §adje... Chronic pyogenic osteomyelitis  Pathogenesis and complications •Complication of AOM §acute inflammatory process replaced by chronic inflammation a... Chronic osteomyelitis Pathogenesis and complications •Persistance of sequestrum and involucrum •Brodie’s abscess (subacute OM) §residual abscess s... Chronic pyogenic osteomyelitis  Clinicopathologic correlation •Initially cardinal features of acute inflammation §redness §pain §swelling §heat §l... Tuberculous OM •1 – 3% from pulmonary TB •Spread to bone §hematogenous dissemination to long bones and vertebrae §direct spread to bone from adjac... Tuberculous OM •Slow evolution of disease process §diagnosis often after severe tissue damage •Extension to joint spaces = TB arthritis •Destructi... Infective arthritis Etiology •Pyogenic (septic) arthritis §Gonococcal §Staphylococcus aureus §Streptococci •Gram negative organisms (drug addicts)... Infective pyogenic arthritis  Pathogenesis •Hematogenous dissemination from a septic focus elsewhere eg. endocarditis; bacteremia •Direct trauma o... Infective arthritis  Pathogenesis •More common in children •Predisposing factors §Diabetes mellitus §Rheumatoid arthritis §Intra-articular procedu... Infective pyogenic arthritis  Clinicopathologic correlation •usually mono-arthritis of large joints •purulent material in joint space •damage of j... Infective pyogenic arthritis  Clinicopathologic correlation •Acute inflammation – cardinal signs §redness §swelling §tenderness / pain §warm §loss... Tuberculous Arthritis •Hematogenous dissemination of organisms or direct from adjacent tissue •Slow but  progressive destructive process •Caseatin... Tuberculous Arthritis  Clinicopathologic correlation •Usually hip or knee in children •Granulomatous inflammation leads to joint destruction, anky... Infective arthritis Specific clinicopathologic variants •Gonococcal arthritis §usually in women or homosexual men §poly-arthritis – hands, wrists,... Infective arthritis  Specific clinicopathologic variants •Virus-associated arthritis §transient arthralgia §hands, wrists §Hepatitis B §rubella §i... Other infective conditions Rare causes •Parasite infestation eg. §Echinococcus cysts may involve and present with skeletal lesions § •Fungi eg. §S... Necrotizing granulomatous inflammation Granulomas with multinucleated giant cells Uninvolved vertebra Extrusion of disc Collapsed vertebra Caseating necrosis Spread around psoas muscle Univolved disc Extention of necrosis into d... Bacterial infection of vertebrae Vertebra Acute suppurative inflammation in vertebra Direct extention of pus into disc and adjacent vertebrae Norm... Micro-abscess Epiphysis Marrow Cartilage Cortex Epiphyseal plate Capillary loop Cortex Periosteum Marrow Bone trabeculae Metaphysis Pyogenic osteo... Cortex Abscess Periosteal reactive bone Bone resorption: osteoclast Organisation: fibrosis Trabeculae New reactive bone: osteoblasts Pyogenic oste... Expansion of abscess Periosteal elevation Shearing of arteries Subperiosteal abscess Reactive bone Ischemia = osteonecrosis (sequestrum) Pyogenic ... Pus in joint Extension into soft tissue Draining sinus Skin Cortical necrosis = sequestrum Reactive bone surround sequestrum: involucrum Continuou... Acute Pyogenic osteomyelitis Pathogenesis •Acute OM – neutrophils and suppuration •Anatomical site varies according to age §Children and adolescen... Inflammatory exudate with predominantly lymphocytes (­) and macrophages (­­) ­ ­­ ­ Organisation of exudate (1) – note granulation tissue (2) and fibrosis (3) (1) (2) (3) Chronic inflammation (1) with fibrosis (2) and reactive bone (3) (1) (2) (3) Chronic Osteomyelitis Complications •Draining of pus from cutaneous sinusses •Squamous cell carcinoma in cutaneous sinusses •Pathological fracture... Granulomatous inflammation with epitelioid cells (*) * * This page uses frames, but your browser doesn't support them. End of slide show, click to exit. Slide 1 INFECTIVE CONDITIONS OF THE MUSCULOSKELETAL SYSTEM THEME 4 Background knowledge Osteomyelitis - concept Acute and chronic pyogenic (septic... Slide 1 INFECTIVE CONDITIONS OF THE MUSCULOSKELETAL SYSTEM THEME 4 PROF. JOHANN W SCHNEIDER DEPARTMENT OF ANATOMICAL PATHOLOGY UNIVERSITY OF STELL... INFECTIVE CONDITIONS OF THE MUSCULOSKELETAL SYSTEM THEME 4 PROF. JOHANN W SCHNEIDER DEPARTMENT OF ANATOMICAL PATHOLOGY UNIVERSITY OF STELLENBOSCH ... Background knowledge • acute and chronic inflammation • cellulitis and erysipelas • necrotising inflammation • suppuration • abscess formation • g... Acute and chronic pyogenic (septic) OM Etiological agents • usually children + adolescents § especially S. aureus • receptors for bone matrix comp... Acute Pyogenic osteomyelitis Pathogenesis • Organisms reach capillaries in § metaphyseal marrow cavitiy § acute inflammation with neutrophils and ... Osteomyelitis - concept • Inflammation of bone and bone marrow cavity • The term OM refers by convention to infective agents • OM can be acute or ... Acute and chronic pyogenic (septic) OM  Etiological agents • Organisms reach bone via: § hematogenous dissemination (bacteria) – most common § dir... Acute pyogenic osteomyelitis Pathogenesis • Central ischemia and necrosis of bone with suppuration and extention through cortical bone • Infection... Pyogenic osteomyelitis Pathogenesis and complications • Progression of infection • Subperiosteal abscesses spread to § skin = draining sinusses § ... Chronic pyogenic osteomyelitis  Pathogenesis and complications • Complication of AOM § acute inflammatory process replaced by chronic inflammation... Chronic osteomyelitis Pathogenesis and complications • Persistance of sequestrum and involucrum • Brodie’s abscess (subacute OM) § residual absces... Chronic pyogenic osteomyelitis  Clinicopathologic correlation • Initially cardinal features of acute inflammation § redness § pain § swelling § he... Tuberculous OM • 1 – 3% from pulmonary TB • Spread to bone § hematogenous dissemination to long bones and vertebrae § direct spread to bone from a... Tuberculous OM • Slow evolution of disease process § diagnosis often after severe tissue damage • Extension to joint spaces = TB arthritis • Destr... Infective arthritis Etiology • Pyogenic (septic) arthritis § Gonococcal § Staphylococcus aureus § Streptococci • Gram negative organisms (drug add... Infective pyogenic arthritis  Pathogenesis • Hematogenous dissemination from a septic focus elsewhere eg. endocarditis; bacteremia • Direct trauma... Infective arthritis  Pathogenesis • More common in children • Predisposing factors § Diabetes mellitus § Rheumatoid arthritis § Intra-articular pr... Infective pyogenic arthritis  Clinicopathologic correlation • usually mono-arthritis of large joints • purulent material in joint space • damage o... Infective pyogenic arthritis  Clinicopathologic correlation • Acute inflammation – cardinal signs § redness § swelling § tenderness / pain § warm ... Tuberculous Arthritis • Hematogenous dissemination of organisms or direct from adjacent tissue • Slow but  progressive destructive process • Casea... Tuberculous Arthritis  Clinicopathologic correlation • Usually hip or knee in children • Granulomatous inflammation leads to joint destruction, an... Infective arthritis Specific clinicopathologic variants • Gonococcal arthritis § usually in women or homosexual men § poly-arthritis – hands, wris... Infective arthritis  Specific clinicopathologic variants • Virus-associated arthritis § transient arthralgia § hands, wrists § Hepatitis B § rubel... Other infective conditions Rare causes • Parasite infestation eg. § Echinococcus cysts may involve and present with skeletal lesions • Fungi eg. §... Necrotizing granulomatous inflammation Granulomas with multinucleated giant cells Tuberculosis of vertebrae Spinal cord Uninvolved vertebra Extrusion of disc Collapsed vertebra Extention of necrosis into dura Caseating necrosis ... Bacterial infection of vertebrae Vertebra Direct extention of pus into disc and adjacent vertebrae Pus into dura Acute suppurative inflammation in... Pyogenic osteomyelitis -pathogenesis Marrow Cartilage Epiphysis Cortex Epiphyseal plate Capillary loop Micro-abscess Metaphysis Cortex Periosteum ... Pyogenic osteomyelitis -pathogenesis Cortex Abscess Periosteal reactive bone Bone resorption: osteoclast Trabeculae Organisation: fibrosis New rea... Pyogenic osteomyelitis -pathogenesis Expansion of abscess Periosteal elevation Subperiosteal abscess Shearing of arteries Reactive bone Ischemia =... Pyogenic osteomyelitis -pathogenesis Pus in joint Extension into soft tissue Skin Draining sinus Cortical necrosis = sequestrum sequestrum Reactiv... Acute Pyogenic osteomyelitis Pathogenesis • Acute OM – neutrophils and suppuration • Anatomical site varies according to age § Children and adoles... Inflammatory exudate with predominantly lymphocytes (?) and macrophages (??) ? ? ?? Organisation of exudate (1) – note granulation tissue (2) and fibrosis (3) (1) (3) (2) Chronic inflammation (1) with fibrosis (2) and reactive bone (3) (1) (2) (3) Chronic Osteomyelitis Complications • Draining of pus from cutaneous sinusses • Squamous cell carcinoma in cutaneous sinusses • Pathological fract... Granulomatous inflammation with epitelioid cells (*) * * INFEKTIEWE TOESTANDE VAN DIEMUSKULOSKELETALE STELSEL TEMA 4 09-Feb-04 Click here to start Table of Contents PPT Slide INFEKTIEWE TOESTANDE VAN DIE... INFEKTIEWE TOESTANDE VAN DIEMUSKULOSKELETALE STELSEL TEMA 4 PROF. JOHANN W SCHNEIDER DEPARTEMENT VAN ANATOMIESE PATOLOGIE UNIVERSITEIT VAN STELLEN... Slide 1 of 35 Slide 2 of 35 Slide 3 of 35 Slide 4 of 35 Slide 5 of 35 Slide 6 of 35 Slide 7 of 35 Slide 8 of 35 Slide 9 of 35 Slide 10 of 35 Slide 11 of 35 Slide 12 of 35 Slide 13 of 35 Slide 14 of 35 Slide 15 of 35 Slide 16 of 35 Slide 17 of 35 Slide 18 of 35 Slide 19 of 35 Slide 20 of 35 Slide 21 of 35 Slide 22 of 35 Slide 23 of 35 Slide 24 of 35 Slide 25 of 35 Slide 26 of 35 Slide 27 of 35 Slide 28 of 35 Slide 29 of 35 Slide 30 of 35 Slide 31 of 35 Slide 32 of 35 Slide 33 of 35 Slide 34 of 35 Slide 35 of 35 PPT Slide Next slide Back to first slide View graphic version INFEKTIEWE TOESTANDE VAN DIEMUSKULOSKELETALE STELSEL TEMA 4 PROF. JOHANN W SCHNEIDER DEPARTEMENT VAN ANATOMIESE PATOLOGIE UNIVERSITEIT VAN STELLEN... Agtergrondkennis akute en chroniese ontsteking sellulitis en erisipelas nekrotiserende ontsteking verettering absesvorming granulomateuse ontsteki... Akute en chroniese OM Infeksie en ontsteking van been tipies metafises van langbene ook ander bene insluitende werwels Etiologiese agense Bakterie... Piogene (septiese) Osteomiëlitis Etiologie gewoonlik kinders + adolessente veral S. aureus pneumokokke gonokokke pseudomonas neonate groep B Strep... Akute Piogene OsteomiëlitisPatogenese hematogene verspreiding (bakteremie) direk na trouma (oop fraktuur, penetrasie) sekondęr vanaf sagte weefsel... Akute Piogene OsteomiëlitisPatogenese Organismes bereik kapillęre bloedvate in metafiseale murgholte mikro-absessies resorpsie van naasliggende be... Piogene Osteomiëlitis - Patogenese Epifise Beenmurg Kraakbeen Korteks Epifiseale plaat Kapillęre lus Mikro-abses Korteks Periosteum Beenmurg Beent... Piogene Osteomiëlitis - Patogenese Korteks Abses Periosteale reaktiewe been Beenresorpsie: osteoklaste Organisasie: fibrose Trabekels Nuwe reaktie... Akute Piogene OsteomiëlitisPatogenese Sentrale isgemie en nekrose van been Infeksie versprei deur die korteks subperiosteale absesse reaktiewe sub... Piogene Osteomiëlitis - Patogenese Uitbreiding van abses Periosteale stroping Bloedvate skeur Subperiosteale abses Reaktiewe been Isgemie = beenne... Akute Piogene OsteomiëlitisPatogenese en komplikasies Progressie van infeksie lei tot Skeuring van perforerende arteries Kortikale beennekrose Sen... Piogene Osteomiëlitis - Patogenese Etter in gewrig Uitbreiding na sagte weefsel Dreinerende sinus Vel Kortikale nekrose = sekwestrum Reaktiewe bee... PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version Chroniese OsteomiëlitisPatogenese en komplikasies Subperiosteale absesse versprei na sagte weefsel = veretterrende ontsteking dreinerende sinusse ... Akute Piogene OsteomiëlitisKlinies-patologiese korrelasie Aanvanklik kardinale tekens van akute ontsteking Koors en sistemiese manifestasies Septi... Chroniese Piogene OsteomiëlitisKlinies-patologiese korrelasie Dreinering van etter deur chroniese velsinusse Plaveiselkarsinoom in velsinusse Pato... Tuberkuleuse OM Hematogene verspreiding na been lang bene en werwels Direkte uitbreiding na been bv. tuberkuleuse limfadenitis Verkasende granulom... PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version Tuberkuleuse OM Siekteproses verloop stadig diagnose dikwels na erge weefselskade Versprei na gewrigspasies = TB artritis Vernietiging van werwels... Infektiewe Artritis Etiologie Piogene (Septiese) artritis Gonokokkaal Spirogete Tuberkuleuse artritis Virusse Previous slide Next slide Back to fi... Infektiewe Artritis Etiologie PIOGENE (Septiese) artritis Staphylococcus aureus + S. albus Streptococcus pyogenes Streptococcus pneumoniae Neisser... Infektiewe Artritis Patogenese Hematogene verspreiding van septiese fokus elders bv. endokarditis; bakteremie Selde vanaf naasliggende OM epifisea... Infektiewe Artritis Patogenese Meer algemeen in kinders Predisponerende faktore Diabetes mellitus Rumatoďede artritis Intra-artikulęre prosedures ... Infektiewe Artritis Klinies patologiese korrelasie gew. mono-artritis van groot gewrigte purulente materiaal in die gewrigspasie gewrigsvlakke bes... Infektiewe Artritis Klinies patologiese korrelasie Akute ontsteking – kardinale tekens rooiheid swelsel teerheid / pyn warmte afname in funksie Si... Tuberkuleuse Artritis organismes versprei hematogeen of direk stadig-verlopende vernietigende proses verkasende granulomateuse ontsteking organisa... Tuberkuleuse Artritis Klinies patologiese korrelasie Gewoonlik heup of knie in kinders Werwelkolom meer alg. in volwassenes as deel van TB osteomi... Tuberkulose van werwels Normale werwel Uitstulp van diskus Kollabeerde werwel Verkasende nekrose Verspreiding langs psoasspier Normale diskus Uitb... Bakteriële infeksie van werwels Werwelliggaam Akute veretterende ontsteking in werwel Direkte uitbreiding na diskus en naasliggende werwels Normal... PPT Slide Previous slide Back to first slide View graphic version ‹header› ‹date/time› Click to edit Master text styles Second level Third level Fourth level Fifth level ‹footer› ‹#› ‹header› ‹date/time› ‹footer› ‹#› Click to edit Master title style Click to edit Master text styles Second level Third level Fourth level Fifth level ‹date/time› ‹footer› ‹#›  Notes Slide Show Outline 1   2 INFEKTIEWE TOESTANDE VAN DIE MUSKULOSKELETALE STELSEL TEMA 4 PROF. JOHANN W SCHNEIDER DEPARTEMENT ANATOMIESE PATOL... INFEKTIEWE TOESTANDE VAN DIE MUSKULOSKELETALE STELSEL TEMA 4 PROF. JOHANN W SCHNEIDER DEPARTEMENT ANATOMIESE PATOLOGIE UNIVERSITEIT VAN STELLENBOS... Agtergrondkennis •akute en chroniese ontsteking •sellulitis en erisipelas •nekrotiserende ontsteking •verettering •absesvorming •granulomateuse on... Piogene osteomiëlitis Etiologiese agense •gewoonlik kinders + adolessente §veral Staphylococcus aureus •reseptore vir beenmatriks komponente •bevo... Akute Piogene Osteomiëlitis Patogenese •Organismes bereik kapillęre bloedvate in §metafiseale murgholte §akute ontsteking met neutrofiele en veret... Akute en chroniese piogene (septiese) OM Etiologiese agense •Organismes bereik been deur : • §hematogeen (bakteremie) - mees algemeen §direkte uit... Akute Piogene Osteomiëlitis Patogenese • •Akute OM – neutrofiele en verettering •Anatomiese ligging wissel met ouderdom: §kinders en adolessente =... Akute Piogene Osteomiëlitis Patogenese •Sentrale isgemie en nekrose van been met verettering en uitbreiding deur kortikale been •Infeksie versprei... Akute Piogene Osteomiëlitis Patogenese en komplikasies •Progressie van infeksie •Subperiosteale absesse versprei na §vel = dreinerende sinusse §aa... Chroniese Osteomiëlitis Patogenese •Komplikasie van AOM §akute inflammatoriese proses vervang met chroniese ontsteking en bindweefselherstel §been... Akute Piogene Osteomiëlitis Klinies-patologiese korrelasie •Aanvanklik kardinale tekens van akute ontsteking §rooiheid §pyn §swelling §hitte §verl... Chroniese Piogene Osteomiëlitis Komplikasies •Dreinering van etter deur chroniese velsinusse • •Plaveiselkarsinoom in velsinusse • •Patologiese fr... Tuberkuleuse OM •1 – 3% van pulmomale TB •verspreiding na been §hematogeen na lang bene en werwels §direkte uitbreiding na been bv. vanaf tuberkul... Tuberkuleuse OM •Siekteproses verloop stadig §diagnose dikwels na erge weefselskade •Versprei na gewrigspasies = TB artritis •Vernietiging van wer... Infektiewe piogene artritis Etiologie •Piogene (Septiese) artritis §Gonokokkaal §Staphylococcus aureus §Streptokokke •Gram- organismes (dwelmversl... Infektiewe piogene artritis Patogenese •Hematogene verspreiding van septiese fokus elders bv. endokarditis; bakteremie •Direkte trauma van die gew... Infektiewe piogene Artritis Patogenese •Meer algemeen in kinders •Predisponerende faktore §Diabetes mellitus §Rumatoďede artritis §Intra-artikulęr... Infektiewe piogene artritis Klinies patologiese korrelasie •gewoonlik mono-artritis van groot gewrigte •purulente materiaal in die gewrigspasie •g... Infektiewe piogene artritis  Klinies patologiese korrelasie •Akute ontsteking – kardinale tekens §rooiheid §swelsel §teerheid / pyn §warmte §afnam... Tuberkuleuse Artritis •organismes versprei hematogeen of direk §sinovium voorkeurarea vir infeksie •stadig-verlopende vernietigende proses •verkas... Tuberkuleuse Artritis  Klinies patologiese korrelasie •Gewoonlik heup of knie in kinders •Granulomateuse ontsteking lei tot gewrigs-vernietiging, ... Inflammatoriese eksudaat met oorwegend limfosiete (­) en makrofae (­­) ­ ­­ ­ Organisasie van eksudaat (1) – let op granulasieweefsel (2) en fibrose (3) (1) (2) (3) Chroniese ontsteking (1) met fibrose (2) en reaktiewe been (3) (1) (2) (3) Nekrotiserende granulomateuse ontsteking Granulome met meerkernige reuseselle Granulomateuse ontsteking met epitelioďedselle (*) * * Normale werwel Uitstulp van diskus Kollabeerde werwel Verkasende nekrose Verspreiding langs psoasspier Normale diskus Uitbreiding van nekrose na d... Piogene OM van werwels Werwelliggaam Akute veretterende ontsteking in werwel Direkte uitbreiding na diskus en naasliggende werwels Normale diskus ... Epifise Beenmurg Kraakbeen Korteks Epifiseale plaat Kapillęre lus Mikro-abses Korteks Periosteum Beenmurg Beentrabekels Metafise Piogene Osteomiël... Korteks Abses Periosteale reaktiewe been Beenresorpsie: osteoklaste Organisasie: fibrose Trabekels Nuwe reaktiewe been: osteoblaste  Piogene Osteo... Uitbreiding van abses Periosteale stroping Bloedvate skeur Subperiosteale abses Reaktiewe been Isgemie = beennekrose (sekwestrum) Piogene Osteomië... Etter in gewrig Uitbreiding na sagte weefsel Dreinerende sinus Vel Kortikale nekrose = sekwestrum Reaktiewe been omring sekwestrum: involucrum Vol... Osteomiëlitis - konsep •Ontsteking van die been en beenmurgholte •Die term OM verwys by konvensie na infektiewe agense •OM kan akuut of chronies w... Chroniese Osteomiëlitis Patogenese en komplikasies •Sekwestrum en involucrum persisteer •Brodie se abses (subakute OM) §oorblywende abses wat omri... Infektiewe Artritis Spesifieke klinies-patologiese variante •Gonokokkale artritis §Veral in vrouens en homoseksuele mans §Poli-artritis – hande, p... Infektiewe Artritis Spesifieke klinies-patologiese variante •Virus-geassosieerde artritis §verbygaande artralgie §hande, polsgewrigte §Hepatitis B... Ander Infektiewe Toestande Raar oorsake •Parasiet infestasie bv. §Echinococcus siste kan met skeletale letsels presenteer § •Swaminfeksies bv. §Sp... This page uses frames, but your browser doesn't support them. End of slide show, click to exit. Slide 1 INFEKTIEWE TOESTANDE VAN DIE MUSKULOSKELETALE STELSEL TEMA 4 Agtergrondkennis Osteomiëlitis - konsep Akute en chroniese piogene (septiese)... Slide 1 INFEKTIEWE TOESTANDE VAN DIE MUSKULOSKELETALE STELSEL TEMA 4 PROF. JOHANN W SCHNEIDER DEPARTEMENT ANATOMIESE PATOLOGIE UNIVERSITEIT VAN ST... INFEKTIEWE TOESTANDE VAN DIE MUSKULOSKELETALE STELSEL TEMA 4 PROF. JOHANN W SCHNEIDER DEPARTEMENT ANATOMIESE PATOLOGIE UNIVERSITEIT VAN STELLENBOS... Agtergrondkennis • akute en chroniese ontsteking • sellulitis en erisipelas • nekrotiserende ontsteking • verettering • absesvorming • granulomate... Piogene osteomiëlitis Etiologiese agense • gewoonlik kinders + adolessente § veral Staphylococcus aureus • reseptore vir beenmatriks komponente • ... Akute Piogene Osteomiëlitis Patogenese • Organismes bereik kapillęre bloedvate in § metafiseale murgholte § akute ontsteking met neutrofiele en ve... Akute en chroniese piogene (septiese) OM Etiologiese agense • Organismes bereik been deur : § hematogeen (bakteremie) - mees algemeen § direkte ui... Akute Piogene Osteomiëlitis Patogenese • Akute OM – neutrofiele en verettering • Anatomiese ligging wissel met ouderdom: § kinders en adolessente ... Akute Piogene Osteomiëlitis Patogenese • Sentrale isgemie en nekrose van been met verettering en uitbreiding deur kortikale been • Infeksie verspr... Akute Piogene Osteomiëlitis Patogenese en komplikasies • Progressie van infeksie • Subperiosteale absesse versprei na § vel = dreinerende sinusse ... Chroniese Osteomiëlitis Patogenese • Komplikasie van AOM § akute inflammatoriese proses vervang met chroniese ontsteking en bindweefselherstel § b... Akute Piogene Osteomiëlitis Klinies-patologiese korrelasie • Aanvanklik kardinale tekens van akute ontsteking § rooiheid § pyn § swelling § hitte ... Chroniese Piogene Osteomiëlitis Komplikasies • Dreinering van etter deur chroniese velsinusse • Plaveiselkarsinoom in velsinusse • Patologiese fra... Tuberkuleuse OM • 1 – 3% van pulmomale TB • verspreiding na been § hematogeen na lang bene en werwels § direkte uitbreiding na been bv. vanaf tube... Tuberkuleuse OM • Siekteproses verloop stadig § diagnose dikwels na erge weefselskade • Versprei na gewrigspasies = TB artritis • Vernietiging van... Infektiewe piogene artritis Etiologie • Piogene (Septiese) artritis § Gonokokkaal § Staphylococcus aureus § Streptokokke • Gram- organismes (dwelm... Infektiewe piogene artritis Patogenese • Hematogene verspreiding van septiese fokus elders bv. endokarditis; bakteremie • Direkte trauma van die g... Infektiewe piogene Artritis Patogenese • Meer algemeen in kinders • Predisponerende faktore § Diabetes mellitus § Rumatoďede artritis § Intra-arti... Infektiewe piogene artritis Klinies patologiese korrelasie • gewoonlik mono-artritis van groot gewrigte • purulente materiaal in die gewrigspasie ... Infektiewe piogene artritis  Klinies patologiese korrelasie • Akute ontsteking – kardinale tekens § rooiheid § swelsel § teerheid / pyn § warmte §... Tuberkuleuse Artritis • organismes versprei hematogeen of direk § sinovium voorkeurarea vir infeksie • stadig-verlopende vernietigende proses • ve... Tuberkuleuse Artritis  Klinies patologiese korrelasie • Gewoonlik heup of knie in kinders • Granulomateuse ontsteking lei tot gewrigs- vernietigin... Inflammatoriese eksudaat met oorwegend limfosiete (?) en makrofae (??) ? ? ?? Organisasie van eksudaat (1) – let op granulasieweefsel (2) en fibrose (3) (1) (3) (2) Chroniese ontsteking (1) met fibrose (2) en reaktiewe been (3) (1) (2) (3) Nekrotiserende granulomateuse ontsteking Granulome met meerkernige reuseselle Granulomateuse ontsteking met epitelioďedselle (*) * * Tuberkulose van werwels Spinaalkoord Normale werwel Uitstulp van diskus Kollabeerde werwel Uitbreiding van nekrose na dura Verkasende nekrose Norm... Piogene OM van werwels Werwelliggaam Direkte uitbreiding na diskus en naasliggende werwels Etter na dura Akute veretterende ontsteking in werwel S... Piogene Osteomiëlitis - Patogenese Beenmurg Kraakbeen Epifise Korteks Epifiseale plaat Kapillęre lus Mikro-abses Metafise Korteks Periosteum Beenm...  Piogene Osteomiëlitis - Patogenese Korteks Abses Beenresorpsie: osteoklaste Trabekels Organisasie: fibrose Nuwe reaktiewe been: osteoblaste Piogene Osteomiëlitis - Patogenese Uitbreiding van abses Periosteale stroping Subperiosteale abses Bloedvate skeur Reaktiewe been Isgemie = beenne... Piogene Osteomiëlitis - Patogenese Etter in gewrig Uitbreiding na sagte weefsel Vel Dreinerende sinus Kortikale nekrose = sekwestrum sekwestrum Vo... Osteomiëlitis - konsep • Ontsteking van die been en beenmurgholte • Die term OM verwys by konvensie na infektiewe agense • OM kan akuut of chronie... Chroniese Osteomiëlitis Patogenese en komplikasies • Sekwestrum en involucrum persisteer • Brodie se abses (subakute OM) § oorblywende abses wat o... Infektiewe Artritis Spesifieke klinies-patologiese variante • Gonokokkale artritis § Veral in vrouens en homoseksuele mans § Poli-artritis – hande... Infektiewe Artritis Spesifieke klinies-patologiese variante • Virus-geassosieerde artritis § verbygaande artralgie § hande, polsgewrigte § Hepatit... Ander Infektiewe Toestande Raar oorsake • Parasiet infestasie bv. § Echinococcus siste kan met skeletale letsels presenteer • Swaminfeksies bv. § ... MUSKULOSKELETALE INFEKSIES QUIZ A)?n 58-jarige vrou, bekend met rumatoďede artritis, presenteer met erge pyn van die knie ten spyte van ?n intra-a... A JBJS article on Septic Arthritis - for 4th Year MB Chb Medical Class INFECTIVE CONDITIONS OF THEMUSCULOSKELETAL SYSTEM THEME 4 09-Feb-04 Click here to start Table of Contents INFECTIVE CONDITIONS OF THEMUSCULOSKELET... INFECTIVE CONDITIONS OF THEMUSCULOSKELETAL SYSTEM THEME 4 PROF. JOHANN W SCHNEIDER DEPARTMENT OF ANATOMICAL PATHOLOGY UNIVERSITY OF STELLENBOSCH F... Slide 1 of 36 Slide 2 of 36 Slide 3 of 36 Slide 4 of 36 Slide 5 of 36 Slide 6 of 36 Slide 7 of 36 Slide 8 of 36 Slide 9 of 36 Slide 10 of 36 Slide 11 of 36 Slide 12 of 36 Slide 13 of 36 Slide 14 of 36 Slide 15 of 36 Slide 16 of 36 Slide 17 of 36 Slide 18 of 36 Slide 19 of 36 Slide 20 of 36 Slide 21 of 36 Slide 22 of 36 Slide 23 of 36 Slide 24 of 36 Slide 25 of 36 Slide 26 of 36 Slide 27 of 36 Slide 28 of 36 Slide 29 of 36 Slide 30 of 36 Slide 31 of 36 Slide 32 of 36 Slide 33 of 36 Slide 34 of 36 Slide 35 of 36 Slide 36 of 36 INFECTIVE CONDITIONS OF THEMUSCULOSKELETAL SYSTEM THEME 4 PROF. JOHANN W SCHNEIDER DEPARTMENT OF ANATOMICAL PATHOLOGY UNIVERSITY OF STELLENBOSCH F... Background knowledge acute and chronic inflammation cellulitis and erysipelas necrotising inflammation suppuration abscess formation granulomatous... Acute and chronic osteomyelitis Infection and inflammation of bone typical metaphysis of long bone also other bones including vertebrae Etiologic ... Pyogenic (septic) osteomyelitis Etiology usually children + adolescents especially S. aureus pneumococci gonococci pseudomonas neonates group B St... Pyogenic osteomyelitis Pathogenesis hematogenous dissemination (bacteria) direct following trauma (open fracture, penetration) secondary from soft... Pyogenic osteomyelitis Pathogenesis Organisms reach capillaries in metaphyseal marrow cavitiy micro-abscesses resorption of adjacent bone trabecul... Pyogenic osteomyelitis -pathogenesis Epiphysis Marrow Cartilage Cortex Epiphyseal plate Capillary loop Micro-abscess Cortex Periosteum Marrow Bone... Pyogenic osteomyelitis -pathogenesis Cortex Abscess Periosteal reactive bone Bone resorption: osteoclast Organisation: fibrosis Trabeculae New rea... Pyogenic osteomyelitis Pathogenesis Central ischemia and necrosis of bone Infection expands through cortex subperiosteal abscesses reactive subper... Pyogenic osteomyelitis -pathogenesis Expansion of abscess Periosteal elevation Shearing of arteries Subperiosteal abscess Reactive bone Ischemia =... Pyogenic osteomyelitis Pathogenesis and complications Progression of infection leads to shearing of perforating arteries cortical osteonecrosis ce... Pyogenic osteomyelitis -pathogenesis Pus in joint Extension into soft tissue Draining sinus Skin Cortical necrosis = sequestrum Reactive bone surr... PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version Chronic pyogenic osteomyelitis Pathogenesis and complications Subperiosteal abscesses expand to soft tissue = suppurative inflammation draining si... Acute pyogenic osteomyelitis Clinicopathologic correlation Initially cardinal signs of acute inflammation Fever and systemic manifestations Septic... Chronic pyogenic osteomyelitis Clinicopathologic correlation Draining of pus through chronic skin sinuses Squamous cell carcinoma in skin sinuses ... Tuberculous OM Hematogenous dissemination long bones and vertebrae Direct extension from adjacent tissue eg. tuberculous lymphadenitis Caseating g... PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version Tuberculous OM Slow evolution of disease process diagnosis often after severe tissue damage Extension to joint spaces = TB arthritis Destruction o... Infective arthritis Etiology Pyogenic (septic) arthritis Gonococcal Spirochaetes Tuberculous arthritis Virusses Previous slide Next slide Back to ... Infective arthritis Etiology Pyogenic (septic) arthritis Staphylococcus aureus + S. albus Streptococcus pyogenes Streptococcus pneumoniae Neisseri... Infective arthritis Pathogenesis Hematogenous dissemination from a septic focus elsewhere eg. endocarditis; bacteremia Seldom from adjacent OM epi... Infective arthritis Pathogenesis More common in children Predisposing factors Diabetes mellitus Rheumatoid arthritis Intra-articular procedures in... Infective arthritis Clinicopathologic correlation usually mono-arthritis of large joints purulent material in joint space damage of joint surfaces... Infective arthritis Clinicopathologic correlation Acute inflammation – cardinal signs redness swelling tenderness / pain warm loss of function Sys... Tuberculous Arthritis Hematogenous dissemination of organisms or direct from adjacent tissue Slow but progressive destructive process Caseating gr... Tuberculous Arthritis Clinicopathologic correlation Usually hip or knee in children Vertebrae most common in adults part of TB osteomyelitis verte... Tuberculosis of vertebrae Uninvolved vertebra Extrusion of disc Collapsed vertebra Caseating necrosis Spread around psoas muscle Univolved disc Ex... Bacterial infection of vertebrae Vertebra Acute suppurative inflammation in vertebra Direct extention of pus into disc and adjacent vertebrae Norm... Infective arthritis Specific clinicopathologic variants Gonococcal arthritis usually in women or homosexual men poly-arthritis – hands, wrists, kn... Infective arthritis Specific clinicopathologic variants Virus-associated arthritis transient arthralgia hands, wrists Hepatitis B rubella infectiv... Other infective conditions Rare causes Parasite infestation eg. Echinococcus cysts may involve and present with skeletal lesions Fungi eg. Sporoth... MUSCULO-SKELETAL INFECTIONS (Bone, Joint and Soft tissue infections) Bone infection (osteomyelitis) and Joint infection (arthritis) Predisposing f... Overview of Septic Arthritis for Medical Students and Generap Practitioners OA & AVN Hip 13 Feb 2002 Hip: Osteoarthritis, Avascular Necrosis Lecture 4th years Ian Robertson Tema 10 Avascular Necrosis Late Changes Collapse ... Bone Tumors MbChB 4 05/02/02 n n n n n n n n n n n ICM Robertson 1 No license: PDF produced by PStill (c) F. Siegert - http://www.this.net/~frank/... Case B Go back Discussion The femoral condyle,on the medial side, shows a fuzziness, that is due to the cortex being broken through by a malignant... Case B Previous Diagnosis AP Xray Lateral View Magntic Resonance History Age:18 years Sex: Male Pain - gradual onset in L knee over 3 months Case B: Magnetic Resonance Image Back Case B Previous Treatment Treatment Osteosarcoma Chemotherapy - Preoperatively Surgery - remove with good margin Amputation Block resection - limb... Case B Previous The following will have to be done for stageing Type Discussion Blood Tests What tests would you do? Imaging What Imaging studies ... Lower Limb Trauma Crossword Complete the crossword, then click on "Check" to check your answer. If you are stuck, you can click on "Hint" to get a... GIF89a# ˙ţ< 10.0.0.5605 Provider=Microsoft.Jet.OLEDB.4.0;Password=&quot;&quot;;User ID=ICM Robertson;Data Source=http://robertson/mainsite/test4.mdb;Mode=Shar... ˙ţ< human gait cycle normal abnormal Pivot Shift Test The anterior cruciate ligament usually breaks in substance A result of the anterior deficient knee is that the patient complains ... Hip dislocations & fractures, femur shaft fractures 19/02/2002 8am Fractures of the Femur, Hip & Dislocations MB ChB 4 Lecture by ICM Robertson Fe... CRITOE. Ossification centres about the elbow Risser's sign - determination of skeletal age Fractures of the Forearm 16-Apr-03 Click here to start Table of Contents Fractures of the Forearm Olecranon Olecranon Radial Head Radial Head Rad.... Notes: This basic lecture discusses the management of fractures of the forearm. Problem fracture, such as the radial head, s and fracture dislocat... Notes: Olecranon fractures are usually displaced because the triceps pulls the olecranon tip proximally. Test for continuity in the extension mech... Notes: If a plate is used in Olecranon fractures, make sure it is not too bulky. Notes: A fall onto the outstretched arm results in the force being transmitted: Up the proximal radius Force is then shared or transferred to the ... Notes: The radial head is an elbow stabiliser. The Ulnar collateral ligament can give way with a varus stress and it too must be stressed and eval... Notes: This is a case where the radial head was resected and the elbow redislocated a few days later because the radial head was not there to stab... Notes: This wrist is an example of radio- Ulnar dissociation caused by a fall on the outstretched hand. The interosseous membrane ruptured and the... Notes: Mason Classification: Type 1: Undisplaced Type 2. Minimally displaced Type 3. Severe comminution Notes: Slide shows a type 2. The fragment is small but displaced. Notes: Slide shows an approach to the radial head by performing a small osteotomy of the lateral epicondyle. Notes: Type 1 fractures can be treated conservatively with early mobilisation. Type 2 fractures need ORIF. The fixation must be done using small p... Notes: A severely communted type 3 fracture. Open reduction is possible but is a challenge! Radial head excision or prosthetic replacements are ot... Notes: In this displaced radial neck fracture a small ‘T’ plate has been used to maintain reduction. Notes: The role of Radial Head excision is getting more limited recently with the advent of prosthetic heads. It is indicated in the stable irrepa... Notes: A prosthetic head replacement is indicated in unstable type 3 radial head fractures. Avoid silicone - make use of a metal head. Notes: Examples of modern prosthetic Radial Heads Some designs are bipolar to allow swiveling of the head. . Notes: High energy lesions such as the above are often unstable. Notes: If the Olecranon fractures with the radial head it is an unstable lesion. Fix the Ulnar fracture with a plate and replace the radial head w... Notes: Coroniod process fractures are a result of elbow dislocations. Notes: Classification. Type 1: - tip avulsion only Type 2: - &#060 50 % of the height of the process is off. Type 3: &#062 50% process fractured o... Notes: Type 3 Coroniod fractures need open reduction and internal fixation. An anterior approach is needed. There are invariably the injuries such... Notes: Most radius and Ulnar fractures require ORIF in the adult. In a child greenstick fractures are the rule and closed reduction and plaster ca... Notes: If there is nor good bone contact due to comminution or a butterfly fracture. Supplement your ORIF with a bone graft. Notes: How accurate must your reduction be in children? Try to get a perfect reduction! Before osteotomy can be considered, accept up to 10 degree... Notes: A Monteggia fracture is an Ulnar fracture with a Radial Head dislocation. Notes: The previous fracture fixed with a plate and the radial head reduced spontaneously. Always check that the head indeed reduced by using fluo... Notes: Types of Monteggia lesions. The type 4 is usually due to massive trauma and there is extensive soft tissue damage. Notes: Plate the ulna first. Usually the radial head reduces spontaneously. Notes: As the Ulnar fracture is a greenstick, closed reduction is usually all that is required in children. The reduction is maintained in an abov... Notes: A Volar Barton’s has a volar lip of bone and is difficult to treat conservatively. The best treatment is a volar plate. Notes: In Commiunted fractures of the distal radius ORIF in the form of K wires is sometimes required. This is preferable to relying on extreme po... Notes: In comminuted fractures maintaining length is difficult in a plaster cast. In these situations an external fixator between the Radial shaft... Notes: Forearm fractures are sometimes open. The principle is to debride the wound and then to fix the fracture with ORIF or other appropriate met... Notes: The forearm is sometimes massively traumatised with multiple fractures at several levels. Notes: This may require ingenuity as to the appropriate type of fixation. Here the ulna has been plated but the comminuted Radius fracture has bee... Notes: Subsequently the radius started to unite in dorsal angulation. The solution was to do a corrective osteotomy. The fracture was plated with ... Notes: In segmental fractures as in this case plates may strip too much of the blood supply to the shaft. Here the Radius was plated and the ulna ... Notes: Complications of forearm fractures are most commonly non or delayed union. Avoid removing metal too early as delayed union under a plate is... Fractures of the Forearm Olecranon Olecranon Radial Head Radial Head Rad. Head & Stability Radial Head Radial Head Radial Head Radial Head Radial ... Fractures of the Forearm AO Basic Course 19/10/2002 ICM Robertson Olecranon Tension band Transverse #s Olecranon Comminuted #s - use plate Radial ... Your browser does not support frames. Try Internet Explorer 3.0 or later or Netscape Navigator 2.0 or later . Slide 1 of 47 Notes: This basic lecture discusses the management of fractures of the forearm. Problem fracture, such as the radial head, s and fra... Slide 2 of 47 Notes: Olecranon fractures are usually displaced because the triceps pulls the olecranon tip proximally. Test for continuity in the ... Slide 3 of 47 Notes: If a plate is used in Olecranon fractures, make sure it is not too bulky. Slide 4 of 47 Notes: A fall onto the outstretched arm results in the force being transmitted: Up the proximal radius Force is then shared or trans... Slide 5 of 47 Notes: The radial head is an elbow stabiliser. The Ulnar collateral ligament can give way with a varus stress and it too must be str... Slide 6 of 47 Notes: This is a case where the radial head was resected and the elbow redislocated a few days later because the radial head was not... Slide 7 of 47 Notes: This wrist is an example of radio- Ulnar dissociation caused by a fall on the outstretched hand. The interosseous membrane ru... Slide 8 of 47 Notes: Mason Classification: Type 1: Undisplaced Type 2. Minimally displaced Type 3. Severe comminution Slide 9 of 47 Notes: Slide shows a type 2. The fragment is small but displaced. Slide 10 of 47 Notes: Slide shows an approach to the radial head by performing a small osteotomy of the lateral epicondyle. Slide 11 of 47 Notes: Type 1 fractures can be treated conservatively with early mobilisation. Type 2 fractures need ORIF. The fixation must be don... Slide 12 of 47 Notes: A severely communted type 3 fracture. Open reduction is possible but is a challenge! Radial head excision or prosthetic repl... Slide 13 of 47 Notes: In this displaced radial neck fracture a small ‘T’ plate has been used to maintain reduction. Slide 14 of 47 Notes: The role of Radial Head excision is getting more limited recently with the advent of prosthetic heads. It is indicated in th... Slide 15 of 47 Notes: A prosthetic head replacement is indicated in unstable type 3 radial head fractures. Avoid silicone - make use of a metal he... Slide 16 of 47 Notes: Examples of modern prosthetic Radial Heads Some designs are bipolar to allow swiveling of the head. . Locally available "Evo... Slide 17 of 47 Notes: High energy lesions such as the above are often unstable. Slide 18 of 47 Notes: If the Olecranon fractures with the radial head it is an unstable lesion. Fix the Ulnar fracture with a plate and replace th... Slide 19 of 47 Notes: Coroniod process fractures are a result of elbow dislocations. Slide 20 of 47 Notes: Classification. Type 1: - tip avulsion only Type 2: - &#060 50 % of the height of the process is off. Type 3: &#062 50% proc... Slide 21 of 47 Notes: Type 3 Coroniod fractures need open reduction and internal fixation. An anterior approach is needed. There are invariably th... Slide 22 of 47 Notes: Most radius and Ulnar fractures require ORIF in the adult. In a child greenstick fractures are the rule and closed reduction... Slide 23 of 47 Notes: If there is nor good bone contact due to comminution or a butterfly fracture. Supplement your ORIF with a bone graft. Slide 24 of 47 Notes: How accurate must your reduction be in children? Try to get a perfect reduction! Before osteotomy can be considered, accept ... Slide 25 of 47 Notes: A Monteggia fracture is an Ulnar fracture with a Radial Head dislocation. Slide 26 of 47 Notes: The previous fracture fixed with a plate and the radial head reduced spontaneously. Always check that the head indeed reduce... Slide 27 of 47 Notes: Types of Monteggia lesions. The type 4 is usually due to massive trauma and there is extensive soft tissue damage. Slide 28 of 47 Notes: Plate the ulna first. Usually the radial head reduces spontaneously. Slide 29 of 47 Notes: As the Ulnar fracture is a greenstick, closed reduction is usually all that is required in children. The reduction is mainta... Slide 30 of 47 Notes: The radial head appears to have reduced after plating. Slide 31 of 47 Notes: The same fracture 2 days later in the ward. The radial head has redislocated by the time this postop photo was taken. Check ... Slide 32 of 47 Notes: The reason for loss of reduction has to do with tracking. The well aligned radial head rotates about the same position in sp... Slide 33 of 47 Notes: Nightstick fractures of the Ulna with greater than half the diameter displaced have significant disruption of the interosseo... Slide 34 of 47 Slide 35 of 47 Slide 36 of 47 Notes: A Galeazzi fracture is a fracture of the Radius wit disruption of the radio-ulnar joint. Suspect it in all isolated Radius s... Slide 37 of 47 Notes: Distal Raduis fractures may be intra articular. They are usually displaced dorsally and the peroistial sleeve dorsally is in... Slide 38 of 47 Notes: A dorsal Barton’s fracture has a dorsal lip of bone. Slide 39 of 47 Notes: A Volar Barton’s has a volar lip of bone and is difficult to treat conservatively. The best treatment is a volar plate. Slide 40 of 47 Notes: In Commiunted fractures of the distal radius ORIF in the form of K wires is sometimes required. This is preferable to relyin... Slide 41 of 47 Notes: In comminuted fractures maintaining length is difficult in a plaster cast. In these situations an external fixator between t... Slide 42 of 47 Notes: Forearm fractures are sometimes open. The principle is to debride the wound and then to fix the fracture with ORIF or other ... Slide 43 of 47 Notes: The forearm is sometimes massively traumatised with multiple fractures at several levels. Slide 44 of 47 Notes: This may require ingenuity as to the appropriate type of fixation. Here the ulna has been plated but the comminuted Radius f... Slide 45 of 47 Notes: Subsequently the radius started to unite in dorsal angulation. The solution was to do a corrective osteotomy. The fracture w... Slide 46 of 47 Notes: In segmental fractures as in this case plates may strip too much of the blood supply to the shaft. Here the Radius was plate... Slide 47 of 47 Notes: Complications of forearm fractures are most commonly non or delayed union. Avoid removing metal too early as delayed union u... Fractures of the Forearm AO Basic Course 19/10/2002 ICM Robertson Next slide Back to first slide View graphic version Notes: This basic lecture di... Olecranon Tension band Transverse #s Previous slide Next slide Back to first slide View graphic version Notes: Olecranon fractures are usually dis... Olecranon Comminuted #s - use plate Previous slide Next slide Back to first slide View graphic version Notes: If a plate is used in Olecranon frac... Radial Head Force Transmission Previous slide Next slide Back to first slide View graphic version Notes: A fall onto the outstretched arm results ... Radial Head Stabiliser of elbow Associated injuries Ligamentous radioulnar joint Previous slide Next slide Back to first slide View graphic versio... Rad. Head & Stability Redislocation after resection Previous slide Next slide Back to first slide View graphic version Notes: This is a case where... Radial Head Stabiliser of elbow Associated injuries Ligamentous radioulnar joint Previous slide Next slide Back to first slide View graphic versio... Radial Head Classification- Mason Previous slide Next slide Back to first slide View graphic version Notes: Mason Classification: Type 1: Undispla... Radial Head Classification- Mason Type 1 Type 2 Type 3 Previous slide Next slide Back to first slide View graphic version Notes: Slide shows a typ... Radial Head Approach Previous slide Next slide Back to first slide View graphic version Notes: Slide shows an approach to the radial head by perfo... Radial Head Classification- Mason Type 1 Type 2 Type 3 Previous slide Next slide Back to first slide View graphic version Notes: Type 1 fractures ... Radial Head Classification- Mason Type 1 Type 2 Type 3 Previous slide Next slide Back to first slide View graphic version Notes: A severely commun... Radial Head ORIF Previous slide Next slide Back to first slide View graphic version Notes: In this displaced radial neck fracture a small ‘T’ plat... Radial Head Head Resection Indications- comminuted / irreparable - no ligamentous instability Previous slide Next slide Back to first slide View g... Radial Head Indications Prosthetic Head Severe Comminution Essex Loprezzi Lesion Ligamentous instability Previous slide Next slide Back to first s... Radial Head Prosthetic Previous slide Next slide Back to first slide View graphic version Notes: Examples of modern prosthetic Radial Heads Some d... Radial head & unstable elbow Previous slide Next slide Back to first slide View graphic version Notes: High energy lesions such as the above are o... Coronoid Process Previous slide Next slide Back to first slide View graphic version Notes: Coroniod process fractures are a result of elbow disloc... Coronoid Process Classification Type 1: Tip Type 2: &#060 50% Type 3: &#062 50% Previous slide Next slide Back to first slide View graphic version... Coronoid Process # Classification Type 1: Tip Type 2: &#060 50% Type 3: &#062 50% Treatment Type 1: Conservative Type 3: ORIF, (anterior) Previous... Shaft Fractures Both Bones - Adult -plate and screws Child - closed reduction Previous slide Next slide Back to first slide View graphic version N... Shaft - both bones Indications bone graft &#062 50% communution Avoid bone on interosseous membrane Previous slide Next slide Back to first slide ... Shaft - both bonesChildren Closed reduction and POP up to 10deg angulation acceptable * (&#06210 yr , midshaft) * Daruwalla 1979, CORR 139:114 Pre... Ulna - Shaft Monteggia Accurate reduction and plate Check radial head reduces Previous slide Next slide Back to first slide View graphic version N... Monteggia Previous slide Next slide Back to first slide View graphic version Notes: The previous fracture fixed with a plate and the radial head r... Monteggia - Classification Type 1: Anterior dislocation Type 2:Posterior dislocation Type 3:Lateral Dislocation - # metaphysis Type 4:Ant. Disloca... Monteggia Previous slide Next slide Back to first slide View graphic version Notes: Plate the ulna first. Usually the radial head reduces spontane... Monteggia Child Previous slide Next slide Back to first slide View graphic version Notes: As the Ulnar fracture is a greenstick, closed reduction ... Monteggia Complications Previous slide Next slide Back to first slide View graphic version Notes: The radial head appears to have reduced after pl... Monteggia - Complications Previous slide Next slide Back to first slide View graphic version Notes: The same fracture 2 days later in the ward. Th... BiomechanicsPronation / Supination Load Spread Previous slide Next slide Back to first slide View graphic version Notes: The reason for loss of re... Ulna - Distal Fracture Night stick fracture Small displacement - POP Large displacement (&#062 1/2 width) Previous slide Next slide Back to first ... Radial FracturesShaft Previous slide Next slide Back to first slide View graphic version Ulna - Distal Fracture Night stick fracture Small displacement - POP Large displacement (&#062 1/2 width) Previous slide Next slide Back to first ... Radial FracturesShaft Galeazzi Restore length with ORIF Previous slide Next slide Back to first slide View graphic version Notes: A Galeazzi fract... Distal Radius Previous slide Next slide Back to first slide View graphic version Notes: Distal Raduis fractures may be intra articular. They are u... Distal RadiusDorsal Barton’s Dorsal Bartons Open fixation - limited ORIF & Ex Fix - dorsal plate Previous slide Next slide Back to first slide Vie... Distal RadiusVolar Barton’s Volar Bartons Previous slide Next slide Back to first slide View graphic version Notes: A Volar Barton’s has a volar l... Distal RadiusTreatment Percutaneous pinning Previous slide Next slide Back to first slide View graphic version Notes: In Commiunted fractures of t... Distal RadiusTreatment Ligamantotaxis Ex Fix Percutaneous pinning Previous slide Next slide Back to first slide View graphic version Notes: In com... Open Fractures Forearm Debridement Primary of delayed ORIF Grade 3 b/c 3/4 sepsis rate Previous slide Next slide Back to first slide View graphic ... Mangled forearm Previous slide Next slide Back to first slide View graphic version Notes: The forearm is sometimes massively traumatised with mult... Mangled forearm Previous slide Next slide Back to first slide View graphic version Notes: This may require ingenuity as to the appropriate type of... Mangled forearm Previous slide Next slide Back to first slide View graphic version Notes: Subsequently the radius started to unite in dorsal angul... Mangled forearm Segmental #s IM rod / plate combination Previous slide Next slide Back to first slide View graphic version Notes: In segmental fra... Complications ORIF Forearm shaft Non-Union - 5% (plate) Synostosis - &#0602% Nerve Lesions Refracture after plate removal Previous slide Back to f... Fractures of the Forearm 16-Apr-03 Click here to start Table of Contents Fractures of the Forearm Olecranon Olecranon Radial Head Radial Head Rad.... Measurenents and Xrays fixation ‹header› ‹date/time› ‹footer› ‹#› Click to edit Master title style Click to edit Master text styles Second level Third level Fourth level Fifth level ‹date/time› ‹footer› ‹#› Click to edit Master title style Click to edit Master subtitle style ‹date/time› ‹footer› ‹#›  Notes Slide Show Outline 1 FRACTURES OF THE WRIST AND HAND 2 COLLE’S FRACTURE Extra-articular fracture in distal 2.5 cm of distal radius. Common ... FRACTURES OF THE WRIST AND HAND COLLE’S FRACTURE nExtra-articular fracture in distal 2.5 cm of distal radius. nCommon in middle aged and elderly ladies nIt can have associated ul... Typical Displacements in Colles’ Fracture nDorsal Tilt (angulation) nDorsal Shift nRadial tilt nRadial shift nImpaction ( shortening) nSupination ... Management nUndisplaced – Colles’ cast nDisplaced – reduce and apply B/E POP nTraction on the hand and counter traction by holding arm to disimpac... Colles’ fracture Management Cont. nIf reduced well, check x-rays next wk to check any re-displacement when swelling is decreased, POP is normally ... Complications nImmediate. n  a) circulatory- swelling of the fingers n  b) CTS n  c) loss of reduction nDelayed. n  a) Malunion n  b) rupture of E... Smith’s Fracture nReverse of colles’ fracture in displacement nUncommon nDeformity of wrist “spade” like. nManagement of fracture is reduction and... Barton’s Fracture nIt is intra-articular fracture dislocation of distal radius.nMarginal fracture of distal radius extends into the joint and ther... Dislocation of the Lunate nLunate dislocation - lunate is dislocated volarly after hyperextension injury of wrist nPerilunate dislocation – lunate... Management nClose reduction of dislocation and application of back slab.nIf after reduction S-L gap more then3 mm “Terry Thomas sign”, it will nee... Scaphoid Fracture nAnatomy -shape, position, blood supply nCommon injury of young adults nMechanism. Fall on outstretched hand nDiagnosis. H/O fal...  AP X-RAY OF A SCAPHOID FRACTURE Hebert screw fixation for scaphoid fracture Complication of Scaphoid fracture nDelayed union- due to impaired blood supply nNon-union nAvascular necrosis- risk is more in proximal pole fract... Scaphoid Fracture Management nUndisplaced fracture- scaphoid cast for n   6-8 wks, change cast every 4 wks nDisplaced fracture- needs ORIF nIf pat... Fractures and Dislocations in the                 Hand nA fracture is a soft tissue injury with a broken bonenFinal result of injury depends upon ... Nail bed injury and fracture distal phalanx nCommon injury in kids nNail bed fractures in distal phalanx fractures even the overlying nail plate a... PIPJ DISLOCATIONS nPIPJ forms a fulcrum that is vulnerable to injury in sports and after a fall nDorsal dislocation is commonest nNeeds reduction ... Middle and proximal phalanx fractures nUn-displaced fractures are treated with neighbour strapping and protective splintnDisplaced fractures needs... Metacarpophalangeal joint nMCPJ dislocations are rare and involve border digits ndorsal dislocations are often irreducible nThumb MCPJ is often in... Metacarpal nCommonest of hand fractures, neck of little finger fracture or ‘boxer’s fracture nCheck for mal-rotation of finger nStable fractures n... Colles fracture Lunate dislocations Look for 3 rings Sign on the lateral X-ray Scapho-lunate disassociation Terry Thomas sign clenched fist sign (Kirk Watson test) Rule of 11 applied to Colles fractures 11mm 22 deg. nBarton’s fracture Lunate dislocations nTrans-scaphoid peri-lunate dislocations n n n n n n n nLunate dislocation nHalf moon faces the nPalm of the hand PIP DISLOCATIONS nVolar plate injury Metacarpal fractures Terry Thomas sign, scapho-lunate disassociation indicating a carpal ligament injury n Scaphoid POP Rotational deformities of metacarpals n This page uses frames, but your browser doesn't support them. End of slide show, click to exit. FRACTURES OF THE WRIST AND HAND COLLE’S FRACTURE Rule of 11 applied to Colles fractures Slide 4 Typical Displacements in Colles’ Fracture Manageme... FRACTURES OF THE WRIST AND HAND COLLE’S FRACTURE Extra-articular fracture in distal 2.5 cm of distal radius. Common in middle aged and elderly lad... FRACTURES OF THE WRIST AND HAND COLLE’S FRACTURE n Extra-articular fracture in distal 2.5 cm of distal radius. n Common in middle aged and elderly ladies n It can have associated... Typical Displacements in Colles’ Fracture n Dorsal Tilt (angulation) n Dorsal Shift n Radial tilt n Radial shift n Impaction ( shortening) n Supin... Management n Undisplaced – Colles’ cast n Displaced – reduce and apply B/E POP n Traction on the hand and counter traction by holding arm to disim... Colles’ fracture Management Cont. n If reduced well, check x-rays next wk to check any re-displacement when swelling is decreased, POP is normally... Complications n Immediate.   a) circulatory- swelling of the fingers   b) CTS   c) loss of reduction n Delayed.   a) Malunion   b) rupture of E.P.... Smith’s Fracture n Reverse of colles’ fracture in displacement n Uncommon n Deformity of wrist “spade” like. n Management of fracture is reduction... Barton’s Fracture n It is intra-articular fracture dislocation of distal radius. n Marginal fracture of distal radius extends into the joint and t... Dislocation of the Lunate n Lunate dislocation - lunate is dislocated volarly after hyperextension injury of wrist n Perilunate dislocation – luna... Management n Close reduction of dislocation and application of back slab. n If after reduction S-L gap more then3 mm “Terry Thomas sign”, it will ... Scaphoid Fracture n Anatomy -shape, position, blood supply n Common injury of young adults n Mechanism. Fall on outstretched hand n Diagnosis. H/O...  AP X-RAY OF A SCAPHOID FRACTURE Hebert screw fixation for scaphoid fracture Complication of Scaphoid fracture n Delayed union- due to impaired blood supply n Non-union n Avascular necrosis- risk is more in proximal pole fr... Scaphoid Fracture Management n Undisplaced fracture- scaphoid cast for    6-8 wks, change cast every 4 wks n Displaced fracture- needs ORIF n If p... Fractures and Dislocations in the         Hand n A fracture is a soft tissue injury with a broken bone n Final result of injury depends upon displ... Nail bed injury and fracture distal phalanx n Common injury in kids n Nail bed fractures in distal phalanx fractures even the overlying nail plate... PIPJ DISLOCATIONS n PIPJ forms a fulcrum that is vulnerable to injury in sports and after a fall n Dorsal dislocation is commonest n Needs reducti... Middle and proximal phalanx fractures n Un-displaced fractures are treated with neighbour strapping and protective splint n Displaced fractures ne... Metacarpophalangeal joint n MCPJ dislocations are rare and involve border digits n dorsal dislocations are often irreducible n Thumb MCPJ is often... Metacarpal Roland fracture Boxer # n Commonest of hand fractures, neck of little finger fracture or ‘boxer’s fracture n Check for mal-rotation of ... Colles fracture Lunate dislocations Look for 3 rings Sign on the lateral X-ray Scapho-lunate disassociation Terry Thomas sign clenched fist sign (Kirk Watson test) Rule of 11 applied to Colles fractures 11mm 22 deg. Barton’s fracture Lunate dislocations Trans-scaphoid peri-lunate dislocations Lunate dislocation Half moon faces the Palm of the hand PIP DISLOCATIONS Volar plate injury Metacarpal fractures Terry Thomas sign, scapho-lunate disassociation indicating a carpal ligament injury Scaphoid POP Rotational deformities of metacarpals Theme 12 Fracture patterns, open fractures and growth plate injuriesSession 114/02/02 P.C. POLDERMAN Definition A fracture is present when there i... ROOSTER VIR LAAT KLINIESE ROTASIES - JAN tot JUL 2006 WEEK I TYD MAANDAG DINSDAG WOENSDAG DONDERDAG VRYDAG SATERDAG SONDAG 07:30 tot 08:30 Kamer 6... 0% & K % ) D V H , 9 ± / D D W . OLQ LH V H 5 R W D V LH V ± 2 5 72 3 (' ,( No license: PDF produced by PStill (c) F. Siegert - http://www.this.ne... 0% & K % 3 K D V H , 9 ± / D W H & OLQ LF D O5 R W D W LR Q V ± 2 5 7+ 2 3 $ (' ,& 6 No license: PDF produced by PStill (c) F. Siegert - http://ww... Contact Orthopaedic lectures, Stellenbosch university Contact Orthopaedic lectures, Stellenbosch university Specific external fixation techniques in orthopaedic surgery Overview of external fixation techniques in orthopaedic surgery Basic plaster techniques, splints and overview of types of orthopaedic operations Basic plaster techniques, splints and overview of types of orthopaedic operations Basic plaster techniques, splints and overview of types of orthopaedic operations Basic plaster techniques, splints and overview of types of orthopaedic operations Basic plaster techniques, splints and overview of types of orthopaedic operations Groeptoets Toets 02/04/2004 Naam Van Nommer Punt / 40 % P.C.J. VAN AS 13068768 27 68% Liesl V. HEYNS 13086820 28 70% C. F. MARAIS 13070029 32 80% ... GUIDE TO THE M MED TRAINING PROGRAMME DEPARTMENT  OF ORTHOPAEDIC SURGERY UNIVERSITY  OF STELLENBOSCH /   TYGERBERG HOSPITAL CONTENTS 1.       BASI... GUIDE TO THE M MED TRAINING PROGRAMME DEPARTMENT OF ORTHOPAEDIC SURGERY UNIVERSITY OF STELLENBOSCH / TYGERBERG HOSPITAL 1 CONTENTS 1. BASIC SCIENC... 1 MB ,ChB Fase III ­ Teoretiese Modules Module 8 Muskuloskeletale Sisteem 2003 No license: PDF produced by PStill (c) F. Siegert - http://www.this.n... Basic operations orthopaedic surgery Basic operations orthopaedic surgery Basic operations orthopaedic surgery Basic operations orthopaedic surgery tendon and nerve Wound Healing and Wound Cover FR Graewe Plastic and Reconstructive Surgery February 2006 Wound Healing An incision created by a scalpel, trauma or... Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Click here to start Table of contents Sagteweefsel besering Velbeserings Praktiese Klassifikasie Klassifikasie - Laserasies Klassifikasie - Abrasi... First page Back Continue Last page Overview Graphics Sagteweefsel besering J de V Odendaal / H de Jongh Notes: First page Back Continue Last page Overview Graphics Velbeserings Stompgeweld - Skaafwonde - Kneusings - Skeurwonde bv. “decollement” Skerpgew... First page Back Continue Last page Overview Graphics Beginsels van Chirurgie Surgeons must be very carefull When they take the knife Underneath th... First page Back Continue Last page Overview Graphics Algemene Beginsels Insnydings Atraumatiese Hantering Disseksie Debridement Hemostase Wondslui... First page Back Continue Last page Overview Graphics Wondsluiting Bakteriële lading Tydsverloop < 8 uur Instrument van besering Gekontamineerd : B... First page Back Continue Last page Overview Graphics Eenvoudige Laserasies Stop Aktiewe Bloeding Skeer Hare Omliggende area skoon - seep , antisep... First page Back Continue Last page Overview Graphics Eenvoudige Laserasies Debrideer Heg - Kleinste hoeveelheid, Dunste Monofilament verminder inf... First page Back Continue Last page Overview Graphics Beginsels Akkurate apposisie lae Spanning : Aproksimasie nie Strangulasie Diep dermale steke ... First page Back Continue Last page Overview Graphics Way 1139 A Way 1139 A Notes: First page Back Continue Last page Overview Graphics Way 1139B + C Way 1139B + C Notes: First page Back Continue Last page Overview Graphics Way 1139D + E Way 1139D + E Notes: First page Back Continue Last page Overview Graphics Oxford 2666 FIG 3 Oxford 2666 FIG 3 Notes: First page Back Continue Last page Overview Graphics Praktiese Klassifikasie Laserasies ( Sny,Steek ) Punksies Abrasies Brandwonde Notes: First page Back Continue Last page Overview Graphics Sabiston 1303 FIG 8 Sabiston 1303 FIG 8 Notes: First page Back Continue Last page Overview Graphics Sabiston 1304 FIG 40-9 Sabiston 1304 FIG 40-9 Notes: First page Back Continue Last page Overview Graphics Notes: First page Back Continue Last page Overview Graphics Beginsels “Jagged” - eksisie Weefselverlies - rotasie, VOP, flappe Abrasies - verwyder â€... First page Back Continue Last page Overview Graphics Anatomiese Areas Borskas Buik Nek Ledemate Notes: First page Back Continue Last page Overview Graphics Arteriëele Beserings Vingers, “probe” - NEE! Direkte Drukking Foley, Deppers met hegting(... First page Back Continue Last page Overview Graphics Harde Tekens Distale Sirkulasie - Isgemie, polse Bruit Vergrotende of pulserende hematoom Art... First page Back Continue Last page Overview Graphics Sagte Tekens Klein Hematoom Naasliggende senuweebesering Skok onverklaar ander beserings Naas... First page Back Continue Last page Overview Graphics Spesiale Ondersoeke Dopler drukke verskil 0.9 Dupleks dopler Arteriografie - as daar tyd is -... First page Back Continue Last page Overview Graphics Hantering Amputasie Primęre Hegting - Transvers Defek - Veen “patch” Reseksie met interpo... First page Back Continue Last page Overview Graphics Klassifikasie - Laserasies Eenvoudig - Heg Primęr “Jagged” - Eksisie rante en heg Komplek... First page Back Continue Last page Overview Graphics Hegting Fyn onoplosbare steke bv. Prolene Intima-intima Eversie Geen vet,bindweefsel Transver... First page Back Continue Last page Overview Graphics Sabiston bl. 13 Fig 1-20 Sabiston bl. 13 Fig 1-20 Notes: First page Back Continue Last page Overview Graphics Gewrigsbeserings Gevaar septiese artritis Beginsel : Chirurgiese eksplorasie met lavage Notes: First page Back Continue Last page Overview Graphics TENDONBESERINGS Fleksor vs Ekstensor Notes: First page Back Continue Last page Overview Graphics FLEKSORTENDON Zone 1 tot 5 â€No mans land’ Notes: First page Back Continue Last page Overview Graphics TENDONHERSTEL Notes: First page Back Continue Last page Overview Graphics SABISTON 1473 fIG 42-68 SABISTON 1473 fIG 42-68 Notes: First page Back Continue Last page Overview Graphics Sabiston 1474 FIG42-69 Sabiston 1474 FIG42-69 Notes: First page Back Continue Last page Overview Graphics Notes: First page Back Continue Last page Overview Graphics SENUWEEBESERINGS Neuropraksie Aksonotmese Neurotmese Notes: First page Back Continue Last page Overview Graphics Klassifikasie - Abrasies “Graze” Abrasie “Degloving” Avulsie Amputasie Notes: First page Back Continue Last page Overview Graphics SENUWEEHERSTEL Primęre hegting – goue standaard 7 tot 10 dae Notes: First page Back Continue Last page Overview Graphics PROGNOSE Ouderdom Geassosieerde beserings Tipe besering Kontaminasie Tipe herstel Notes: First page Back Continue Last page Overview Graphics â€DEGLOVING BESERINGS’ Hoë energie beserings Hoë morbiditeit Notes: First page Back Continue Last page Overview Graphics “Crush” Ekstensiewe stomp sagteweefselbesering - sambok , ledemaat vergruising Mioglobien... First page Back Continue Last page Overview Graphics Metodes van Genesing Primęre (eerste) intensie Sekondęre (tweede) intensie - Brandwonde - Inf... First page Back Continue Last page Overview Graphics Hegtingsmateriale - Klassifikasie Monofilament vs Multifilament - Hanterings eienskappe - Inf... First page Back Continue Last page Overview Graphics Oplosbare steke Catgut / Chromic catgut Polyglycolic Acid ( Dexon ) - Multi Polyglyconate ( M... First page Back Continue Last page Overview Graphics Onoplosbaar Sy Poly-ester :Onbedek(Mersileen)- Multi Bedek - Silikon(Tri - Cron) Polybutilaat... First page Back Continue Last page Overview Graphics Ander Hegting Velkrammetjies Steri-Strips Chirurgiese gomme bv Fibrin Glue Notes: Index => Orthopaedic Quiz Quiz Click on the most likely choice. In some cases partial marks will be given if the answer is a plausable choice in a... UNIVERSITEIT VAN STELLENBOSCH FAKULTEIT GESONDHEIDSWETENSKAPPE MB CHB IV - ORTOPEDIE MUSKULOSKELETALE SISTEEM 471 TYD/TIME: 2'/2uur/2'/2hrs PUNTET... UNIVERSITEIT VAN STELLENBOSCH FAKULTEIT GENEESKUNDE DEPARTEMENT ORTOPEDIE TOETS : MB ChB 6 Tyd: 45 Minute Datum 23.1.2004 1:Bespreek die volgende:... Tendinitis and Tenosynovitis.Upper and lower limbs 19-Dec-03 Click here to start Table of Contents Tendinitis and Tenosynovitis.Upper and lower li... Slide 1 of 40 Slide 2 of 40 Slide 3 of 40 Notes: Notice the difference between the normal tendon under the microscope and the degenerate tendon. The areas of pink on the tend... Slide 4 of 40 Notes: Tenosynovitis is inflammation of the tendons synovium. It is mainly seen in tendons with a synovial sheath such as the flexor... Slide 5 of 40 Notes: An early sign of bacterial synovitis is pain on extension of the involved finger/s. Swelling in the hand is a very late sign. Slide 6 of 40 Notes: Treatment is drainage under a tourniquet and bloodless field. A drainage catheter may be left in the synovial sheath. Slide 7 of 40 Notes: In South African TB is a common cause of Tenosynovitis. Suspect it if the symptoms are more than a few weeks duration. Slide 8 of 40 Notes: Rheumatoid arthritis causes synovial inflammation and thickening. Involvement of the synovial sheath causes the tendons to ap... Slide 9 of 40 Slide 10 of 40 Notes: This is an overuse injury of the Abductor pollicis longus and the extensor pollicis brevis. It presents as tenderness on the... Slide 11 of 40 Slide 12 of 40 Notes: Treatment is rest, splitting the hand e.g. POP cast or backslab and local steroid injection. If the condition persists surgi... Slide 13 of 40 Notes: In trigger finger the finger sticks in flexion and cannot be extended. RA and trauma are common causes. There is a palpable ... Slide 14 of 40 Notes: Treatment of trigger finger is to try steroids. If this fails surgical release of the tendon sheath is required. Slide 15 of 40 Slide 16 of 40 Notes: Note the narrow space between the bony anterior acromion and the humeral head. The Supraspinatus has a poor blood supply and... Slide 17 of 40 Notes: Note the Supraspinatus coff tears just at this critical point. Slide 18 of 40 Notes: The mid arc of abduction is painful. There is tenderness just inferior to the anterior acromion. Slide 19 of 40 Notes: Tendinosis in the Supraspinatus at this point leads to rupture at he spot depicted above. Slide 20 of 40 Notes: The mid range of abduction is not only painful there is weakness in this range, The patient may have to support the arm with... Slide 21 of 40 Notes: Late sequelae of a Supraspinatus tear is rotator cuff arhtropathy. This is superior migration of the humeral head on X-ray. ... Slide 22 of 40 Notes: Treatment is initially conservative. A steroid injection will relieve pain and allow physiotherapy. Not more than three ster... Slide 23 of 40 Notes: Physiotherapy - mobilisation of the shoulder and muscle exercises are the mainstay of conservative therapy. Slide 24 of 40 Notes: Operative treatment will be needed if conservative therapy fails after a reasonable trial (say 3 months). Anterior acromione... Slide 25 of 40 Notes: Postoperative mobilisation of the shoulder is required. Ask the surgeon if the deltoid required detachment as this will dela... Slide 26 of 40 Notes: Calcific tendonitis is a painful accumulation of calcium in the supraspinatus. The deposits are seen on x-ray. Treatment is ... Slide 27 of 40 Notes: In biceps tendinitis there is tenderness when the biceps is contracted. Tenderness is over the biceps groove and sometimes a... Slide 28 of 40 Slide 29 of 40 Notes: This snapping can ba elicited by Yergasson’s test . The shoulder is externally rotrated and the snap felt over the biceps gr... Slide 30 of 40 Notes: If rupture of the biceps has taken place, the muscle mass gives the biceps a “Popeye” appearance. Slide 31 of 40 Notes: In Frozen shoulder the shoulder becomes painful and motion is lost. Slide 32 of 40 Notes: Ask the patient if he is diabetic. There is a strong association with diabetes mellitus. All shoulder motions are severely l... Slide 33 of 40 Notes: The condition is self limiting and the cycle lasts up to 2 years. The initial pain becomes stiffness. This limits the pain. ... Slide 34 of 40 Notes: If physiotherapy fails the shoulder may, rarely need to be mobilised in theater under general anaesthetic. Slide 35 of 40 Notes: About the knee the patellar tendon degenerates in many sporting activities eg long jump. Tenderness is over the inferior pol... Slide 36 of 40 Slide 37 of 40 Notes: Athletes often get acute inflamed achilles tendons. Tendonitis is acute inflammation. In chronic cases tendonosis of physica... Slide 38 of 40 Notes: In tendonitis a heel raise and limitation of the causative sporting activity is curative. Slide 39 of 40 Notes: Ballet dancers are prone to unusual overuse tendon injuries such as flexor hallucis longus tendonitis. Slide 40 of 40 Notes: Shin splints and stress fracture are common overuse sport injuries. A bone scan will be positive in stress fracture. Tendinitis and TenosynovitisUpper and lower limbs Physio and Occupational therapy by ICM Robertson Definitions Tendinitis - inflammation in a tend... Tendinitis and TenosynovitisUpper and lower limbs Physio and Occupational therapy by ICM Robertson Next slide Back to first slide View graphic ver... Definitions Tendinitis - inflammation in a tendon Tendinosis - degeneration of a tendon Tenosynovitis - inflammatory process in tendon sheath Prev... Histology Normal Degenerative Tendon Previous slide Next slide Back to first slide View graphic version Notes: Notice the difference between the n... Tenosynovitis: Bacterial Previous slide Next slide Back to first slide View graphic version Notes: Tenosynovitis is inflammation of the tendons sy... Bacterial TenosynovitisFinger flexors Pain on extension Local tenderness Pyrexia Previous slide Next slide Back to first slide View graphic versio... Bacterial Flexor synovitisTreatment General anaesthetic Bloodless field Drain & debride Irrigate sheath Antibiotic Hand baths Physiotherapy Previo... Tuberculous synovitis Thickened synovium Painless Raised ESR Positive TB Skin test Treatment Anti TB drugs Early mobilisation Previous slide Next ... Rheumatoid Arthritis Previous slide Next slide Back to first slide View graphic version Notes: Rheumatoid arthritis causes synovial inflammation a... Rheumatoid synovitis Thickened tendon sheaths Other signs of RA e.g. small joint inflammation Treatment Medical (NSAIDS, Steroids etc.) Synovectom... De Quervain’sStenosing Synovitis EPL & Abd Pollicis brevis Previous slide Next slide Back to first slide View graphic version Notes: This is an ov... De Quervain’sStenosing Synovitis Diagnosis - Finkelstein’s test Previous slide Next slide Back to first slide View graphic version De Quervain’sStenosing Synovitis Treatment Splints Local Steroid Mobilisation Previous slide Next slide Back to first slide View graphic version N... Trigger Finger Causes Rheumatiod Trauma Previous slide Next slide Back to first slide View graphic version Notes: In trigger finger the finger sti... Trigger Finger Treatment Steroid Injection Incise Flexor Sheath Previous slide Next slide Back to first slide View graphic version Notes: Treatmen... Rotator Cuff Lesions Supraspinatus Calcific tendinitis Impingement Syndrome Tear of rotator cuff Biceps Tendinitis Previous slide Next slide Back ... PPT Slide Anatomy Previous slide Next slide Back to first slide View graphic version Notes: Note the narrow space between the bony anterior acromi... PPT Slide Anatomy: Cuff Tear Previous slide Next slide Back to first slide View graphic version Notes: Note the Supraspinatus coff tears just at t... Impingement Syndrome Cause Supraspiatus tendinosis Abnormal anterior acromion Clinical Painful mid arc tender anterior to acromion Previous slide ... Torn Supraspinatus Tendinosis supraspinatus leads to rotator cuff rupture Drop arm test Previous slide Next slide Back to first slide View graphic... Torn Supraspinatus Weakness at mid arc Previous slide Next slide Back to first slide View graphic version Notes: The mid range of abduction is not... Impingement SyndromeRotator cuff arthropathy X ray Superior migration humaral head Osteoarthritis Previous slide Next slide Back to first slide Vi... Treatment - Impingement syndrome Conservative Physiotherapy Local Steroid Previous slide Next slide Back to first slide View graphic version Notes... Treatment - Impingement syndrome Conservative Physiotherapy Previous slide Next slide Back to first slide View graphic version Notes: Physiotherap... Treatment - Impingement syndrome Operative Indications failed conservative Rx Acromioplasty Previous slide Next slide Back to first slide View gra... Impingement syndromePostop. Physiotherapy Previous slide Next slide Back to first slide View graphic version Notes: Postoperative mobilisation of ... Calcific Tendinitis Cause Dystrophic Ca++ Tendinosis Supraspinatus Symptoms Pain acute in deltoid Previous slide Next slide Back to first slide Vi... Biceps tendinitis Shoulder pain Tenderness in Biceps groove Previous slide Next slide Back to first slide View graphic version Notes: In biceps te... Biceps tendinitis Shoulder pain Tenderness in Biceps groove Previous slide Next slide Back to first slide View graphic version Biceps tendinitis Yergason’s sign Pain - biceps groove on external rotation Previous slide Next slide Back to first slide View graphic version Not... Biceps tendinitis Rupture Yergason’s Sign Previous slide Next slide Back to first slide View graphic version Notes: If rupture of the biceps has t... Adhesive Capsulitis Previous slide Next slide Back to first slide View graphic version Notes: In Frozen shoulder the shoulder becomes painful and ... Adhesive Capsulitis Pain esp. at night Limited motion Often diabetic Previous slide Next slide Back to first slide View graphic version Notes: Ask... Adhesive Capsulitis Previous slide Next slide Back to first slide View graphic version Notes: The condition is self limiting and the cycle lasts u... Frozen shoulder Treatment Physiotherapy mobilise shoulder MUA resistant cases Previous slide Next slide Back to first slide View graphic version N... Patellar tendinitis Overuse injury - Jumper’s Knee A cause of anterior knee pain Patellar tendon - young athlete Quadriceps tendon - older athlete... Patellar tendinitis Jumper’s knee Tender at inferior pole patella Previous slide Next slide Back to first slide View graphic version Achilles tendinosis Chronic heel pain in the athlete Previous slide Next slide Back to first slide View graphic version Notes: Athletes often get ... Achilles tendinosis Treatment Reduce sporting activity Shoe heel raise Previous slide Next slide Back to first slide View graphic version Notes: I... TendinosisFlexor hallucis longus Pain on standing on toes Ballet dancers Previous slide Next slide Back to first slide View graphic version Notes:... Shin Splints Pain in posterior medial border of distal tibia Running sports Differential diagnosis - stress fracture Treatment - diminish activity... Basic traction in orthopaedic surgery Basic femoral traction in orthopaedic surgery. Conservative treatment femur fractures. Basic cervical traction in Orthopaedic surgery. Conservative treatment neck fractures and sprains. Other traction methods in Orthopaedic surgery. Conservative treatment pelvis, back supracondylar humerus Basic femoral traction in orthopaedic surgery. Conservative treatment femur fractures. Basic traction in orthopaedic surgery Self StudyPainful hip Hip problems,AVN, OA ICM Robertson Tema 10 Session 2 CASE A: CASE A: CASE B: CASE B: CASE B: CASE C: CASE C: CASE C:1 yr. la... Department of Orthopaedic Surgery Stellenbosch University Contents Musculoskeletal system Use the drop down menus to navigate this site. Alternati... Angular Deformities Knee 13/02/2002 Angular deformities of the knee, Osteotomies, Knee Replacements Lecture 4th Year ICM Robertson Terminology Ref... 15h00 Fractures & Dislocations Ankle MB ChB 4 Lecture ICM Robertson Tema 16 Session 7 Fractures & Dislocations Ankle Causes Theme 16 Session 7 ICM... Hip: Osteoarthritis, Avascular Necrosis 18-Feb-04 Click here to start Table of Contents Hip: Osteoarthritis, Avascular Necrosis Osteoarthritis Ost... Slide 1 of 33 Slide 2 of 33 Slide 3 of 33 Slide 4 of 33 Slide 5 of 33 Slide 6 of 33 Slide 7 of 33 Slide 8 of 33 Slide 9 of 33 Slide 10 of 33 Slide 11 of 33 Slide 12 of 33 Slide 13 of 33 Slide 14 of 33 Slide 15 of 33 Slide 16 of 33 Slide 17 of 33 Slide 18 of 33 Slide 19 of 33 Slide 20 of 33 Slide 21 of 33 Slide 22 of 33 Slide 23 of 33 Slide 24 of 33 Slide 25 of 33 Slide 26 of 33 Slide 27 of 33 Slide 28 of 33 Slide 29 of 33 Slide 30 of 33 Slide 31 of 33 Slide 32 of 33 Slide 33 of 33 Hip: Osteoarthritis, Avascular Necrosis Lecture 4th years Ian Robertson Tema 14 Next slide Back to first slide View graphic version Osteoarthritis osteophytes cyst joint space narrowing only wt bearing area Previous slide Next slide Back to first slide View graphic version Osteoarthritis osteophytes cyst joint space narrowing dysplastic acetabulum Previous slide Next slide Back to first slide View graphic version Osteoarthritis osteophytes cyst joint space narrowing Previous slide Next slide Back to first slide View graphic version Osteoarthritis Previous slide Next slide Back to first slide View graphic version Avascular Necrosis Late Changes Collapse of segment -&#062 Secondary OA Previous slide Next slide Back to first slide View graphic version Avascular Necrosis Causes Alcohol Steroids Blood diseases Trauma Diving Previous slide Next slide Back to first slide View graphic version Avascular Necrosis Causes Alcohol Steroids Blood diseases Trauma Diving Sickle Cell disease Previous slide Next slide Back to first slide View gra... Avascular Necrosis Causes Alcohol Steroids Blood diseases Trauma Diving Hip Dislocation Previous slide Next slide Back to first slide View graphic... Avascular Necrosis Causes Alcohol Steroids Blood diseases Trauma Diving Previous slide Next slide Back to first slide View graphic version Avascular Necrosis ANormal Cartilage BNecrotic Bone CHealing bone DNormal Bone Previous slide Next slide Back to first slide View graphic version Avascular Necrosis ANormal Cartilage BNecrotic Bone CHealing bone DNormal Bone Previous slide Next slide Back to first slide View graphic version Avascular Necrosis Separation of necrotic segment “Crescent Sign” Previous slide Next slide Back to first slide View graphic version Avascular Necrosis Late Changes Collapes of segment -&#062 Secondary OA Previous slide Next slide Back to first slide View graphic version Early Avascular Necrosis Separation of necrotic segment “Crescent Sign” Previous slide Next slide Back to first slide View graphic version Avascular NecrosisSpecial investigations Tc Scan - check other hip MR - more sensitive CT Scan - osteotomy planning Previous slide Next slide Back... Treatment Painful Hip Conservative Pain Relief - NSAIDS Walking aid Lose Weight Modify activities Physiotherapy Previous slide Next slide Back to ... Treatment Painful Hip- Operative options Oseotomy Athrodesis Excision Arthroplasty - Girdlestone Arthroplasty Hemi Total Previous slide Next slide... OsteoarthritisTreatment Operative Osteotomy Arthrodesis Joint Replacement Excision Arthroplasty Valgus osteotomy Previous slide Next slide Back to... Treatment Operative Osteotomy Arthrodesis Joint Replacement Excision Arthroplasty Arthrodesis - young patient Normal other hip Previous slide Next... Treatment Operative Problems with Arthrodesis OA Ipsilateral knee Back Pain Loss of mobility Previous slide Next slide Back to first slide View gr... Treatment Operative Osteotomy Arthrodesis Joint Replacement Excision Arthroplasty Girdlestone Septic cases Previous slide Next slide Back to first... Treatment Operative Excision Arthroplasty Problems shortening pain Girdlestone Previous slide Next slide Back to first slide View graphic version Treatment Operative Osteotomy Arthrodesis Joint Replacement Excision Arthroplasty Previous slide Next slide Back to first slide View graphic versi... Total Hip ReplacementIndications Age 60 plus Grade 3 pain Limited walking distance Previous slide Next slide Back to first slide View graphic vers... Total Hip ReplacementContraindications Absolute Any sepsis Neuromuscular Relative Youth Previous slide Next slide Back to first slide View graphic... Total Hip -Sterility preoperative cultures antibiotics technique lamina flow theater Previous slide Next slide Back to first slide View graphic ve... Total Hip -Sterility Lamia flow Previous slide Next slide Back to first slide View graphic version Complications Total Hip Early Systemic Pulmonary Embolus Local Dislocation Acute Sepsis Late Mechanical Loosening Sepsis Chronic Wear grannuloma f... Complications Total Hip Wear particles to macrophages Loosening Previous slide Next slide Back to first slide View graphic version Total HipComplications Sepsis Loosening Dislocation Previous slide Next slide Back to first slide View graphic version Avascular NecrosisTreatment Early - biopsy / graft Later - Osteotomy Advanced - Total Hip Rotation osteotomy Previous slide Next slide Back to fir... Avascular NecrosisTreatment Dilemma Bilateral disease 80% (steriods & alcohol) Arthrodesis only if unilateral Alcoholics poor tot hip candidates E... Chronic Knee Instability Lecture MB ChB 4 by ICM Robertson Chronic Meniscus Tears Chronic Meniscus Tears Chronic Meniscus Tears Management Meniscu... Use either the menu or the sitemap below to navigate Fractures and dislocations foot 25/02/2002 16h00 Fractures of the foot MB ChB 4 Lecture ICM Robertson Tema 16 Session 8 Calcaneus Fracture Acute P... Previous Case 1: Severely injured knee Diagnosis Knee Dislocation. Must be suspected in all severe injuries Ligaments injured: both cruciates, lat... Previous Case 2 "Isolated" Anterior Cruciate Acute Management: Check that neurovascular intact, analgesics, Robert Jones Bandage Does he need ACL ... Previous Case 3: Anterior Cruciate Sedentary Patient Acute Management: Aspirate a tense haemarthrosis, splint limb in Robert Jones bandage Reconst... Case 4: Meniscus Injury Previous The symptoms and signs are those of a Medial Meniscus injury Any foreign body such a osteochonrditis dessicans ca... Case 5: Early OA Previous This is an acute injury on a chronic (OA Knee). The acute injury will be treated symptomatically. The early medial joint... Fractures about the Knee 15-Jan-04 Click here to start Table of Contents Fractures about the Knee Distal Femoral Fractures Supracondylar fractures... Slide 1 of 32 Slide 2 of 32 Slide 3 of 32 Slide 4 of 32 Slide 5 of 32 Slide 6 of 32 Slide 7 of 32 Slide 8 of 32 Slide 9 of 32 Slide 10 of 32 Slide 11 of 32 Slide 12 of 32 Slide 13 of 32 Slide 14 of 32 Slide 15 of 32 Slide 16 of 32 Slide 17 of 32 Slide 18 of 32 Slide 19 of 32 Slide 20 of 32 Slide 21 of 32 Slide 22 of 32 Slide 23 of 32 Slide 24 of 32 Slide 25 of 32 Slide 26 of 32 Slide 27 of 32 Slide 28 of 32 Slide 29 of 32 Slide 30 of 32 Slide 31 of 32 Slide 32 of 32 Fractures about the Knee MB ChB 4 ICM Robertson Tema 20 Session 2 Next slide Back to first slide View graphic version Distal Femoral Fractures Forces Displacing gastrocnemius quadriceps Result Posterior angulation Previous slide Next slide Back to first slide View... Supracondylar fracturesFemur No intra articular extension Previous slide Next slide Back to first slide View graphic version Supracondylar Femur Often comminuted open Previous slide Next slide Back to first slide View graphic version Supracondylar #Conservative Previous slide Next slide Back to first slide View graphic version Supracondylar #Operative Most require operation To mobilise knee Need articular reduction Angles about knee Previous slide Next slide Back to firs... Supracondylar #Operative Debridement if open Accurate reduction Hold with blade plate condylar screw Early physiotherapy DCS Previous slide Next s... Patella Fractures Classification Transverse Stellate Transverse Lower pole Previous slide Next slide Back to first slide View graphic version Patella FracturesTreatment Conservative quadriceps mechanism intact less than 3mm displaced Stovepipe plaster Previous slide Next slide Back to fi... Patella FracturesTreatment Operative quadriceps mechanism not intact &#062 3mm displaced Kwires and tension band Previous slide Next slide Back to... Patella FracturesTreatment Operative Patellectomy ireducible # Patellectomy Problems weakens extension tendon pain Previous slide Next slide Back ... Patella Tendon RuptureTreatment Previous slide Next slide Back to first slide View graphic version Knee Dislocations Diagnosis Complications Treatment Previous slide Next slide Back to first slide View graphic version Diagnosis- usually obvious Suspect it in all Serious knee injuries Previous slide Next slide Back to first slide View graphic version Complications Arterial damage 30% incidence Do ARTERIOGRAM in ALL cases Previous slide Next slide Back to first slide View graphic version Treatment Reduce knee Splint Get arteriogram Admit and observe patient Conservative plaster cast or Exfix. Operative - Delayed ligament suture Pre... Anterior Dislocation Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version Anterior dislocationClinical Previous slide Next slide Back to first slide View graphic version Ligament Repair Harvest of patellar ligament graft for PCL repair Previous slide Next slide Back to first slide View graphic version PPT Slide Posterior Dislocation reduced and Ex. Fix. Previous slide Next slide Back to first slide View graphic version Posterior Dislocation Abnormal Arteriogram Previous slide Next slide Back to first slide View graphic version PPT Slide Posterior Dislocation L - End Result Previous slide Next slide Back to first slide View graphic version Acute ligament rupturesKnee Painful knee Aspirate effusion Is blood present ? Xrays are there bony avulsions? Examine knee Local MUA Previous slid... Medial Collateral Conservative if isolated Robert Jones bandage Previous slide Next slide Back to first slide View graphic version Lateral Collateral Complex Conservative if grade 1 or 2 Operative repair & suture grade 3 multiple ligaments Previous slide Next slide Back to fir... Cruciate ligaments Complex Conservative most cases Acute repair bony avulsions Previous slide Next slide Back to first slide View graphic version Plateau Fractures Previous slide Next slide Back to first slide View graphic version Plateau Fractures Previous slide Next slide Back to first slide View graphic version Plateau Fractures Conservative treatment &#060 5mm displaced Skeletal traction - distal tibia Mobilise knee POP Previous slide Next slide Back to ... Plateau FracturesSurgical Treatment Split # - reduce and screw or buttress plate Previous slide Next slide Back to first slide View graphic version Plateau FracturesSurgical Treatment Depressed # - reduce & Bone Graft Previous slide Back to first slide View graphic version Choice Powerpoint vs HTML Chronic Meniscus Injuries, Patellar & Knee Instability 22-Apr-03 Click here to start Table of Contents Chronic Meniscus Injuries, Patellar & Knee ... Slide 1 of 36 Notes: In this series of pages chronic ligamentous instability of the knee, meniscus injuries and the place of Arthroscopy will be d... Slide 2 of 36 Notes: The medial meniscus is “C” shaped, while the lateral meniscus is “O” shaped. Note the anterior attachment of the Anterior Cru... Slide 3 of 36 Notes: Tears of the meniscus can vary in extent. The Bucket Handle type is a large longitudinal tear resulting in a handle shaped lo... Slide 4 of 36 Notes: Clinical symptoms are Locking _ failure to extend the knee fully on one or more occasions. An effusion is almost always prese... Slide 5 of 36 Notes: Special investigations are X rays of the knee. Make sure there is not another diagnosis such as fractures, Osteochondritis De... Slide 6 of 36 Notes: This picture shows the technique of arthroscopy. The instrument is introduced under sterile conditions and bloodless field. T... Slide 7 of 36 Notes: This picture shows the intra articualar surfaces that can be seen by a ‘scope. Slide 8 of 36 Notes: A view taken from the Arthroscopy monitor screen.On the left is a fibrillated meniscus. On the right it has bee debrided or s... Slide 9 of 36 Notes: In general ligamnetous instabilities can be divided into Grade1 or mild. Grade 2 or moderate - e.g. the knee opens up to 2 cm... Slide 10 of 36 Notes: Contact sports such as soccer, rugby and net ball are a common cause of knee ligament and meniscus injuries. A twisting forc... Slide 11 of 36 Notes: Look for other knee ligament injuries too. The ACL rarely breaks in isolation. Slide 12 of 36 Notes: In the ACL injury the knee is unstable in an anterior posterior direction in both 20 degrees flexion (Lachman) and in the 90... Slide 13 of 36 Notes: The anterior Drawyer Test in 90 degrees flexion is a good test for severe tears of the Anterior Cruciate Ligament. Do not co... Slide 14 of 36 Pivot Shift Notes: Pivot Shift test is for anteriolateral rotatory subluxation associated with ACL laxity. Slide 15 of 36 Pivot Shift Notes: An anterior capsule plus ACL can result in the pivot shift phenomenon. Here the Ileotibial band reduces the tend... Slide 16 of 36 Pivot Shift Notes: Performing the pivot shift test. Slide 17 of 36 Notes: Mild ligamentous sprains and tears can be treated conservatively. Immobilise the knee in a Robert Jones (bulky) dressing. A ... Slide 18 of 36 Notes: Surgery is indicated in the grossly unstable knee. The ligaments must be sutured within 10 days. If the ACL or PCL is ruptur... Slide 19 of 36 Notes: Bone Patellar Bone technique A strip of patellar tendon with small piece of bone either end is harvested. Slide 20 of 36 Notes: It is placed in the normal position of the ACL. The bone ends of the harvested graft are buried in tunnels bored in the tibi... Slide 21 of 36 Notes: Post operative rehabilitation of the ACL repair involves a brace. Mobilisation of the knee and gradual return to activity ov... Slide 22 of 36 Notes: In the PCL deficient knee there is recurvatum of the knee. It can go into excessive hyperextension. There is a step off as t... Slide 23 of 36 Notes: A PCL injury implies massive knee trauma. In this case the knee was dislocated and was reduced some hours later. It is now b... Slide 24 of 36 Notes: The patella dislocates laterally. In habitual dislocations underlying causes are maltracking due to a valgus pull of the qua... Slide 25 of 36 Notes: The slide lists causes of maltracking of the patella. Slide 26 of 36 Notes: A patella dislocation is to the lateral side. It invariably causes the patient to fall to the ground. This distinguishes if ... Slide 27 of 36 Slide 28 of 36 Notes: Before any surgery is done there must be a clear cause. Shaving of the patella via the arthroscope is a simple operation but... Slide 29 of 36 Notes: Hauser operation is medial advancement of the tubercle of the tibia. Slide 30 of 36 Adolescent Anterior Knee pain Notes: Anterior knee pain has many causes. In the young patient it is often patellar Tendinitis. In t... Slide 31 of 36 Anterior Knee Pain Syndrome Notes: Condromalacia patella is softening and fibrillation of the cartilage under the patella. It can v... Slide 32 of 36 Notes: The picture shows an Arthroscopic view of the underside of the patella. The Chondromalacia is in a stage of fibrillation Slide 33 of 36 Notes: Chondromacia is being treated by patella shaving using a “shaver” instrument under Arthroscopic control. Slide 34 of 36 Notes: An Arthroscopy being done at Tygerberg Hospital. Slide 35 of 36 Notes: An arthroscopy is never done for purely diagnostic reasons. The above is a list of the most common indications. Slide 36 of 36 Notes: More controversial uses are in acute trauma. It is seldom necessary in the acute knee. The knee is blood filled and ligament... Chronic Meniscus Injuries, Patellar & Knee Instability Lecture MB ChB 4 By ICM Robertson Next slide Back to first slide View graphic version Notes... Chronic Meniscus Tears Previous slide Next slide Back to first slide View graphic version Notes: The medial meniscus is “C” shaped, while the late... Chronic Meniscus Tears Previous slide Next slide Back to first slide View graphic version Notes: Tears of the meniscus can vary in extent. The Buc... Chronic Meniscus Tears Symptoms Locking Swelling Pain Signs Effusion Joint line tenderness Mc Murray/ Appley positive Previous slide Next slide Ba... Management Meniscus Tear Confirm diagnosis X ray knee Arthrogram Or Arthroscopy Surgery: options Open menesectomy Arthroscopic menesectomy Meniscu... Arthroscopy Previous slide Next slide Back to first slide View graphic version Notes: This picture shows the technique of arthroscopy. The instrum... Arthroscopic Anatomy Previous slide Next slide Back to first slide View graphic version Notes: This picture shows the intra articualar surfaces th... Arthroscopic Anatomy Previous slide Next slide Back to first slide View graphic version Notes: A view taken from the Arthroscopy monitor screen.On... Chronic Ligament Instability Grade 1 - mild Grade 2 - definite end stop Grade 3 - no end stop Previous slide Next slide Back to first slide View g... Anterior Cruciate Instability Causes Twisting forces Previous slide Next slide Back to first slide View graphic version Notes: Contact sports such... Anterior Cruciate Instability Rarely isolated look for MCL and LCL Instability Previous slide Next slide Back to first slide View graphic version ... Anterior Cruciate Ligament Lachman Test - Knee 20 deg flexion Previous slide Next slide Back to first slide View graphic version Notes: In the ACL... Anterior Cruciate Ligament Anterior Draw Sign 90 deg. Flexion Anterior Instability Previous slide Next slide Back to first slide View graphic vers... Anterior Cruciate Ligament Pivot Shift - anterolateral rotary instability Previous slide Next slide Back to first slide View graphic version Notes... Anterior Cruciate Ligament Pivot Shift - anterolateral rotary instability Previous slide Next slide Back to first slide View graphic version Notes... Anterior Cruciate Ligament Previous slide Next slide Back to first slide View graphic version Notes: Performing the pivot shift test. Anterior Cruciate LigamentTreatment Conservative Physiotherapy Brace Previous slide Next slide Back to first slide View graphic version Notes: Mil... Anterior Cruciate LigamentTreatment Surgical - if indicated Bone patellar bone Hamstring Previous slide Next slide Back to first slide View graphi... Anterior Cruciate LigamentReconstruction Previous slide Next slide Back to first slide View graphic version Notes: Bone Patellar Bone technique A ... Anterior Cruciate LigamentReconstruction Previous slide Next slide Back to first slide View graphic version Notes: It is placed in the normal posi... ACL ReconstructionRehabilitation Brace Regain ROM Gradual return to sport Previous slide Next slide Back to first slide View graphic version Notes... Posterior Cruciate Previous slide Next slide Back to first slide View graphic version Notes: In the PCL deficient knee there is recurvatum of the ... Posterior Cruciate Seldom seen in isolation often other ligament damage Previous slide Next slide Back to first slide View graphic version Notes: ... Patella Instability Causes of maltracking Pull of quadriceps Shape of patella Patellar tendon insertion Valgus vectors Previous slide Next slide B... Patella Instability Causes of maltracking Pull of quadriceps Shape of patella Patellar tendon insertion Valgus vectors Previous slide Next slide B... Patellar Dislocations Dislocates to lateral side Patient falls to ground Congenital Knee flexed at birth Small patella Recurrent Repeated episodes... Patellar Dislocations Factors contributing Genu valgum Shallow lateral condyle Long patellar tendon Deficient vastus medialis Ext. Tibial torsion ... Patellar DislocationsTreatment Conservative Physio medial quadriceps Operative Treat cause Arthroscopic shaving distal realignment patella-femoral... Patella Instability Treatment Conservative - quadriceps exercises etc Operative - correct cause Hauser - for patellar tendon realignment Previous ... Anterior Knee Pain Causes Chondromalacia patella Patellar Tendinitis Quadriceps Tendinitis Osteoarthritis Previous slide Next slide Back to first ... Anterior Knee PainChondromalacia Previous slide Next slide Back to first slide View graphic version Notes: Condromalacia patella is softening and ... Anterior Knee PainChondromalacia Stage of fibrillation Previous slide Next slide Back to first slide View graphic version Notes: The picture shows... Anterior Knee Pain Treatment Conservative modify sport physiotherapy Operative Patella shaving Correct alignment Osteotomy Previous slide Next sli... PPT Slide Previous slide Next slide Back to first slide View graphic version Notes: An Arthroscopy being done at Tygerberg Hospital. ArthroscopyIndications Accepted uses Meniscus pathology Foreign bodies Cruciate ligaments Sepsis Biopsy Debridement - shaver Previous slide Next s... ArthroscopyIndications Controversial Uses diagnostic acute trauma Previous slide Back to first slide View graphic version Notes: More controversia... Self study - Long term outlook:- Knee and meniscus injuries Visit these sites to brush up your knee ligament knowledge: Useful Links Study the cas... Knee Injury Self Study Below is a list of useful links Meniscus injuries http://wheeless.orthoweb.be/oo1/56.htm Anterior Cruciate http://www.stone... Fractures about the Knee 10 am Fractures about the Knee MB ChB 4 ICM Robertson Tema 20 Session 2 Distal Femoral Fractures Forces Displacing · gast... Angular deformities of the knee,Osteotomies,Knee Replacements 18-Feb-04 Click here to start Table of Contents Angular deformities of the knee,Oste... Slide 1 of 30 Slide 2 of 30 Slide 3 of 30 Slide 4 of 30 Slide 5 of 30 Slide 6 of 30 Slide 7 of 30 Slide 8 of 30 Slide 9 of 30 Slide 10 of 30 Slide 11 of 30 Slide 12 of 30 Slide 13 of 30 Slide 14 of 30 Slide 15 of 30 Slide 16 of 30 Slide 17 of 30 Slide 18 of 30 Slide 19 of 30 Slide 20 of 30 Slide 21 of 30 Slide 22 of 30 Slide 23 of 30 Slide 24 of 30 Slide 25 of 30 Slide 26 of 30 Slide 27 of 30 Slide 28 of 30 Slide 29 of 30 Slide 30 of 30 Angular deformities of the knee,Osteotomies,Knee Replacements Lecture 4th Year ICM Robertson Next slide Back to first slide View graphic version Terminology Previous slide Next slide Back to first slide View graphic version Referred Pain hip ankle always examine these joints too ! Previous slide Next slide Back to first slide View graphic version Type of pain Mechanical worse exercise relieved rest Rheumatiod morning stiffness worse night other joints Previous slide Next slide Back to first... Conditions causing deformities Osteoarthris - varus Tuberculosis - valgus Metabolic osteomalacia rickets Blaunt’s -tibia vara Medial compartment O... Conditions causing deformities Osteoarthris - varus Tuberculosis - valgus Metabolic osteomalacia rickets Blaunt’s -tibia vara Tricompartmental OA ... Conditions causing deformities Osteoarthris - varus Tuberculosis - valgus Metabolic osteomalacia rickets Blaunt’s -tibia vara Previous slide Next ... Conditions causing deformities Osteoarthris - varus Tuberculosis - valgus Metabolic osteomalacia rickets Blaunt’s -tibia vara Previous slide Next ... Conservative Management Walking aid - Lose weight Drugs- NSAIDS Brace Physiotherapy Previous slide Next slide Back to first slide View graphic ver... Medial OAForces on Knee Resultant force Med OA Varus deformity moves R medially Valgus osteotomy corrects R back to midline Previous slide Next sl... Surgical Options Osteotomy Arthrodesis Knee replacement Previous slide Next slide Back to first slide View graphic version Surgical Options Osteotomy Arthrodesis Knee replacement Macquet - ball &socket Previous slide Next slide Back to first slide View graphic version Surgical Options Osteotomy Arthrodesis Knee replacement Varus Before After Osteotomy Previous slide Next slide Back to first slide View graphic ve... Surgical Options Osteotomy Arthrodesis Knee replacement Coventry Wedge Previous slide Next slide Back to first slide View graphic version Surgical Options - Osteotomy Problems Temporary about 5yr. Indications OA younger patient Varus Coventry Wedge Previous slide Next slide Back to f... Osteotomies Genu Valgus distal femoral osteotomy Genu Varus proximal tibia Previous slide Next slide Back to first slide View graphic version Surgical Options Osteotomy Arthrodesis Knee replacement Previous slide Next slide Back to first slide View graphic version Surgical Options - Arthrodesis Problems No flexion sitting stairs Indications sepsis OA young patient Previous slide Next slide Back to first slid... Surgical Options Osteotomy Arthrodesis Knee replacement Hemi Unconstrained Hinge Previous slide Next slide Back to first slide View graphic version Total Knee Replacement Indications Over 60 yr. Grade 3 pain Limited walking distance Previous slide Next slide Back to first slide View graphic ve... PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Postop mobilise on crutches prevent DVT - heparin Previous slide Next slide Back to first slide View graphic version Total Knee Replacement Contraindications OA under 60 yr Any Sepsis Previous slide Next slide Back to first slide View graphic version Effusion - Lipohaemarthrosis Horizontal Xray “fat line” Previous slide Next slide Back to first slide View graphic version Knee Aspiration Indications trauma -large effusion suspected sepsis steroid injection Previous slide Next slide Back to first slide View graphic v... Knee Aspiration Technique sterile needle under patella Previous slide Next slide Back to first slide View graphic version Knee Aspiration Synovial Fluid - Analysis Blood - trauma is fat present? Pus white cells &#062 100 000/mm^3 = bacterial sepsis or gout Turbid any ... AnatomyKnee Bursae Previous slide Next slide Back to first slide View graphic version Bursitis Non Septic Prepatellar Housmaid’s knee Infrapatellar priest’s knee Popliteal cyst Baker’s cyst Previous slide Next slide Back to first sl... Bursitis Septic Good ROM inflammation skin Incise & drain Staphylococcus Previous slide Back to first slide View graphic version and patella, knee dislocations 10 am Fractures about the Knee MB ChB 4 ICM Robertson Tema 16 Session 3 Distal Femoral Fractures Forces Displacing ... Knee Injury Self Study Below is a list of useful links Meniscus injuries Wheeless online textbook Anterior Cruciate Soneclinic.com Knee Disloactio... Knee Injury Self Study Below is a list of useful links Meniscus injuries Wheeless online textbook Anterior Cruciate Soneclinic.com Knee Disloction... Fractures & DislocationsAnkle 19-Feb-04 Click here to start Table of Contents Fractures & DislocationsAnkle Fractures & DislocationsAnkle PPT Slid... Slide 1 of 23 Slide 2 of 23 Slide 3 of 23 Slide 4 of 23 Slide 5 of 23 Slide 6 of 23 Slide 7 of 23 Slide 8 of 23 Slide 9 of 23 Slide 10 of 23 Slide 11 of 23 Slide 12 of 23 Slide 13 of 23 Slide 14 of 23 Slide 15 of 23 Slide 16 of 23 Slide 17 of 23 Slide 18 of 23 Slide 19 of 23 Slide 20 of 23 Slide 21 of 23 Slide 22 of 23 Slide 23 of 23 Fractures & DislocationsAnkle MB ChB 4 Lecture ICM Robertson Tema 20 Session 6 Next slide Back to first slide View graphic version Fractures & DislocationsAnkle Causes Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version Xray Evaluation Mortice view AP Lateral Mortice AP Normal Previous slide Next slide Back to first slide View graphic version Xray Evaluation AP Previous slide Next slide Back to first slide View graphic version Xray Evaluation Lateral - Posterior Subluxation Previous slide Next slide Back to first slide View graphic version Classification Weber A - Medial comminution Weber B - Lateral comminution Weber C - Syndesmosis disrupted Previous slide Next slide Back to first ... Classification Previous slide Next slide Back to first slide View graphic version Weber A Fibula : Transverse # Low Med.Malleolus: Transverse # Vertical # Post. Malleolus: Intact Previous slide Next slide Back to first slide Vie... Weber B Fibula : Spiral # Joint level Med.Malleolus: Transverse Post.Malleolus: May # or post syndesmosis rupture Previous slide Next slide Back t... Weber C Fibula : Spiral # Above syndesmosis Med.Malleolus: Transverse Post.Malleolus: May # anterior and post syndesmosis rupture Previous slide N... Weber C Previous slide Next slide Back to first slide View graphic version PPT Slide Weber C Other names Dupytren’s # Maisonneuve # - Where fibula # at Proximal end NB Always examine ankle if fibula neck # Previous slide ... Complications Swelling Fracture blisters Early reduction mandatory Previous slide Next slide Back to first slide View graphic version Conservative treatment Closed reduction If swollen - backslab and elevate When swelling subsides -POP - below knee Previous slide Next slide Back ... Conservative treatment Reduce all immediately to prevent blisters Must get accurate reduction - 1mm if not obtained ORIF Previous slide Next slide... Management Operative Medial Malleolus - screw Lateral Malleolus - Reduce - hold with plate & screws Synesmosis - Weber C - Screw fib to tibia Post... ORIF -Weber B Previous slide Next slide Back to first slide View graphic version ORIF -Weber C “Synesmosis” screw for diastasis Previous slide Next slide Back to first slide View graphic version Postoperative Management Elevate limb Plaster cast Remove Syndesmosis screw at 6 weeks Previous slide Next slide Back to first slide View graphic ... Ligament injury Clinical diagnosis Xrays, Stress views Immobilise strapping POP Brace Mobilise Physiothrapy proprioception exercises Previous slid... Lateral Ligaments Stress views &#06215 deg = instability Previous slide Next slide Back to first slide View graphic version Ankle Dislocation Mostly open Debride Delayed ORIF Previous slide Back to first slide View graphic version Fractures of the Femur,Hip & Dislocations 19-Feb-04 Click here to start Table of Contents Fractures of the Femur,Hip & Dislocations Femur Fracture... Slide 1 of 45 Slide 2 of 45 Slide 3 of 45 Slide 4 of 45 Slide 5 of 45 Slide 6 of 45 Slide 7 of 45 Slide 8 of 45 Slide 9 of 45 Slide 10 of 45 Slide 11 of 45 Slide 12 of 45 Slide 13 of 45 Slide 14 of 45 Slide 15 of 45 Slide 16 of 45 Slide 17 of 45 Slide 18 of 45 Slide 19 of 45 Slide 20 of 45 Slide 21 of 45 Slide 22 of 45 Slide 23 of 45 Slide 24 of 45 Slide 25 of 45 Slide 26 of 45 Slide 27 of 45 Slide 28 of 45 Slide 29 of 45 Slide 30 of 45 Slide 31 of 45 Slide 32 of 45 Slide 33 of 45 Slide 34 of 45 Slide 35 of 45 Slide 36 of 45 Slide 37 of 45 Slide 38 of 45 Slide 39 of 45 Slide 40 of 45 Slide 41 of 45 Slide 42 of 45 Slide 43 of 45 Slide 44 of 45 Slide 45 of 45 Fractures of the Femur,Hip & Dislocations MB ChB 4 Lecture by ICM Robertson Next slide Back to first slide View graphic version Femur FracturesForces Displacing Abducted Psoas Flexes Adductors Distal only Previous slide Next slide Back to first slide View graphic version Forces Displacing Treatment align distal with proximal = Flexion and Abduction Previous slide Next slide Back to first slide View graphic version PPT Slide ClassificationPosition of prox. fragment Proximal - flexion & abduction Midshaft - neutral Distal -posterior angulation Previous slide N... Shaft - Conservative Treatment Adult Denham pin Skeletal traction - 10% body weight Balkan frame Knee Physiotherapy When Stable - mobilise on crut... Conservative Adult Previous slide Next slide Back to first slide View graphic version Conservative Adult Box Plaster - Ischial Weight Bearing - once stable Previous slide Next slide Back to first slide View graphic version Conservative - Adult Cast Brace - Ischial Weight Bearing - once stable Previous slide Next slide Back to first slide View graphic version Femoral ShaftChildren Under 12 kg - Gallows Traction Skin Traction with Thomas Splint in older child Early mobilisation - spicka cast or Crutches ... Femoral ShaftChildren Gallows Under 12 kg Vascular complications Previous slide Next slide Back to first slide View graphic version Shaft - Children Previous slide Next slide Back to first slide View graphic version Shaft - Children Skin Traction Detail “Inner under, outer over ” - Counteracts External. rotation Previous slide Next slide Back to first slide Vi... Shaft - Children 90-90 Traction Provides flexion for proximal fractures Previous slide Next slide Back to first slide View graphic version Indications for ORIF Inability to obtain reduction Inability to maintain reduction Vascular injury Pathological # Intra-articualr Multi trauma Age... Surgical treatment Closed nailing Low sepsis rate Fewer mechanical failures Previous slide Next slide Back to first slide View graphic version Surgical treatment Subtrocanteric & higher need Screw into neck Previous slide Next slide Back to first slide View graphic version ORIF - Alternatives Plate & screws Ender Pins Previous slide Next slide Back to first slide View graphic version External Fixators Avoid in Femur Indicated only in severe sepsis massive skin wounds Previous slide Next slide Back to first slide View graphic ve... ORIF - Complications Bent pin Previous slide Next slide Back to first slide View graphic version ORIF - Complications Loose Plate Screws alone are inadequate Previous slide Next slide Back to first slide View graphic version Complications -general Deep venous thrombosis Previous slide Next slide Back to first slide View graphic version Mobilisation Previous slide Next slide Back to first slide View graphic version Hip Dislocation Diagnosis and Treatment Previous slide Next slide Back to first slide View graphic version CAUSES Low energy - High energy trauma - MVA Previous slide Next slide Back to first slide View graphic version Shenton’s Line Line between the Inferior border of neck and Superior Pubic ramus If broken = dislocation femur neck # 2 Previous slide Next slide ... Shenton’s Line Line between the Inferior border of neck and Superior Pubic ramus If broken = dislocation femur neck # 2 Previous slide Next slide ... PPT Slide Previous slide Next slide Back to first slide View graphic version Position of limb - Post Dislocation Adducted Internal rotation Flexion Shortening 3 Previous slide Next slide Back to first slide View graphic ver... Xray Signs - Posterior Dislocation Broken Shenton’s line adduction internal rotation shortening 4 Previous slide Next slide Back to first slide Vi... Clinical Signs -Anterior Dislocation Abducted Externally rotated Shortened 5 Previous slide Next slide Back to first slide View graphic version Clinical Signs -Anterior Dislocation Abducted Externally rotated Shortened 5 Previous slide Next slide Back to first slide View graphic version Anterior Dislocation Abduction External rotation Lengthening 6 Previous slide Next slide Back to first slide View graphic version Treatment - posterior dislocation Emergency General Anaesthetic & Muscle relaxant Traction - length flex and pull Bed rest with skeletal traction ... Treatment - anterior dislocation Emergency General Anaesthetic & Muscle relaxant Disimpact - assistant - lat. force internal rotation Bed rest wit... Complications Early Sciatic nerve Thrombosis Other #s, head, femur neck Late AVN OA - 40% Previous slide Next slide Back to first slide View graph... Complications Early Sciatic nerve Thrombosis Other #s, head, femur neck Late AVN OA - 40% Previous slide Next slide Back to first slide View graph... Complications Early Sciatic nerve Thrombosis Other #s, head, femur neck Late AVN OA - 40% Avascular Necrosis Previous slide Next slide Back to fir... Fracture dislocation Femur fracture 10% Acetabular rim Head Femur Neck Previous slide Next slide Back to first slide View graphic version Prognosis AVN 5% Early reduction NB Osteoarthritis 40% Complications ~Velocity of trauma Previous slide Next slide Back to first slide View graphi... ‘Hip’ - Proximal FemurFractures Intracapsular Exta capsular Previous slide Next slide Back to first slide View graphic version Extracapsular fractures Age: Commonly 70+ Good blood supply no AVN Unite in varus Previous slide Next slide Back to first slide View graphic versi... Extracapsular fracturesTreatment Prevent DVT & PE rehydration elevate foot bed TED Stockings Mobilise Early ORIF Sliding Screw Previous slide Next... Intracapsular fractures Age: Commonly 70+ Poor blood supply AVN Non union if not fixed Previous slide Next slide Back to first slide View graphic ... Intracapsular fractures Treatment &#060 55 yr. ORIF 60 - 70 Total hip (if fit) &#062 70 (Unfit) Hemi arthroplasty Austin Moore Previous slide Next... Hip fractures Aim is a mobile patient Early ORIF & Mobilisation Previous slide Back to first slide View graphic version Fractures of the foot 19-Feb-04 Click here to start Table of Contents Fractures of the foot Calcaneus Fracture Classification Calcaneus # Classifi... Slide 1 of 30 Slide 2 of 30 Slide 3 of 30 Slide 4 of 30 Slide 5 of 30 Slide 6 of 30 Slide 7 of 30 Slide 8 of 30 Slide 9 of 30 Slide 10 of 30 Slide 11 of 30 Slide 12 of 30 Slide 13 of 30 Slide 14 of 30 Slide 15 of 30 Slide 16 of 30 Slide 17 of 30 Slide 18 of 30 Slide 19 of 30 Slide 20 of 30 Slide 21 of 30 Slide 22 of 30 Slide 23 of 30 Slide 24 of 30 Slide 25 of 30 Slide 26 of 30 Slide 27 of 30 Slide 28 of 30 Slide 29 of 30 Slide 30 of 30 Fractures of the foot MB ChB 4 Lecture ICM Robertson Tema 20 Session 7 Next slide Back to first slide View graphic version Calcaneus Fracture Acute Problems: Severe swelling Associated #s Thoracolumbar Plateau Hip Previous slide Next slide Back to first slide View grap... Classification Calcaneus # Extra articular Intra articular Previous slide Next slide Back to first slide View graphic version Classification Calcaneus # Extra articular Intra articular Extra-articular Intra-articular Previous slide Next slide Back to first slide View grap... Calcaneus #: Clinical Horse shoe bruising Flattening of heel Previous slide Next slide Back to first slide View graphic version Calcaneus #Xray Evaluation Bohler’s Angle Normal 25 to 40 deg. Indicates:- flattening Tendo achillies lengthening Previous slide Next slide Back t... CalcaneusSpecial Investigations X rays Calcaneus Thoracolumbar CT Scan Previous slide Next slide Back to first slide View graphic version Complications Calcaneus # Long term Pain Subtalar Peroneal tendons Heel pad Shoe Size Discrepancy Shortening TA Previous slide Next slide Back to ... Calacneus #Treatment Conservative Elevate foot Ice packs Reduction (if possible) POP (BK, later boot) Previous slide Next slide Back to first slid... Calacneus #Treatment Operative Selected fractures Problems skin breakdown sepsis Previous slide Next slide Back to first slide View graphic version Talus #s Classification a) Dome b) Neck Previous slide Next slide Back to first slide View graphic version Talus #s Problems Avascular necrosis 20-90% Talar # neck Previous slide Next slide Back to first slide View graphic version Talus #sDome Commonly complicate ankle # lateral ligament Problems OA ankle Talar # dome Previous slide Next slide Back to first slide View graphi... Talus #s Treatment Displaced ORIF K- Wire Screw Undisplaced Elevate Late POP Previous slide Next slide Back to first slide View graphic version Talus #s Treatment Anatomical reduction & ORIF Lowers incidence AVN Previous slide Next slide Back to first slide View graphic version Talus dislocations AVN - 90%+ Previous slide Next slide Back to first slide View graphic version Talar dislocationsTreatment Immediate reduction debridement (open) K wire fication Previous slide Next slide Back to first slide View graphic vers... Talar dislocationsTreatment Pantalar dislocation After reduction and ORIF Previous slide Next slide Back to first slide View graphic version AVN Talus Causes Talus neck # Dislocations Previous slide Next slide Back to first slide View graphic version Other Tarsal Injuries Indicates crush injury Swelling ++ Navicular # Previous slide Next slide Back to first slide View graphic version Metatarsal #s Base Metatarsal Jones Previous slide Next slide Back to first slide View graphic version Metatarsal #s Metatarsal Shaft # Previous slide Next slide Back to first slide View graphic version Metatarsal #s Metatarsal Shaft # - K-wire Previous slide Next slide Back to first slide View graphic version Metatarsal #s Treatment Undisplaced POP Displaced ORIF K-wire Plate Previous slide Next slide Back to first slide View graphic version Lisfranc fracture dislocation “Keystone” = 2nd MT disloacted Previous slide Next slide Back to first slide View graphic version Lisfranc Treatment Accurate reduction Closed ORIF Previous slide Next slide Back to first slide View graphic version Lisfranc Complications Early Swelling Dorsalis pedis rupture Late Pain - midfoot arthritis Previous slide Next slide Back to first slide View grap... Dislocations MP Joint, IP Joint Closed reduction Open reduction irreducible “button hole” Previous slide Next slide Back to first slide View graph... Phalanx Fracture Closed # boot buddy strapping Open Debride Save nail Previous slide Next slide Back to first slide View graphic version Phalanx Fracture ORIF Indications Intra-articular Large fragment Method Kwires Screws Previous slide Back to first slide View graphic version Fractures about the Knee 19-Feb-04 Click here to start Table of Contents Fractures about the Knee Distal Femoral Fractures Supracondylar fractures... Slide 1 of 32 Slide 2 of 32 Slide 3 of 32 Slide 4 of 32 Slide 5 of 32 Slide 6 of 32 Slide 7 of 32 Slide 8 of 32 Slide 9 of 32 Slide 10 of 32 Slide 11 of 32 Slide 12 of 32 Slide 13 of 32 Slide 14 of 32 Slide 15 of 32 Slide 16 of 32 Slide 17 of 32 Slide 18 of 32 Slide 19 of 32 Slide 20 of 32 Slide 21 of 32 Slide 22 of 32 Slide 23 of 32 Slide 24 of 32 Slide 25 of 32 Slide 26 of 32 Slide 27 of 32 Slide 28 of 32 Slide 29 of 32 Slide 30 of 32 Slide 31 of 32 Slide 32 of 32 Fractures about the Knee MB ChB 4 ICM Robertson Tema 20 Session 2 Next slide Back to first slide View graphic version Distal Femoral Fractures Forces Displacing gastrocnemius quadriceps Result Posterior angulation Previous slide Next slide Back to first slide View... Supracondylar fracturesFemur No intra articular extension Previous slide Next slide Back to first slide View graphic version Supracondylar Femur Often comminuted open Previous slide Next slide Back to first slide View graphic version Supracondylar #Conservative Previous slide Next slide Back to first slide View graphic version Supracondylar #Operative Most require operation To mobilise knee Need articular reduction Angles about knee Previous slide Next slide Back to firs... Supracondylar #Operative Debridement if open Accurate reduction Hold with blade plate condylar screw Early physiotherapy DCS Previous slide Next s... Patella Fractures Classification Transverse Stellate Transverse Lower pole Previous slide Next slide Back to first slide View graphic version Patella FracturesTreatment Conservative quadriceps mechanism intact less than 3mm displaced Stovepipe plaster Previous slide Next slide Back to fi... Patella FracturesTreatment Operative quadriceps mechanism not intact &#062 3mm displaced Kwires and tension band Previous slide Next slide Back to... Patella FracturesTreatment Operative Patellectomy ireducible # Patellectomy Problems weakens extension tendon pain Previous slide Next slide Back ... Patella Tendon RuptureTreatment Previous slide Next slide Back to first slide View graphic version Knee Dislocations Diagnosis Complications Treatment Previous slide Next slide Back to first slide View graphic version Diagnosis- usually obvious Suspect it in all Serious knee injuries Previous slide Next slide Back to first slide View graphic version Complications Arterial damage 30% incidence Do ARTERIOGRAM in ALL cases Previous slide Next slide Back to first slide View graphic version Treatment Reduce knee Splint Get arteriogram Admit and observe patient Conservative plaster cast or Exfix. Operative - Delayed ligament suture Pre... Anterior Dislocation Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version Anterior dislocationClinical Previous slide Next slide Back to first slide View graphic version Ligament Repair Harvest of patellar ligament graft for PCL repair Previous slide Next slide Back to first slide View graphic version PPT Slide Posterior Dislocation reduced and Ex. Fix. Previous slide Next slide Back to first slide View graphic version Posterior Dislocation Abnormal Arteriogram Previous slide Next slide Back to first slide View graphic version PPT Slide Posterior Dislocation L - End Result Previous slide Next slide Back to first slide View graphic version Acute ligament rupturesKnee Painful knee Aspirate effusion Is blood present ? Xrays are there bony avulsions? Examine knee Local MUA Previous slid... Medial Collateral Conservative if isolated Robert Jones bandage Previous slide Next slide Back to first slide View graphic version Lateral Collateral Complex Conservative if grade 1 or 2 Operative repair & suture grade 3 multiple ligaments Previous slide Next slide Back to fir... Cruciate ligaments Complex Conservative most cases Acute repair bony avulsions Previous slide Next slide Back to first slide View graphic version Plateau Fractures Previous slide Next slide Back to first slide View graphic version Plateau Fractures Previous slide Next slide Back to first slide View graphic version Plateau Fractures Conservative treatment &#060 5mm displaced Skeletal traction - distal tibia Mobilise knee POP Previous slide Next slide Back to ... Plateau FracturesSurgical Treatment Split # - reduce and screw or buttress plate Previous slide Next slide Back to first slide View graphic version Plateau FracturesSurgical Treatment Depressed # - reduce & Bone Graft Previous slide Back to first slide View graphic version Click here to start Table of contents INTRAARTICULAR FRACTURE Of DISTAL TIBIA CLASSIFICATION Slide 3 Slide 4 CAUSES TREATMENT OPTIONS PROBLEMS - (... INTRAARTICULAR FRACTUREOfDISTAL TIBIA “Pilon” Fractures by ICM Robertson CLASSIFICATION Type 1:No significant displacement Type 2:Significant ... First page Back Continue Last page Overview Graphics INTRAARTICULAR FRACTURE Of DISTAL TIBIA “Pilon” Fractures by ICM Robertson First page Back Continue Last page Overview Graphics CLASSIFICATION Type 1:No significant displacement Type 2:Significant articular incongruity Ty... First page Back Continue Last page Overview Graphics First page Back Continue Last page Overview Graphics Exoskeletal Fixation First page Back Continue Last page Overview Graphics First page Back Continue Last page Overview Graphics First page Back Continue Last page Overview Graphics Limited ORIF Plate fibula Minimal incision for articular reconstruction Subcutaneous plate or... First page Back Continue Last page Overview Graphics OPEN FRACTURES Debride Plate Fibula Exoskelet First page Back Continue Last page Overview Graphics First page Back Continue Last page Overview Graphics First page Back Continue Last page Overview Graphics Prognosis 50% + Good or excellent results Wyrsch - JBJS 78-A 15/18 ORIF Comps. 3 amputations ... First page Back Continue Last page Overview Graphics First page Back Continue Last page Overview Graphics First page Back Continue Last page Overview Graphics Complications: 35 yr. Male First page Back Continue Last page Overview Graphics First page Back Continue Last page Overview Graphics CAUSES Low energy - rotational High energy trauma - MVA First page Back Continue Last page Overview Graphics TREATMENT OPTIONS Conservative Open reduction Exoskeletal fixation First page Back Continue Last page Overview Graphics PROBLEMS - (ORIF) Poor vascularity -> Skin Breakdown -> Sepsis Respect the soft tissues First page Back Continue Last page Overview Graphics Skin Problems First page Back Continue Last page Overview Graphics CONSERVATIVE TREATMENT Calcaneal traction -> Early mobilisation Plaster cast - nondisplaced f... First page Back Continue Last page Overview Graphics Principles of ORIF Timing: - wait for swelling to subside Incisions: - 2 incisions, 8cm apart... Fractures of the Tibia 19-Feb-04 Click here to start Table of Contents Fractures of the Tibia Classification Shaft Fracture Closed Plaster Cast We... Slide 1 of 30 Slide 2 of 30 Slide 3 of 30 Slide 4 of 30 Slide 5 of 30 Slide 6 of 30 Slide 7 of 30 Slide 8 of 30 Slide 9 of 30 Slide 10 of 30 Slide 11 of 30 Slide 12 of 30 Slide 13 of 30 Slide 14 of 30 Slide 15 of 30 Slide 16 of 30 Slide 17 of 30 Slide 18 of 30 Slide 19 of 30 Slide 20 of 30 Slide 21 of 30 Slide 22 of 30 Slide 23 of 30 Slide 24 of 30 Slide 25 of 30 Slide 26 of 30 Slide 27 of 30 Slide 28 of 30 Slide 29 of 30 Slide 30 of 30 Fractures of the Tibia Student Lecture 4th Year by ICM Robertson Next slide Back to first slide View graphic version Classification Proximal Fractures Plateau Shaft fractures Distal Fractures Pilon Open Closed Previous slide Next slide Back to first slide View gr... Shaft Fracture Closed Closed reduction and above knee plaster cast Previous slide Next slide Back to first slide View graphic version Plaster Cast No anaesthetic if minimally displaced G. A. if shortened Knee 15 deg Ankle 90 deg Length - Groin to MP joints displaced Previous slid... Wedging an angulated # Previous slide Next slide Back to first slide View graphic version Wedging an angulated # Previous slide Next slide Back to first slide View graphic version Wedging an angulated # Previous slide Next slide Back to first slide View graphic version Management Shaft Fracture Check X ray Circulation check next morning Follow up X ray week later in POP Replace cast at 2 weeks - check X ray Regul... Fracture - later management PTB Cast Bear Cast Indications Midshaft or lower Stable fracture Previous slide Next slide Back to first slide View gr... PPT Slide Previous slide Next slide Back to first slide View graphic version Open Fractures Debridement leave wound open secondary suture later antibiotic Stabilisation No skin tension - POP Skin defect - Exfix may need ski... Open Fracture Previous slide Next slide Back to first slide View graphic version Open Fracture WaWash limb & prep. Previous slide Next slide Back to first slide View graphic version Open Fracture Enlarge wound Previous slide Next slide Back to first slide View graphic version Open Fracture Curette Marrow Cavity Previous slide Next slide Back to first slide View graphic version Open Fracture Irrigate ++ Previous slide Next slide Back to first slide View graphic version Open Fracture Result Previous slide Next slide Back to first slide View graphic version Amputation BK Traumatic Factors to consider skin muscle vascular nerve contamination time factor Previous slide Next slide Back to first slide Vie... Amputation BK Traumatic Technique debride wound leave open -”guillotine” definitive closure 12 cm minimum Previous slide Next slide Back to first ... PPT Slide AO External Fixator Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version Indications for ORIF Inability to obtain reduction hold reduction Previous slide Next slide Back to first slide View graphic version Unstable fracture Previous slide Next slide Back to first slide View graphic version Intramedullary pin Previous slide Next slide Back to first slide View graphic version Unstable / Comminuted fracture Plate fibula Bone graft ExFix Previous slide Next slide Back to first slide View graphic version Unstable / Segmental fracture IM pin is one soution Previous slide Next slide Back to first slide View graphic version Unstable / Segmental fracture Previous slide Next slide Back to first slide View graphic version Complications: Malunion Previous slide Next slide Back to first slide View graphic version Complications Nonunion Previous slide Next slide Back to first slide View graphic version PPT Slide Tibial Plafond Previous slide Back to first slide View graphic version Lower Limb Trauma Crossword Complete the crossword, then click on "Check" to check your answer. If you are stuck, you can click on "Hint" to get a... Ottawa rules for ankle and foot fractures Not all ankle injuries justify taking an X ray. The Ottawa rules are designed to help the doctor decide ... INTRAARTICULAR FRACTURE Of DISTAL TIBIA "Pilon" Fractures by ICM Robertson CLASSIFICATION · Type 1: No significant displacement · Type 2: Signific... DHTML Menu Builder 4.7.001 14h00 Tema 16, Session 6 ICM Robertson 1 No license: PDF produced by PStill (c) F. Siegert - http://www.this.net/~frank/pstill.html 14h00 Tema 16,... <= Index => Bone Tumors Multiple-choice exercise Choose the correct answer for each question. OK <= Index => ˙Ř˙áExif Use either the menus or click on the tumour pages below Menisci, Patella Dislocations & Knee, Instability 21/02/2006 Chronic Meniscus Injuries, Patellar & Knee Instability Lecture MB ChB 4 By ICM Robert... Handouts Students have been issued with a book of printed lecture notes covering the whole Musculoskeletal module. Due to cost considerations hand... Infective Conditions ­ musculoskeletal 2005 · · · · · · · J Schneider 4 EME H T ME T SY S LA TELEK S OLUC SUM E H T F O S N O I T ID N OC EV I TCE... PROF. JOHANN W SCHNEIDER 1 4 AME T LE SLE T S ELA TELEK S OLUK SUM E ID NAV ED NA T SE O T E WE I TKE F N I 4 AME T LE SLE T S ELA TELEK S OLUK SU... Paediatric Hip DDH, LCPD (Perthes disease), SUFE DR PJ DANEEL DDH Developmental dysplasia of the hip 2 per 1000 births Unstable 5-20 per 1000 F:M ... ONCOLOGICAL CONDITIONS OF THE MUSCULOSKELETAL SYSTEM THEME 11 PROF. JOHANN W SCHNEIDER DEPARTEMENT OF ANATOMICAL PATHOLOGY UNIVERSITY OF STELLENBO... Onkologiese Toestande van die Muskuloskeletale stelsel Prof. J. Schneider Slide 1 ONKOLOGIESE TOESTANDE VAN DIE MUSKULOSKELETALE STELSEL TEMA 11 P... Orthopaedic aspects of neuromuscular disease Orthopaedic aspects of neuromuscular disease and cerebral palsy DR PJ DANEEL Classification of neurol... Radiological signs of traumatic and nontraumatic conditions Radiological signs of traumatic and non-traumatic conditions Dr PJ Daneel Describing a... Wrist Fractures FRACTURES OF THE WRIST AND HAND COLLE'S FRACTURE Extra-articular fracture in distal 2.5 cm of distal radius. Common in middle aged... ");}else{if(aWgmnbspm||Awgmnbspm){document.write(" ");}};document.write(" "); Course Handouts Tutorials Links Quiz ");}else{if(aWgmnbspm||Awgmnbspm){document.write(" ");}};document.write(" "); Course Handouts Tutorials Links Quiz Search this site Enter one or more keywords to search for using the Zoom Search Engine. Note that '*' and '?' wildcards are supported. You must ha... Use this map as an alternative way to navigate Use this map as an alternative way to navigate Search this site Enter one or more keywords to search for using the Zoom Search Engine. Note that '*' and '?' wildcards are supported. You must ha... Primary and Secondary Bone Tumours ICM Robertson Benign vs. Malignant Benign Malignant Well defined margin Poorly defined margin Slow Growth Rapid... Download Lecture Notes Below is a table of class notes you received during the relevant lecture Feel free to download a copy. The notes are in MSW... Download Page for Class Notes Below is a list of Class Notes that may be downloaded from this page. If you have attended the lectures you should a... Primary and Secondary Bone Tumours ICM Robertson Benign vs. Malignant Benign Well defined margin Slow Growth Never metastases Malignant Poorly def... ENKEL EN VOET FRAKTURE EN ONTWRIGTING Mb Chb 4, ICM Robertson ANATOMIE Mediale ligament: Deltoid ligament. Mediale malleolus - Kalkaneus. Laterale... HEUPONWRIGTINGS, FEMURNEK, INTERTROGANTERIESE EN FEMURSKAG FRAKTURE Mb Chb 4 ICM Robertson 08h00 24/02/2004 Femurskagfrakture Klassifikasie. 1. Bo... Fractures of the foot ICM Robertson MB ChB. 4 Theme 20, Session 7 Calcaneus Fractures Usually result from a fall from a height. The heel is usuall... Fractures and Injuries about the Knee ICM Robertson MB ChB 4 09h00 24/02/2004 Supracondylar Fractures of the Femur High incidence in elderly (oste... Pag e MUSKULOSKELETALE INFEKSIES (Been-, Gewrigs- en Sagteweefsel infeksies) Beeninfeksie (osteomiëlitis) en Gewrigsinfeksie (arthritis) Predispon... Pag e MUSCULO-SKELETAL INFECTIONS (Bone, Joint and Soft tissue infections) Bone infection (osteomyelitis) and Joint infection (arthritis) Predispo... Self study Long term outlook:Knee and meniscus injuries ICM Robertson Mb Chb 4, On 24th February from 10h00 ­ 12h00 a period allocated for you to ... FRACTURES OF THE TIBIA Mb Chb 4, ICM Robertson Fractures of the tibia are usually obvious on clinical examination; they are often open, as the bon... Wound Healing & Wound Cover Wound Healing and Wound Cover FR Graewe Plastic and Reconstructive Surgery Plastic and Reconstructive Surgery February... Download Lecture Notes PDF Archive Below is a table of class notes you received during the relevant lecture Feel free to download a copy. The note... Onderste ledemaat pyn in die atleet Dr PJ Daneel Patologie Sagteweefsel tendon bursae spier Been/gewrigte Evaluasie Geskiedenis Kliniese ondersoek... FOOT DEFORMITIES IN CHILDREN...CONGENITAL CLUB FEET(CTEV).METATARSUS ADDUCTUS.PES CAVUS.PES PLANUS 18-02-04 Click here to start Table of Contents ... FOOT DEFORMITIES IN CHILDRENCONGENITAL CLUB FEET(CTEV)METATARSUS ADDUCTUSPES CAVUSPES PLANUS Dr PJ Daneel CONGENITAL CLUB FEET It is a structural ... Slide 1 of 47 Slide 2 of 47 Slide 3 of 47 Slide 4 of 47 Slide 5 of 47 Slide 6 of 47 Slide 7 of 47 Slide 8 of 47 Slide 9 of 47 Slide 10 of 47 Slide 11 of 47 Slide 12 of 47 Slide 13 of 47 Slide 14 of 47 Slide 15 of 47 Slide 16 of 47 Slide 17 of 47 Slide 18 of 47 Slide 19 of 47 Slide 20 of 47 Slide 21 of 47 Slide 22 of 47 Slide 23 of 47 Slide 24 of 47 Slide 25 of 47 Slide 26 of 47 Slide 27 of 47 Slide 28 of 47 Slide 29 of 47 Slide 30 of 47 Slide 31 of 47 Slide 32 of 47 Slide 33 of 47 Slide 34 of 47 Slide 35 of 47 Slide 36 of 47 Slide 37 of 47 Slide 38 of 47 Slide 39 of 47 Slide 40 of 47 Slide 41 of 47 Slide 42 of 47 Slide 43 of 47 Slide 44 of 47 Slide 45 of 47 Slide 46 of 47 Slide 47 of 47 FOOT DEFORMITIES IN CHILDRENCONGENITAL CLUB FEET(CTEV)METATARSUS ADDUCTUSPES CAVUSPES PLANUS Dr PJ Daneel Next slide Back to first slide View grap... CONGENITAL CLUB FEET It is a structural foot deformity that is present at birth Bilateral in 50% Occurs 1 out of 800 births More common in males t... CTEV Genetic tendency If both parents are normal with an affected child, 2 - 5% risk of the following child having a club foot With one affected p... Diff diagnosis Myotonic muscular dystrophy Arthogryposis multiplex congenita Myelomeningocele Poliomyelitis Cerebral palsy Peroneal type of progre... CONGENITAL CLUB FEET CAUSES Congenital Spina bifida Sacral agenisis Arthrogryposis multiplex congenita Neuro muscular disease Previous slide Next ... Clincal examination Hindfoot eqinous,varus Forefoot Adduction,cavus,supination Previous slide Next slide Back to first slide View graphic version Bad prognostic signs Rigid foot with a small heel tucked up in equinous and varus Deep medial skin fold midfoot Short 1st ray Small calf muscle Pr... X-rays AP Lateral Kite`s angle &#060 40 deg. Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version Treatment Aim Obtain a plantigrade foot Can never achieve a normal foot The foot will always be smaller than the normal foot The calf will always ... TREATMENT Manipulation/strapping/serial pops Surgical limited release(Ponseti) Postero-medial release(Turco,Cincinnati) Post-op follow-up Outcomes... Severe uncorrected c.t.e.v. Previous slide Next slide Back to first slide View graphic version Manipulation Previous slide Next slide Back to first slide View graphic version Strapping Previous slide Next slide Back to first slide View graphic version Pop application Previous slide Next slide Back to first slide View graphic version Postero-medial release Previous slide Next slide Back to first slide View graphic version Metatarsus adductus Forefoot adducted at the tarso-metatarsal joints Usually seen at the 1st year of birth Bilateral in 50% of patients may be ass... Examination Determine whether the hindfoot is completely normal Determine whether the foot can be passively corrected Previous slide Next slide Ba... X-rays usually not necessary X-rays usually not necessary To record the deformity trace an outline of the foot,or place the foot on a photocopier ... Treatment Non operative Approx. 85% will resolve spontaneously Passive stretching Denis Browne night splints Casting before age of 1years up to 4 ... Pes cavus Abnormal high longitudinal foot arch Calcaneus dorsiflexion and or forefoot equinous Previous slide Next slide Back to first slide View ... PPT Slide Pes cavus Longitudinal arch Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version Causes Neuromuscular Cerebral palsy Central cord Peripheral nerves/muscles Congenital Traumatic An MRI of the spinal cord is indicated in unilater... Clinical signs Claw toes Foot less supple Metatarsalgia,abnormal weight bare areas on the foot,cushion migrates distally Usually becomes symtomati... Treatment Conservative arch supports Surgical Corrective hindfoot osteotomy Midfoot osteotomy Correction of the claw toes Triple arthrodesis Previ... Pes planus Mobile (flexible) Rigid Previous slide Next slide Back to first slide View graphic version Causes Mobile hereditary ligamentous laxity shotened tendon achilles ascessory navicula Rigid Conginital vertical talus tarsal coalitions juvenile... Flexible flat foot: clinical examination Too many toes Previous slide Next slide Back to first slide View graphic version PPT Slide Flexible flat foot: clinical examination Hind foot valgus Previous slide Next slide Back to first slide View graphic version PPT Slide Flexible flat foot: clinical examination Hind foot valgus Corrects with toe standing and medial arch develops Previous slide Next slide ... PPT Slide Flexible flat foot: clinical examination Jack’s hyperextension test Hip:femoral anteversion Achilles shortened Active / passive ROM Sole... PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Flexible Flat Foot : Radiology Indications for X-Ray What to look for: On AP Previous slide Next slide Back to first slide View graphic ... PPT Slide Flexible Flat Foot : Radiology Indications for X-Ray What to look for: On lateral Previous slide Next slide Back to first slide View gra... Treatment mobile flat feet Shoe inserts,arch supports UCBL heels Physio,TA stretching.foot muscle exercises Sugical excision of a symtomatic asses... PPT Slide Surgery for Flexible flat foot Dwyer / modifications Previous slide Next slide Back to first slide View graphic version PPT Slide Surgery for Flexible flat foot Evans Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version Vertical talus Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version Treatment rigid flat feet Excision of the coalition Triple arthrodesis Previous slide Next slide Back to first slide View graphic version Fulford prosedure Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Back to first slide View graphic version Click to edit Master title style Click to edit Master text styles Second level Third level Fourth level Fifth level ‹date/time› ‹footer› ‹#› Click to edit Master title style Click to edit Master subtitle style ‹date/time› ‹footer› ‹#›  Notes Slide Show Outline 1 DDH, LCPD (Perthes disease), SUFE DR PJ DANEEL 2 DDH Developmental dysplasia of the hip 2 per 1000 births Unstable 5-2... DDH, LCPD (Perthes disease), SUFE n n nDR PJ DANEEL DDH nDevelopmental dysplasia of the hip n2 per 1000 births nUnstable 5-20 per 1000 nF:M =7:1 nL> R hip nMore common in nFemale,breech,firstborn,ol... Pathogenesis nExcessive capsular laxity and shallow acetabulum at birth nFemoral head anteverted, valgus nPulvinar nInverted limbus nDysplastic ac... Natural history n90 % of unstable hips stabilise by the age of 9 weeksnMaximum acetabular remodelling appears below the age of 18 months nA false ... Clinical nEarly nBarlow, Ortolani tests nMore accurate within 48 hrs n90%specificity & 60% sensitivity nLimb shortened, abnormal skin folds nLate ... Special investigations nUltrasound static and dynamic nX-rays after 6 months nArthrogram Treatment nAim: n   Concentric reduction, early acetabular development nClosed reduction and pop spica with hips in 90 degrees flexion and 30 to 6... Treatment first 3 months nImmobilise hips in 90 degrees flexion and 40 degrees abduction nDouble nappies nPavlik harness nFrejka cushion Pavlik Bone procedures after 2 years nFemoral procedures nDerotation, varus osteotomy of prox. Femur nAcetabular procedures nPembeton,Salter,Chiari,Shelf... Complications of DDH nAVN nOA Legg-Calve-Perthes disease(LCPD) nOsteonecrosis of the prox. Femoral epiphysis in a growing child nIncidence nM:F = 4:1,onset usually 4 to 8 yrs (... Pathological stages Takes 2 -4 yrs to complete nIschaemia/necrosis nFragmentation/resorption nRe-ossification/resolution nRemodelling n n Diff. diagnosis n Bilateral Perthes (skeletal survey as part of work up) nHypothyroidism nMultiple epiphyseal dysplasia nSpondyloepiphyseal dyspla... Other conditions associated with Perthes nSickle cell nThalassanemia nLeukemia nLymphoma nITP nHaemophilia nSteroids Investigations nAP and lateral (Löwenstein/frog leg) plain x-rays nBone scan nMRI nArthrography nFbc,diff wbc, ESR Clinical nClinical picture varies depending on the age of the child and the stage of the disease and the amount of head involved nLimp is often pa... SUFE nIncidence n3/100,000 whites n7/100,000 blacks nAge nMales 12 -14 yrs nFemales 10 – 13 yrs nBilateral in 25% Radiological signs nEarly nWaldenström sign nCrescent sign nLate nFragmentation and collapse of epiphysis nCalcification lateral to the epiphysis ... Classifications nCatterall nHerring = lateral pillar nStulberg =sphericity of head and congruency n n n n n                                       ... Prognosis nIndicators for poor prognosis nSex: F worse than M nBone age > 6 yrs nUncovering of the head nPercentage of the head involvement - •50%... Summary of treatment in Perthes disease § 2 - 4  yrs n     Watchful neglect prognosis usually good prognosis n     Treat synovitis,traction,nsaid`... Predisposition nObesity nRapid growth nEndocrinopathies-hypothyroidism, renal rickets, pituitary deficiency, GH deficiency when treated with GH  a... Aetiology n1. Mechanical nReduction in anteversion nIncreased body mass nSlope of epiphysis nIncreased physeal height due to widened zone of hyper... Presentation nPre-slip nAcute slip nSymptoms for less than 3/52 nChronic slip nSymptoms for greater than 3/52 nAcute on chronic slip nSymptoms for... Investigations nX- rays nAP and lateral of both hips nWidened epiphysis nDecreased epiphyseal height nKlein's line, Trethowan sign nBlanche sign n... Treatment n nPinning in situ n   Do not attempt a reduction as this causes AVNnSubtrochanteric osteotomy once the epiphysis has fused in the grade... Complications nChondrolysis nAVN nSubtrochanteric fracture nosteoarthritis n AP X-RAY DEMONSTRATING VARIOUS LINES TO DRAW to ascertain whether the hip is located, only useful after 6 months HILGENREINERS LINE Perkins line Southwick slip angle measured on The lateral x-ray Catterall's radiological classification Arthrogram done before surgery to determine concentric containment Treatment of Perthes under 5 years of age   nSupervised neglect Varus osteotomy at 5 to 8 years containment therapy nHelps head to heal in protected nenvironment Older than 8 yrs - Salvage procedures for an incongruent femur head in symptomatic hips n n n n Hinged abduction Valgus Osteotomy For hinged abduc... DDH nDDH Old DDH with false acetabulum and OA Position of normal acetabulum Ortolani test of reduction in the neonate Positioning-Ortolani n90 degree flexion n45 degree abduction Positioning of hip in pop spica n nSpica  at 3 months Walking age - clinical signs nShort leg nReduced abduction Treatment walking age arthrogram nCONCENTRIC REDUCTION   –   SPICA 12 WKS nNON CONCENTRIC REDUCTION  -  OPEN REDUCTION  AND  SPICA    6WKS n Diagnosis in the neonate nUltrasound Morphological profile of patient with SUFE Single screw fixation Immobilization with an ex-fix Minimal invasive subtrochanteric osteotomy Natural course of untreated Perthes remodeling NECROSIS FRAGMENRATION REOSSIFICATION REMODELING  A limping child with hip pathology Differential diagnosis 0-5yrs           5-10 yrs            10-15 yrs n n nDDH                  Irritable hip ... Severity of the slip Klein's line Valgus triplanar osteotomy The changing pattern of the blood supply to the femoral capital epiphysis in a child Newborn Foveal artery Retinacular vessels Metaphyseal vessels... Abduction splint - Rhino walker Salter osteotomy -  done to obtain head coverage Abduction pop - Gordon Petrie plasters X-ray changes in Perthes AP X-RAY SHENTONS LINE End stage Perthes with a bad prognosis Treatment 5 to 8 yrs nContainment therapy This page uses frames, but your browser doesn't support them. End of slide show, click to exit. DDH, LCPD (Perthes disease), SUFE DDH DDH Pathogenesis Natural history Clinical Ortolani test of reduction in the neonate Walking age - clinical s... DDH, LCPD (Perthes disease), SUFE DR PJ DANEEL DDH Developmental dysplasia of the hip 2 per 1000 births Unstable 5-20 per 1000 F:M =7:1 L> R hip M... DDH, LCPD (Perthes disease), SUFE DR PJ DANEEL DDH n Developmental dysplasia of the hip n 2 per 1000 births n Unstable 5-20 per 1000 n F:M =7:1 n L> R hip n More common in Female,breech,firstbo... Pathogenesis n Excessive capsular laxity and shallow acetabulum at birth n Femoral head anteverted, valgus n Pulvinar n Inverted limbus n Dysplast... Natural history n 90 % of unstable hips stabilise by the age of 9 weeks n Maximum acetabular remodelling appears below the age of 18 months n A fa... Clinical n Early Barlow, Ortolani tests More accurate within 48 hrs 90%specificity & 60% sensitivity Limb shortened, abnormal skin folds n Late Li... Special investigations n Ultrasound static and dynamic n X-rays after 6 months n Arthrogram    Treatment n Aim:    Concentric reduction, early acetabular development n Closed reduction and pop spica with hips in 90 degrees flexion and 30 ... Treatment first 3 months Bone procedures after 2 years n Femoral procedures Derotation, varus osteotomy of prox. Femur n Acetabular procedures Pembeton,Salter,Chiari,Shelf... Complications of DDH n AVN n OA Legg-Calve-Perthes disease(LCPD) n Osteonecrosis of the prox. Femoral epiphysis in a growing child n Incidence M:F = 4:1,onset usually 4 to 8 yrs ... Pathological stages Takes 2 -4 yrs to complete n Ischaemia/necrosis n Fragmentation/resorption n Re-ossification/resolution n Remodelling Diff. diagnosis Bilateral Perthes (skeletal survey as part of work up) n Hypothyroidism n Multiple epiphyseal dysplasia n Spondyloepiphyseal dyspl... Other conditions associated with Perthes n Sickle cell n Thalassanemia n Leukemia n Lymphoma n ITP n Haemophilia n Steroids Investigations n AP and lateral (Löwenstein/frog leg) plain x- rays n Bone scan n MRI n Arthrography n Fbc,diff wbc, ESR Clinical n Clinical picture varies depending on the age of the child and the stage of the disease and the amount of head involved n Limp is often ... SUFE Incidence n 3/100,000 whites n 7/100,000 blacks Age n Males 12 -14 yrs n Females 10 – 13 yrs n Bilateral in 25% Radiological signs Waldenström sign Cox magna Coxa vara Coxa brevi Sagging rope sign Crescent sign Classifications n Catterall n Herring = lateral pillar n Stulberg =sphericity of head and congruency                                              ... Prognosis n Indicators for poor prognosis n Sex: F worse than M n Bone age > 6 yrs n Uncovering of the head n Percentage of the head involvement -... Summary of treatment in Perthes disease § 2 - 4  yrs      Watchful neglect prognosis usually good prognosis      Treat synovitis,traction,nsaid`s ... Predisposition n Obesity n Rapid growth n Endocrinopathies-hypothyroidism, renal rickets, pituitary deficiency, GH deficiency when treated with GH... Aetiology 1. Mechanical n Reduction in anteversion n Increased body mass n Slope of epiphysis n Increased physeal height due to widened zone of hy... Presentation n Pre-slip n Acute slip Symptoms for less than 3/52 n Chronic slip Symptoms for greater than 3/52 n Acute on chronic slip n Symptoms ... Investigations X- rays n AP and lateral of both hips n Widened epiphysis n Decreased epiphyseal height n Klein's line, Trethowan sign n Blanche si... Treatment n Pinning in situ    Do not attempt a reduction as this causes AVN n Subtrochanteric osteotomy once the epiphysis has fused in the grade... Complications n Chondrolysis n AVN n Subtrochanteric fracture n osteoarthritis Perkins line HILGENREINERS LINE Southwick slip angle measured on The lateral x-ray Catterall's radiological classification Arthrogram done before surgery to determine concentric containment Treatment of Perthes under 5 years of age Supervised neglect Varus osteotomy at 5 to 8 years containment therapy n Helps head to heal in protected environment Older than 8 yrs - Salvage procedures for an incongruent femur head in symptomatic hips Hinged abduction Valgus Osteotomy For hinged abduction She... DDH Old DDH with false acetabulum and OA n DDH Position of normal acetabulum Ortolani test of reduction in the neonate Positioning-Ortolani n 90 degree flexion n 45 degree abduction Positioning of hip in pop spica n Spica  at 3 months Walking age - clinical signs n Short leg n Reduced abduction Treatment walking age arthrogram CONCENTRIC REDUCTION   –   SPICA 12 WKS NON CONCENTRIC REDUCTION  -  OPEN REDUCTION  AND SPICA    6WKS Diagnosis in the neonate Ultrasound Morphological profile of patient with SUFE Single screw fixation Immobilization with an ex-fix Minimal invasive subtrochanteric osteotomy Natural course of untreated Perthes FRAGMENRATION NECROSIS REOSSIFICATION REMODELING  A limping child with hip pathology Differential diagnosis 0-5yrs           5-10 yrs            10-15 yrs DDH                  Irritable hip      ... Severity of the slip Klein's line Valgus triplanar osteotomy The changing pattern of the blood supply to the femoral capital epiphysis in a child Abduction splint - Rhino walker Salter osteotomy -  done to obtain head coverage Abduction pop - Gordon Petrie plasters X-ray changes in Perthes AP X-RAY SHENTONS LINE End stage Perthes with a bad prognosis Treatment 5 to 8 yrs n Containment therapy Click to edit Master title style Click to edit Master text styles Second level Third level Fourth level Fifth level ‹date/time› ‹footer› ‹#› Click to edit Master title style Click to edit Master subtitle style ‹date/time› ‹footer› ‹#›  Notes Slide Show Outline 1 Orthopaedic aspects of neuromuscular disease and cerebral palsy DR PJ DANEEL 2 Classification of neurological conditio... Orthopaedic aspects of neuromuscular disease and cerebral palsy DR PJ DANEEL Classification of neurological conditions nNeurological nCerebral palsy nSpina bifida nHSMN nAnt. horn cell, polio nNeuromuscular junction nMuscul... Cerebral palsy nDefinition n   Defective movement and posture nCaused by a static brain lesion occurring at the stage of rapid brain developmentn ... Epidemiology n1-5 in 1000 births nMore common in developed countries, in the lower social class Causes §Prenatal 30% n    Maternal infections,drugs,congenital brain malformation nPerinatal 60% n  seen in prems < 2500g,25-40%, n   Anoxia 10-20...  Classification of CP §Spastic 60%,monoplegic,hemiplegic diplegic, quadriplegic §Athetoid/dyskinetic nAtaxia nHemi ballistic nHypotonic nCombinati... Associated conditions nSeen in whole body CP nMental retardation nConvulsions nLearning disorders nEmotional problems nEye sight and hearing impai... Normal development nHead control at 3/12 nSit independently 6/12 nCrawl 8/12 nPull themselves up at 9/12 nWalks 12/12 CP EN AMBULATION nVarious gait patterns seen nScissoring nStiff knee nCrouch nEquinus nHemiplegic nAtaxic Predicting  walking in a child with CP at one year of age nAsymmetrical tonic neck reflex nSymmetrical tonic neck reflex nNeck righting reflex nMo... Orthopaedic treatment nMultidisciplinary approach nChild must be evaluated repeatedly before planning any surgery nRealistic goal setting nThe pat... Objectives nUpright spine and a horizontal pelvis nMaintain a located mobile and painless hip nMobile knees for transfer § Plantigrade feet  §Supp... Strategy n0-3yr - physio n4-6-yr- surgery n7-8yr-school en psychological development n18-jr ?work, accommodation Orthopaedic procedures §Botox injections §Orthoses §Surgery n   Soft tissue releases n   Bone procedures n Soft tissue procedures nHip nAdductor release, ilio psoas release nPartial obturator nerve neurectomy nKnee nMedial hamstring release nPosterior c... Clinical nUpper limb n    Thumb in palm nEvaluate spine n    scoliosis pelvis obliquity nLower limb n   Thomas test  Staheli - Fl contracture hips... Ankle/feet nTA shortening nSilfverskiöld test nVulpius lengthening, TA lengthening -Hoke, Z-plasty nTibialis Anterior transfer (SPLAT) nTibialis p... Bone procedures § Hip dislocations nOpen reduction, external rotational osteotomies of the femur, arthrodesis nTIBIA nInternal rotation osteotomy ... CEREBRAL PALSY nSpasticity inhibits: n nIntegrated muscle movement nMobility nGait pattern. nLeads to contractures n n nCONTROL OF SPASTICITY SHOU... CP  CLINICAL PATTERNS Equinus Intoe-ing Wheel chair bound GASTROCNEMIUS SOLEUS COMPLEX Silfverskiöld test to test for soleus/gastrocnemius tightness Spasticity leads to toe gait; Positive supportive refle... MEDIAL  HAMSTRINGS tightness Sacral sitting crouch                                    scissor HIPS Flexion contractures MANAGEMENT  MODALITIES n1.Physiotherapy n2.Splints n3.Botulinum toxin n4.Medication n5.Orthopaedic surgery n6.Selective dorsal rhizotomy n nAnterior horn cell due to viral infection nLower motor neuron lesion nMotor loss nNormal sensation nAsymmetrical paralysis nMultiple deformities ... DUCHENNE MUSCULAR DYSTROPHY n   Hereditary, sex linked recessive, mother the carrier, seen in boys n   Progressive disease n  Girdle weakness, 95%... Spina bifida/cystica nDevelopmental defect n5% of normal population have a laminar defect – spinae bifida occulta nCystica 2 – 3:1000 live births ... Pathology                               spina bifida                                                                                              ... Pathology continued nHydrocephalus often associated with spina bifida cystica 70%nDistraction on cord may cause herniation on cerebellum through t... Clinical nSp. bif. occulta sometimes causes some dysfunction, defect seen on AP x-ray in the midline, central bony ridge may be indicative of a di... Table to demonstrate the deformities seen in the lower limb depending on the level of the lesion n Almost normal AFO,SHOE INSERT Calc-valgus MILD ... Treatment nEarly – skin closure within 48 hrs. ventrico-cavl shunt n    Feet deformities – physio n    IVP to locate urinary tract abnormalities n... Natural history - Duchenne's nLoss of ability to independent ambulation at age 10 yrs nWalks with a KAFO until 12-14 yrs nWheelchair bound 15 yrs ...                                     Gowers sign Wheelchair bound SPECIAL INVESTIGATIONS nIncreased CPK nMuscle biopsy - histology Ř   Absent dystrophin Ř   Focal areas of necrosis and inflammatory infiltration ARTHROGRYPOSIS CONGENITA MULTIPLEX nCongenital, non progressive. limitation of joint movement due to soft tissue contractures nMultiple causes nLo... Clinical nMyopathy/neuropathy/combined nMultiple rigid joints nNormal intelligence nLoss of skin folds over joints nSkin tightness and shiny nMusc... Presenting patterns nBuda position nShoulders-add + internal rotation nWrists Fl, ulnar deviation nHips FL, Add, ER, dislocated  35% nKnees FL nFe... Treatment nMay require multiple procedures nPassive stretching, serial pops, osteotomies nU/limb n    Pace one arm in extension other arm in flexi... Principles of treatment nPrevent deformities nPhysio nOrthoses nSurgery to correct deformities nCrouch gait Stiff knee gait External tibial torsion Thomas test – Flexion contracture of the hip Staheli test for flexion contractures of the hip with flexion contracture of the knees. Thomas test cannot be done Phelps test for adductor and medial hamstring tightness Ely's test for Rectus femoris tightness Femoral popliteus angle – test for hamstring tightness Foot thigh angle – test for tibial torsion Foot alignment Fem/pop angle This page uses frames, but your browser doesn't support them. End of slide show, click to exit. Orthopaedic aspects of neuromuscular disease and cerebral palsy Classification of neurological conditions Cerebral palsy CEREBRAL PALSY  Classific... Orthopaedic aspects of neuromuscular disease and cerebral palsy DR PJ DANEEL Classification of neurological conditions Neurological Cerebral palsy... Orthopaedic aspects of neuromuscular disease and cerebral palsy DR PJ DANEEL Classification of neurological conditions n Neurological Cerebral palsy Spina bifida HSMN n Ant. horn cell, polio n Neuromuscular junction n Muscu... Cerebral palsy n Definition    Defective movement and posture n Caused by a static brain lesion occurring at the stage of rapid brain development ... Epidemiology n 1-5 in 1000 births n More common in developed countries, in the lower social class Causes § Prenatal 30%     Maternal infections,drugs,congenital brain malformation n Perinatal 60%   seen in prems < 2500g,25-40%,    Anoxia 10-20%...  Classification of CP § Spastic 60%,monoplegic,hemiplegic diplegic, quadriplegic § Athetoid/dyskinetic n Ataxia n Hemi ballistic n Hypotonic n Com... Associated conditions Seen in whole body CP n Mental retardation n Convulsions n Learning disorders n Emotional problems n Eye sight and hearing i... Normal development n Head control at 3/12 n Sit independently 6/12 n Crawl 8/12 n Pull themselves up at 9/12 n Walks 12/12 CP EN AMBULATION n Various gait patterns seen n Scissoring n Stiff knee n Crouch n Equinus n Hemiplegic n Ataxic Predicting  walking in a child with CP at one year of age n Asymmetrical tonic neck reflex n Symmetrical tonic neck reflex n Neck righting reflex ... Orthopaedic treatment n Multidisciplinary approach n Child must be evaluated repeatedly before planning any surgery n Realistic goal setting n The... Objectives n Upright spine and a horizontal pelvis n Maintain a located mobile and painless hip n Mobile knees for transfer §  Plantigrade feet § ... Strategy n 0-3yr - physio n 4-6-yr- surgery n 7-8yr-school en psychological development n 18-jr ?work, accommodation Orthopaedic procedures § Botox injections § Orthoses § Surgery    Soft tissue releases    Bone procedures Soft tissue procedures n Hip Adductor release, ilio psoas release Partial obturator nerve neurectomy n Knee Medial hamstring release Posterior cap... Clinical n Upper limb     Thumb in palm n Evaluate spine     scoliosis pelvis obliquity n Lower limb    Thomas test  Staheli - Fl contracture hips... Ankle/feet n TA shortening Silfverskiöld test Vulpius lengthening, TA lengthening -Hoke, Z- plasty Tibialis Anterior transfer (SPLAT) Tibialis pos... Bone procedures §  Hip dislocations Open reduction, external rotational osteotomies of the femur, arthrodesis n TIBIA Internal rotation osteotomy ... CEREBRAL PALSY Spasticity inhibits: Integrated muscle movement Mobility Gait pattern. Leads to contractures CONTROL OF SPASTICITY SHOULD IMPROVE G... CP  CLINICAL PATTERNS Equinus Intoe-ing Wheel chair bound GASTROCNEMIUS SOLEUS COMPLEX Silfverskiöld test to test for soleus/gastrocnemius tightness Spasticity leads to toe gait; Positive supportive refle... MEDIAL  HAMSTRINGS tightness crouch                                    scissor Sacral sitting HIPS Flexion contractures MANAGEMENT  MODALITIES 1.Physiotherapy 2.Splints 3.Botulinum toxin 4.Medication 5.Orthopaedic surgery 6.Selective dorsal rhizotomy POLIOMYELITIS Anterior horn cell due to viral infection Lower motor neuron lesion Motor loss Normal sensation Asymmetrical paralysis Multiple defo... DUCHENNE MUSCULAR DYSTROPHY    Hereditary, sex linked recessive, mother the carrier, seen in boys    Progressive disease   Girdle weakness, 95% de... Spina bifida/cystica n Developmental defect n 5% of normal population have a laminar defect – spinae bifida occulta n Cystica 2 – 3:1000 live birt... Pathology                               spina bifida                                                                                              ... Pathology continued n Hydrocephalus often associated with spina bifida cystica 70% n Distraction on cord may cause herniation on cerebellum throug... Clinical n Sp. bif. occulta sometimes causes some dysfunction, defect seen on AP x-ray in the midline, central bony ridge may be indicative of a d... Table to demonstrate the deformities seen in the lower limb depending on the level of the lesion Treatment n Early – skin closure within 48 hrs. ventrico-cavl shunt     Feet deformities – physio     IVP to locate urinary tract abnormalities n ... Natural history - Duchenne's n Loss of ability to independent ambulation at age 10 yrs n Walks with a KAFO until 12-14 yrs n Wheelchair bound 15 y...                                     Gowers sign Wheelchair bound SPECIAL INVESTIGATIONS n Increased CPK n Muscle biopsy - histology Ř    Absent dystrophin Ř    Focal areas of necrosis and inflammatory infiltrati... ARTHROGRYPOSIS CONGENITA MULTIPLEX n Congenital, non progressive. limitation of joint movement due to soft tissue contractures n Multiple causes n... Clinical n Myopathy/neuropathy/combined n Multiple rigid joints n Normal intelligence n Loss of skin folds over joints n Skin tightness and shiny ... Presenting patterns n Buda position n Shoulders-add + internal rotation n Wrists Fl, ulnar deviation n Hips FL, Add, ER, dislocated  35% n Knees F... Treatment n May require multiple procedures n Passive stretching, serial pops, osteotomies n U/limb     Pace one arm in extension other arm in fle... Principles of treatment n Prevent deformities n Physio n Orthoses n Surgery to correct deformities Crouch gait Stiff knee gait External tibial torsion Thomas test – Flexion contracture of the hip Staheli test for flexion contractures of the hip with flexion contracture of the knees. Thomas test cannot be done Phelps test for adductor and medial hamstring tightness Ely's test for Rectus femoris tightness Femoral popliteus angle – test for hamstring tightness Foot thigh angle – test for tibial torsion Foot alignment Fem/pop angle Rotational and alignment deformities of the lower limbs in children,leg pain in children and osteochondroses 18-Feb-04 Click here to start Table o... Rotational and alignment deformities of the lower limbs in children,leg pain in children and osteochondroses Dr PJ Daneel Rotational and alignment... Slide 1 of 37 Slide 2 of 37 Slide 3 of 37 Slide 4 of 37 Slide 5 of 37 Slide 6 of 37 Slide 7 of 37 Slide 8 of 37 Slide 9 of 37 Slide 10 of 37 Slide 11 of 37 Slide 12 of 37 Slide 13 of 37 Slide 14 of 37 Slide 15 of 37 Slide 16 of 37 Slide 17 of 37 Slide 18 of 37 Slide 19 of 37 Slide 20 of 37 Slide 21 of 37 Slide 22 of 37 Slide 23 of 37 Slide 24 of 37 Slide 25 of 37 Slide 26 of 37 Slide 27 of 37 Slide 28 of 37 Slide 29 of 37 Slide 30 of 37 Slide 31 of 37 Slide 32 of 37 Slide 33 of 37 Slide 34 of 37 Slide 35 of 37 Slide 36 of 37 Slide 37 of 37 Rotational and alignment deformities of the lower limbs in children,leg pain in children and osteochondroses Dr PJ Daneel Next slide Back to first... Rotational and alignment deformitiesThis is what we are talking about Anteversion of the hip Internal and lateral tibia torsion Genu valgum,genu v... PPT Slide Femoral anteversion Children are born with ante version of the femoral neck of +\- 40 degrees.As the child grows the ante version lessen... PPT Slide Femoral anteversion Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Craig`s test for anteversion Previous slide Next slide Back to first slide View graphic version PPT Slide http://www.orthoteers.co.uk/Nrujp~ij33lm/Images/thighfoot.gif http://www.orthoteers.co.uk/Nrujp~ij33lm/Images/transmall.gif Foot thigh a... Physiological alignment profile in the lower limbs in the child http://www.orthoteers.co.uk/Nrujp~ij33lm/Images/kneeage.jpg Previous slide Next sl... PPT Slide Tibia Torsion Natural history Tibia rotates laterally with growth Fetus –med malleolus behind lat. malleolus At birth – tips of malleoli... PPT Slide Tibia Torsion Medial rotation rare in isolation,more common when associated with cong. metarsus varus , developmental genu valgum or wit... PPT Slide Lateral Tibia Torsion Can occur in isolation or associated with : 1.A tight ITB band 2. Secondary to persistent femoral ante version Cli... PPT Slide Ober`s test Previous slide Next slide Back to first slide View graphic version PPT Slide Treatment Does not correct with growth Early treatment is recommended Stretching of ITB band Operative supra-malleolar osteotomy at age ... Alignment deformities Genu varum Genu valgum Previous slide Next slide Back to first slide View graphic version Metatarsus adductus Heel normal Forefoot in adduction and supination Treatment Manipulation Shoes surgery Previous slide Next slide Back to first ... Causes of alignment deformities Physiological Blount`s disease Metabolic,rickets Dysplasia,dwarfism Neurofibromatosis Previous slide Next slide Ba... Physiological Physiological Bilateral,symmetrical Lateral thrust absent Drennan`s angle &#060 11 deg Upper tibia metaphysis normal Epiphysis norma... PPT Slide Drennan`s angle Blounts Previous slide Next slide Back to first slide View graphic version Documentationof deformity Measuring clinically,med. malleoli at ankles on standing,tracing on paper Standing x-rays of lower limbs Measurement of ... PPT Slide Previous slide Next slide Back to first slide View graphic version Blounts disease Infantile Adolescent Infantile most common growth disorder of med. portion of proximal tibial physis med. angulation and int. tib.... Orthotic management,warn while child is wait bearing,long knee brace with locked –knee and pelvic band Orthotic management,warn while child is wai... Blounts disease Previous slide Next slide Back to first slide View graphic version PPT Slide Blounts Previous slide Next slide Back to first slide View graphic version PPT Slide Blounts Previous slide Next slide Back to first slide View graphic version PPT Slide Corrective osteotomy for Blounts Previous slide Next slide Back to first slide View graphic version Genu valgum Previous slide Next slide Back to first slide View graphic version PPT Slide CORRECTIVE OSTEOTOMY Previous slide Next slide Back to first slide View graphic version PPT Slide Rickets Classic deformity baby Child X-rays Generalized osteoporosis epiphysis appear late Growth plates are widened, cupping metaphysea... PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Rickets Previous slide Next slide Back to first slide View graphic version PPT Slide Medical If commenced before 4 years of age,no severe deformities are seen Dieatary supplements-vit.D Hypophosphatemic deficiency has to ... Osteochondroses in children Osteochondritis dessicans,intra-articular knee &#060 10 years,treatment differs &#062 10 years Osgood-slatters disease... PPT Slide Osteochondritis dessicans Juvenile &#060 10 years no treatment,good prognosis Adolescent &#062 10 years Prognosis guarded sometimes surg... PPT Slide Osgood slatters disease http://www.orthoteers.co.uk/Nrujp~ij33lm/Images/osgood1.jpg Previous slide Next slide Back to first slide View g... PPT Slide http://www.orthoteers.co.uk/Nrujp~ij33lm/Images5/Freibergs1.jpg http://www.orthoteers.co.uk/Nrujp~ij33lm/Images5/Freibergs2.jpg Freiberg... Leg pain in children(growing pains) Age 2 to 7 Night pain Intermittent Diaphysis of long bones,quads and calf muscles Sometimes abdominal cramps P... Hello World Choice Powerpoint vs HTML Onderste ledemaat pyn in die atleet Dr PJ Daneel Patologie Sagteweefsel tendon bursae spier Been/gewrigte Evaluasie Geskiedenis Kliniese ondersoek... ‹header› ‹date/time› ‹footer› ‹#› Click to edit Master title style Click to edit Master text styles Second level Third level Fourth level Fifth level ‹date/time› ‹footer› ‹#›  Notes Slide Show Outline 1 Radiological signs of traumatic and non-traumatic conditions Dr PJ Daneel 2 Describing a fracture  Open or closed ? Wh... Radiological signs of traumatic and non-traumatic conditions Dr PJ Daneel Perkin’s timetable for fracture healing » » » » » » •Lower limb –add on 25%                                           •    spiral fractures 3/52 x... Xray`s   rule of two’s •Two views •Two joints •Two limbs •Two injuries •Two occasions Describing a fracture • Open or closed ? •Which bone and where? •Has it involved a joint ? •What is the shape of the fracture? Types of fractures •Transverse •Oblique •Spiral •Butterfly •Comminuted •Segmental Osteoarthritis  R A         RA  X-Rays of the hands  RA deterioration over 10 years in same patient Gout  Tophacious gout Rheumatoid arthritis of the feet INVOLUCRUM SEQUESTRUM Chronic osteomyelitis                     Bone lesions/location       osteoarthritis Paget's Paget’s disease •Chronic non malignant disease characterized by increased  bone turnover •Aggressive disorganized bone resorption by osteoclasts •... Clinical- symptoms and signs •Pain •Limb deformities                                             •O.A. joints •Nerve compression •Skull enlargemen... Complications •Pathological # •Neurological •Cardiac •Kidney –Stones –Hypercalcemia   –Gout •Malignancy 1% –osteogenic sarcoma –chondrosarcoma X-Rays • Osteoporosis Rickets • Classic deformities –Baby –Child • X rays –generalized osteoporosis –epiphysis ossification centers appear late –Growth plate widening -... Osteomalacia •Diffuse bone pain                                       bone deformities                               pathological #               ... Xrays rickets cupping deformities Xray Osteomalacia Looser zones Biconcave vertebrae Trefoil pelvis protrusia acetabuli Singh index Ward triangle Trabecular pattern Tensile Compression Grade 1-7 Subluxation/dislocation •Joint articular surface partially displaced •Articular surface totally displaced Dislocations •Clinical features of a dislocation      abnormal position of the limb       movements are painful and restricted •X ray clinches the... Anterior dislocated shoulder     Posterior dislocated shoulder Skeletal dysplasia •Physeal and metaphyseal changes •Epiphyseal and/or vertebral changes •Diaphyseal changes •Mixture of epiphyseal,metaphyseal, v... Bony changes due to radiation segmental spiral butterfly Bone cyst        Hip osteoarthitis Enchondroma Ewing's sarcoma Osteogenic sarcoma Radiation •Skin manifestations •Blood •Bone Perkin`s rule continued •Upper limb spiral fractures take  6-8/52 to consolidate add 25% if there is a transverse fracture or if the femur is invo... Comminuted fracture Causes of fratures •Direct trauma •Indirect trauma General metabolic bone diseases •Osteoporosis •Osteomalacia •Rickets •Renal osteodystrophy •Hyperparathyroidism •Pagets disease •Gout Article Update June 2000,page 35 •Rational use in primary care for x-rays investigations of the spine Bone tumours,questions to ask when looking at an x-ray (Watt,1985) •Is the lesion solitary or multiple? •What type of bone is involved? •Where is ... Rational use of x-rays investigations of the spine in Primary care • Appropriate use- indications for x-rays are: •Chronic backache in a young pat... Continued •Suspected or actual scoliosis •Patients with known malignancy and backache•Backache associated with systemic illnesses and persistent w... Inappropriate use of spinal x-rays •To diagnose spondylosis after age of 50 years •Acute disc prolapse •To detect or monitor osteoporosis •More th... Tips and pitfalls •Bone metastases can be missed on plain          x-ray- 50% of bone must be lost before metastases become evident•Poor correlati... Key points •A plain x-ray is rarely helpful in diagnosis •Most patients over 50 years have OA changes•There can be a normal x-ray with a disc prol... This page uses frames, but your browser doesn't support them. End of slide show, click to exit. Radiological signs of traumatic and non-traumatic conditions Describing a fracture Causes of fratures Types of fractures Slide 5 Slide 6 X ray`s  ... Radiological signs of traumatic and non-traumatic conditions Dr PJ Daneel Describing a fracture  Open or closed ? Which bone and where? Has it inv... Radiological signs of traumatic and non-traumatic conditions Dr PJ Daneel Perkin’s timetable for fracture healing • Upper limb Spiral fractures       3/52 x2x2=12 weeks Transverse fractures   3/5 x2x2x2=24 weeks • Lower ... Xray`s   rule of two’s • Two views • Two joints • Two limbs • Two injuries • Two occasions Describing a fracture •  Open or closed ? • Which bone and where? • Has it involved a joint ? • What is the shape of the fracture? Types of fractures • Transverse • Oblique • Spiral • Butterfly • Comminuted • Segmental Osteoarthritis  R A         RA  X-Rays of the hands  RA deterioration over 10 years in same patient Gout  Tophacious gout Rheumatoid arthritis of the feet Chronic osteomyelitis INVOLUCRUM SEQUESTRUM                     Bone lesions/location       osteoarthritis Paget's Paget’s disease • Chronic non malignant disease characterized by increased  bone turnover • Aggressive disorganized bone resorption by osteoclasts... Clinical- symptoms and signs • Pain • Limb deformities • O.A. joints • Nerve compression • Skull enlargement • Spinal stenosis • Serological • Inc... Complications • Pathological # • Neurological • Cardiac • Kidney – Stones – Hypercalcemia – Gout • Malignancy 1% – osteogenic sarcoma – chondrosar... X-Rays Rickets • Classic deformities – Baby – Child • X rays – generalized osteoporosis – epiphysis ossification centers appear late – Growth plate widen... Osteomalacia • Diffuse bone pain bone deformities pathological # periarticular calcifications muscular weakness sec. hyperparathyroidism osteitis ... Xrays rickets cupping deformities Xray Osteomalacia Trefoil pelvis protrusia acetabuli Looser zones Trabecular pattern Tensile Compression Singh index Grade 1-7 Subluxation/dislocation • Joint articular surface partially displaced • Articular surface totally displaced Dislocations • Clinical features of a dislocation abnormal position of the limb movements are painful and restricted • X ray clinches the diagnosi... Anterior dislocated shoulder     Posterior dislocated shoulder Skeletal dysplasia • Physeal and metaphyseal changes • Epiphyseal and/or vertebral changes • Diaphyseal changes • Mixture of epiphyseal,metaphysea... Bony changes due to radiation segmental butterfly spiral Bone cyst        Hip osteoarthitis Enchondroma Ewing's sarcoma Osteogenic sarcoma Radiation • Skin manifestations • Blood • Bone Perkin`s rule continued • Upper limb spiral fractures take  6-8/52 to consolidate add 25% if there is a transverse fracture or if the femur is inv... Comminuted fracture Causes of fratures • Direct trauma • Indirect trauma General metabolic bone diseases • Osteoporosis • Osteomalacia • Rickets • Renal osteodystrophy • Hyperparathyroidism • Pagets disease • Gout Article Update June 2000,page 35 • Rational use in primary care for x-rays investigations of the spine Bone tumours,questions to ask when looking at an x-ray (Watt,1985) • Is the lesion solitary or multiple? • What type of bone is involved? • Where ... Rational use of x-rays investigations of the spine in Primary care Appropriate use- indications for x-rays are: • Chronic backache in a young pati... Continued • Suspected or actual scoliosis • Patients with known malignancy and backache • Backache associated with systemic illnesses and persiste... Inappropriate use of spinal x-rays • To diagnose spondylosis after age of 50 years • Acute disc prolapse • To detect or monitor osteoporosis • Mor... Tips and pitfalls • Bone metastases can be missed on plain x-ray- 50% of bone must be lost before metastases become evident • Poor correlation bet... Key points • A plain x-ray is rarely helpful in diagnosis • Most patients over 50 years have OA changes • There can be a normal x-ray with a disc ... Onderste ledemaat pyn in die atleet Dr PJ Daneel Patologie Sagteweefsel tendon bursae spier Been/gewrigte Evaluasie Geskiedenis Kliniese ondersoek... Muskuloskeletale Termiologie en Deformiteite PJ Daneel Mediese terme Dorlands mediese woordeboek Adduksie,abduksie Ankilose,antalgies Artritis,art... Muskuloskeletale Termiologie en Deformiteite 25-11-03 Click here to start Table of Contents Muskuloskeletale Termiologie en Deformiteite Mediese t... Slide 1 of 28 Slide 2 of 28 Slide 3 of 28 Slide 4 of 28 Slide 5 of 28 Slide 6 of 28 Slide 7 of 28 Slide 8 of 28 Slide 9 of 28 Slide 10 of 28 Slide 11 of 28 Slide 12 of 28 Slide 13 of 28 Slide 14 of 28 Slide 15 of 28 Slide 16 of 28 Slide 17 of 28 Slide 18 of 28 Slide 19 of 28 Slide 20 of 28 Slide 21 of 28 Slide 22 of 28 Slide 23 of 28 Slide 24 of 28 Slide 25 of 28 Slide 26 of 28 Slide 27 of 28 Slide 28 of 28 Muskuloskeletale Termiologie en Deformiteite PJ Daneel Next slide Back to first slide View graphic version Mediese terme Dorlands mediese woordeboek Adduksie,abduksie Ankilose,antalgies Artritis,artrodese Artroplastiek,artrose Bunion,cavus Diafise,displ... Mediese terme Olistese,osteitis Osteochondritis Ostechondrose Osteolise,ostesklerose Osteotomie Plantaarfleksie,planus Pollux,procurvatum Pronasie... Teksboeke en verwysings Concise System of Orthopaedics and fractures AG Apley/L Solomon Apleys System of Orthopaedics Clinical Orthopaedic examati... websites Google search-wheeless textbook of orthopaedics Journal of American Family Physicians Previous slide Next slide Back to first slide View ... PPT Slide Genu varum Previous slide Next slide Back to first slide View graphic version PPT Slide Genu valgum Previous slide Next slide Back to first slide View graphic version PPT Slide Belyning fisiologiese verandering met groei Previous slide Next slide Back to first slide View graphic version PPT Slide Heup anteversie Previous slide Next slide Back to first slide View graphic version PPT Slide Heup anteversie Previous slide Next slide Back to first slide View graphic version PPT Slide Pes planus Previous slide Next slide Back to first slide View graphic version PPT Slide metatarsalgie Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Beenlengte verskille Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Normale Previous slide Next slide Back to first slide View graphic version Gait Stance swing Previous slide Next slide Back to first slide View graphic version PPT Slide Langbene epifiese metafiese diafiese Previous slide Next slide Back to first slide View graphic version PPT Slide Osteitis Previous slide Next slide Back to first slide View graphic version PPT Slide Akute osteitis neonaat Ouer kinders Previous slide Next slide Back to first slide View graphic version PPT Slide Chroniese osteitis Previous slide Next slide Back to first slide View graphic version PPT Slide Spondilolistesis Previous slide Next slide Back to first slide View graphic version PPT Slide Gradering van spodilolistese Previous slide Next slide Back to first slide View graphic version PPT Slide Spondiloliese Scotty dog sign Previous slide Next slide Back to first slide View graphic version PPT Slide Torticollis Previous slide Back to first slide View graphic version Muskuloskeletale Sisteem 6/02/2006 - 24/02/2006 Tema Sessie Datum Voorsitter Tyd Aktviteit Onderwerp Dosent Verwelkoming 06/02/2006 J. du Toit 08h... Case 1: Diagnosis Simple bone cyst Treatment Home Case 1: Detail of Case 1 Go back Take note of the perosteal reaction Go back Treatment varies according to the size of the cyst Presume the diagnosis is simple bone cyst in the same child What if: My treatment would be: Pre... Case 1: Treatment Operative The periosteal reaction suggests the cyst is in a pre-fracture stage Curettage and pack cyst with bone chips Go back O... Case 1: Xray Findings Cystic, slightly expansile lesion of the humerus. Not well loculated Detail -shows a periosteal reaction present Go back Dia... Free JavaScripts provided by The JavaScript Source Search this Musculoskeltal site for key words Enter a search word (try an orthopaedic or anatomical term) - the associated document/s will be retr... Free JavaScripts provided by The JavaScript Source Back Ache : The Problem Lumbar Spine: Backache The most expensive problem in the world Most expensive industrial injury Highest cause of disabilit... Back Ache : The Problem 20-Feb-04 Click here to start Table of Contents PPT Slide Back Ache : The Problem Lumbar Spine: Backache Back Ache : Natur... Slide 1 of 31 Slide 2 of 31 Slide 3 of 31 Slide 4 of 31 Slide 5 of 31 Slide 6 of 31 Slide 7 of 31 Slide 8 of 31 Slide 9 of 31 Slide 10 of 31 Slide 11 of 31 Slide 12 of 31 Slide 13 of 31 Slide 14 of 31 Slide 15 of 31 Slide 16 of 31 Slide 17 of 31 Slide 18 of 31 Slide 19 of 31 Slide 20 of 31 Slide 21 of 31 Slide 22 of 31 Slide 23 of 31 Slide 24 of 31 Slide 25 of 31 Slide 26 of 31 Slide 27 of 31 Slide 28 of 31 Slide 29 of 31 Slide 30 of 31 Slide 31 of 31 PPT Slide Back Pain in the Workplace Prof GJ Vlok University of Stellenbosch Next slide Back to first slide View graphic version Back Ache : The Problem Disease of Mankind 80% of People Commonest Cause of Musculo- Skeletal Disability Previous slide Next slide Back to first s... Lumbar Spine: Backache The most expensive problem in the world Most expensive industrial injury Highest cause of disabilities &#060 45 years Most ... Back Ache : Natural History Self limiting disease 70% clears spontaneous in 2 – 3 weeks 95% clears with conservative treatment in 6 – 8 weeks &#06... BACK ACHE COIDA / WCA Most common cause disability 25% Claims 33% Compensation cost 40% Absences of work Previous slide Next slide Back to first s... Back Ache : Diagnosis BASIS: Clinical Examination: Sophisticated Special Investigations: - Confirm Clinical Diagnosis - Must Correlate Clinical Fi... Compensation for OccupationalInjury and Disease Act (130 of 1993) The provide that employees who experience personal injury by an accident arising... No fault system Everybody wins as a result of the employee’s unfortunate injury: Employee get big settlement. Doctors and Hospitals and other medi... IOD Back is a Pain Game In this game there is no solution and very frequently no end. Patients challenges the medical providers to diagnose his pa... Role of the Employee in the Game Injured worker Patient Chronic suffer Victim of “unfair” compensation procedures Client Plaintiff Previous slide ... How does the game begin First consultation: Full history is substituted by the tag of ”IOD” Medical examination, x-rays The fact that the person h... Effects on the medical profession: “IOD back” fogs the doctors customary critical analysis of the real pathology – an over anxious desire to start... PPT Slide Specialist start playing the pain game Physical and neurological examination are negative The employee is then referred for the followin... PPT Slide Patient has continuous complaints Expect explanation - facet blocks Surgeon suggest: - exploration back - fusion Employee embraces sugge... PPT Slide Patient better 10 – 14 days Then worse Further investigation Several operations follow Previous slide Next slide Back to first slide Vie... PPT Slide Patient worse Blame everyone, especially work/COIDA Commissioner receive letters from: Employer Lawyer Health Therapist Psychiatrist Oth... Risk Factors thatPlays a Role 1. Type of work: Manual labourers Truck, tractor, forklift etc. driver Job Satisfaction Previous slide Next slide Ba... Risk Factors thatPlays a Role 2. Individual Factors: Age Smoking Overweight Previous operation Schooling Political factors Previous slide Next sli... Risk Factors thatPlays a Role 3. Psychological Factors: Low control at work Time pressure Work stress No support supervisors or co-workers Previou... PPT Slide Previous slide Next slide Back to first slide View graphic version Impact of IOD Back on the Fund – South Africa Statistics 1997 Total working days lost 225148 Total fatal cases 18 Total cases 23857 Financial Impa... PPT Slide Months to Return to Function Fig. 3. Chronology of back pain: 80% of persons with non- Specific low back pain return to function in abou... Prevention of Disabilityin the Workplace IMPAIRMENT ARISE IN WORKPLACE – NOT DISABILITY Previous slide Next slide Back to first slide View graphic... Prevention of Disabilityin the Workplace Employer must be pro-active: Prevent accidents Workers trained & skilled Identify risk factors Manage ear... Prevention of Disability Employer: Implement health promotion programmes Stress Management Alcohol, Substance abuse Weight control Hypertension Sm... Prevention of Disability Employee: Job satisfaction Social political condition Motivation, counseling Previous slide Next slide Back to first slid... Prevention of Disability The doctor: Thorough clinical examination Definite diagnosis No experimental surgery No prolonged sick leave Prevent boar... Implications of Disability on Worker No Job Multiple operations Depressed, frustrated Divorce Legal action Totally destroyed 5 – 10 years time Pre... ADVICE Patiens must not see IOD as pension Doctors must not use boarding as an easy exit Use fixed guidelines – AMA Always motivated patients Empl... Workmans Compensation Do not pay doctors Difficult to communicate SAOA unable to contact Minister of Labour Is is feasible to work through agents ... PPT Slide The End! Previous slide Back to first slide View graphic version Prof GJ Vlok AO Spine Course 22 – 24 Jan 2003 Nachemson: Self limiting disease 70% clears spontaneously in 2 – 3 weeks 95% clears with conserv... Microsoft PowerPoint Presentation 20-Feb-04 Click here to start Table of Contents PPT Slide PPT Slide PPT Slide PPT Slide PPT Slide PPT Slide PPT ... Slide 1 of 34 Slide 2 of 34 Slide 3 of 34 Slide 4 of 34 Slide 5 of 34 Slide 6 of 34 Slide 7 of 34 Slide 8 of 34 Slide 9 of 34 Slide 10 of 34 Slide 11 of 34 Slide 12 of 34 Slide 13 of 34 Slide 14 of 34 Slide 15 of 34 Slide 16 of 34 Slide 17 of 34 Slide 18 of 34 Slide 19 of 34 Slide 20 of 34 Slide 21 of 34 Slide 22 of 34 Slide 23 of 34 Slide 24 of 34 Slide 25 of 34 Slide 26 of 34 Slide 27 of 34 Slide 28 of 34 Slide 29 of 34 Slide 30 of 34 Slide 31 of 34 Slide 32 of 34 Slide 33 of 34 Slide 34 of 34 PPT Slide Prof GJ Vlok AO Spine Course 22 – 24 Jan 2003 NON-OPERATIVE OPTIONS FOR LOW BACK PAIN (Conservative Treatment) Next slide Back to first ... PPT Slide INFORMATION Nachemson: (a) Neck & Back Pain – 202 articles (b) Newest Knowledge on Back Ache – Corr 1992 2. Back Pain in Work Place – Fo... PPT Slide NON-OPERATIVE OPTIONS FOR LOW BACK PAIN Contents: Natural History of Lower Back Pain Conservative Measures Recommendations Idet Previous... PPT Slide Lower Back Pain Disease of mankind Effects 80% of people Many causes known ± 20% a specific cause never identified Previous slide Next s... PPT Slide Nachemson: Self limiting disease 70% clears spontaneously in 2 – 3 weeks 95% clears with conservative treatment in 6 – 8 weeks &#060 5% ... PPT Slide Fordyce 1996: Back Pain in the Workplace Most Expensive Orthopaedic problem in the world Most Expensive Industrial Injury Cause of Highe... PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide BACK ACHE No Problem: Excellent natural history Self limiting disease Spine tends to stabilize spontaneously Problem: -Causes not always... PPT Slide BACK ACHE Spine Interactive Courses: Davos 2002 No evidence that spinal fusion gives better outcome for Back Ache TRUE: Back Ache defini... PPT Slide Risk Factors thatPlays a Role Type of work: - Manual Labourers - Truck, tractor, forklift etc. driver - Job Satisfaction Previous slide ... PPT Slide Individual Factors: - Age - Smoking - Overweight - Previous operation - Schooling - Political factors Previous slide Next slide Back to ... PPT Slide LOW BACK PAIN Van Tulder / Waddell: Which Intervention is most effective? Are these Interventions effective regarding: 1) Overall improv... PPT Slide Low Back Pain: Van Tulder / Waddell Classification: Acute &#060 6 weeks Sub-acute 6 – 12 weeks Chronic &#062 12 weeks Levels of Evidence... PPT Slide Analgesics: LEVEL A: 6 RCT’s – only one high quality Use Aspirin, Paracetamol, weak Opoieds NOT BETTER THAN NSAID Conservative Treatment... PPT Slide NSAID: Level A:Good relief for LBP No effect-Natural History -Return to work Different types equally effective Can have serious side eff... PPT Slide Conservative Treatment of Lower Back Pain 3. Muscle Relaxants: 18 High quality RCT’s 6 Low quality RCT’s Level A-Effective acute Low Bac... PPT Slide Conservative Treatment of Lower Back Pain 4. Anti-depressants Facet Joint / Triggerpoint Injection Acupuncture Level D Previous slide Ne... PPT Slide Conservative Treatment of Lower Back Pain 7. Oral Steroids Level C Oral steroids not effective Complications:1. Short term: minimal 2. L... PPT Slide Conservative Treatment of Lower Back Pain Epidural Injections 2 RCT’s Level C:Limited evidence that it is better than Placebo / bed rest... PPT Slide Bed rest: 10 RCT-5 high quality -5 low quality Level A:Not effective for lower back pain Level C:Not effective for lower back pain c roo... PPT Slide 10. Advice on staying active 8 RCT’s-6 high quality all positive 2 low quality Level A:Continue ordinary activity as normal as possible ... PPT Slide Conservative Management of Back Ache 11. Back Exercises:10 RCT’s-2 high quality -8 low quality Level A:Acute not very effective Sub-acut... PPT Slide Conservative Management for Lower Back Pain 13. Manipulation & Mobilization: 10 RCT’s-2 high quality -14 low quality Level B: -If done b... PPT Slide Conservative Treatment for Back Ache 14. TENS: 2 RCT’s1 high quality 1 low quality Level C 15: Traction:2 RCT’s-small sizes Level C -No ... PPT Slide Conservative Treatment for Low Back Pain Strong evidence exists for the following: NSAID effective for simple low back pain Muscle relax... PPT Slide RECOMMENDATIONS Waddell / 2. Royal College of Gen Practitioners / 3. Dutch General Practice Guidelines Acute Back Ache: Bed rest – max 2... PPT Slide RECOMMENDATIONS Drug Therapy-Analgesics fixed period -NSAID -Muscle relaxant 4.Physio -Pain relief, return to normalactivities and rehab... PPT Slide RECOMMENDATIONS Sub-acute Lower Back Pain: Advice on staying active:- Increase / fixed schedule Back exercises:- Fixed programme - Impro... PPT Slide RECOMMENDATION Chronic Lower Back Pain: Goal:- Return to work / usual activities - Coping with symptoms - Control of pain - Improve qual... PPT Slide Drug Therapy: - Avoid long-term Analgesics Manual Therapy / Exercises: - Improve daily functioning - Increase intensity of exercise - Ge... PPT Slide Multi Disciplinary Treatment: Functional Restoration Behavioural Management Pain Management Chronic Low Back Pain Previous slide Next sl... PPT Slide Intradiscal Electro Thermal Treatment for Chronic Lower Back Pain Saal JA & JS Spine 2002 Disc is Pain Generator Patients:- No response ... PPT Slide IDET Thermal catheter Temp 90ş for 13 minutes Post Idet Treatment: Intensive physio for 3 weeks Results:60 – 70% success rate Previous s... PPT Slide IDET CONCLUSION: A cohart of patients suffering from chronic discogenic low back pain with previous failed conservative treatment has a ... Degeneratiewe toestande van die Lumbale Werwelkolom Click here to start Table of contents Degeneratiewe toestande van die Lumbale Werwelkolom RUGP... Degeneratiewe toestandevan dieLumbale Werwelkolom PROF GJ VLOK 22 Augustus 2002 RUGPYN: DIE PROBLEEM Siekte van die mens 80% van mense Algemeenste... Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: Notes: First page Back Continue Last page Summary Graphics Degeneratiewe toestande van die Lumbale Werwelkolom PROF GJ VLOK 22 Augustus 2002 Notes: First page Back Continue Last page Summary Graphics RUGPYN: DIE PROBLEEM Siekte van die mens 80% van mense Algemeenste oorsaak van Muskuloskeletal... First page Back Continue Last page Summary Graphics Degeneratiewe Verandering: Diagnose Kliniese Ondersoek X-foto ? AP, Lat & Fleksie Ekstensie Mi... First page Back Continue Last page Summary Graphics Spinale Stenose Vernouing van die spinale kanaal met drukking op neurale elemente: Sentraal < ... First page Back Continue Last page Summary Graphics Notes: First page Back Continue Last page Summary Graphics Notes: First page Back Continue Last page Summary Graphics Notes: First page Back Continue Last page Summary Graphics Spinale Stenose Kliniese beeld : Ou persoon ? loop vooroor Neurogene kloudikasie ? uni / bilat... First page Back Continue Last page Summary Graphics Spinale Stenose: Behandeling Medikasie Modifiseer aktiwiteite Stutte nie van veel waarde Epidu... First page Back Continue Last page Summary Graphics Spinale Stenose Indikasie vir chirurgie : Radikulęre pyn Neurologiese uitval Cauda Equina Sind... First page Back Continue Last page Summary Graphics Spinale Stenose Dekompressie : Doen doelgerig Probeer so veel as moontlik liggamente en beenst... First page Back Continue Last page Summary Graphics Lumbale Stenose met Spondilolistesis F.F.F.F.F. Rugpyn Radikulęre pyn Notes: First page Back Continue Last page Summary Graphics Rugpyn: Oorsake Baie oorsake bekend 20% spesifieke oorsaak nooit gevind in Gevaar: Radiologies... First page Back Continue Last page Summary Graphics Notes: First page Back Continue Last page Summary Graphics Degeneratiewe Spondilolistese Fisiese Ondersoek : - Loop vooroor - Goeie beweging - Neurologie... First page Back Continue Last page Summary Graphics Degeneratiewe Spondilolistesis Behandeling Non-operatief Operatief Goeie resultate 10 ? 15 % R... First page Back Continue Last page Summary Graphics Degeneratiewe Spondilolistesis Chirurgiese behandeling : Dekompressie, veral wortel kanaal Fus... First page Back Continue Last page Summary Graphics Degeneratiewe Spondilolistesis Fusie + Instrumentasie : Gebruik Titanium Geringe distraksie Ni... First page Back Continue Last page Summary Graphics Faset Sindroom Faset is bron van pyn Blokke nie van veel waarde Blokke nie van waarde om resul... First page Back Continue Last page Summary Graphics Sinoviale Siste Deel van faset degenerasie MRI diagnose Verskeie tipes: - Sinoviale siste - Pe... First page Back Continue Last page Summary Graphics Notes: First page Back Continue Last page Summary Graphics Notes: First page Back Continue Last page Summary Graphics Degeneratiewe Verandering + Skoliose Groot probleem Bepaal: 1. Rigiditeit 2. Stabiliteit 3. Lo... First page Back Continue Last page Summary Graphics Rugpyn : Natuurlike Verloop Self beperkende toestand 70% klaar spontaan op in 2 ? 3 weke 95% k... First page Back Continue Last page Summary Graphics Degeneratiewe verandering + Skoliose Almal benodig nie ?n fusie nie Indikasie vir fusie: - As ... First page Back Continue Last page Summary Graphics Spinale Fusies Posterolaterale Intertransversfusie Instrumentasie goue standaard Ander opsies:... First page Back Continue Last page Summary Graphics Diskus Prostesis Kommersieël gedryf Baie duur - 3 vlak - R88 920-00 (Onlangse kwotasie) Indika... First page Back Continue Last page Summary Graphics Notes: First page Back Continue Last page Summary Graphics Diskus Prostesis Kan groot voordeel inhou Behou beweging segment Indikasies is vaag Langtermyn... First page Back Continue Last page Summary Graphics Pedikulęre Fiksasie Beter fusie resultate Beheer belyning Vroeë mobilisasie Pasiënt is meer ge... First page Back Continue Last page Summary Graphics Pedikulęre Fiksasie Belangrike deel van spinale fusies Verskeie sisteme Baie duur R35 000-00 G... First page Back Continue Last page Summary Graphics Notes: First page Back Continue Last page Summary Graphics Pedikulęre Fiksasie sonder Fusie Geen indikasie Duur Beenskroef loslating is groot probleem No... First page Back Continue Last page Summary Graphics Notes: First page Back Continue Last page Summary Graphics Lumbale Werwelkolom : Rugpyn Duurste mediese probleem Duurste industriële besering Grootste oo... First page Back Continue Last page Summary Graphics Vertebro Plastie / Kifoplastie Beperkte gebruik Kommersieël gedryf Ernstige komplikasies Onlan... First page Back Continue Last page Summary Graphics Notes: First page Back Continue Last page Summary Graphics Degeneratiewe Verandering INTERNE FIKSASIE / KEUSE VAN METALE: Vlekvrye Staal : Titanium Probe... First page Back Continue Last page Summary Graphics Rugpyn: Behandeling Kry definitiewe diagnose Altyd konserwatief Moet definitiewe indikasie vir... First page Back Continue Last page Summary Graphics Notes: First page Back Continue Last page Summary Graphics Notes: First page Back Continue Last page Summary Graphics RUGPYN COIDA / WCA : Algemeenste oorsaak van ongeskiktheid 25% van eise 33% Vergoedingskoste 4... First page Back Continue Last page Summary Graphics RUGPYN: DIAGNOSE KLINIESE ONDERSOEK VORM GRONDSLAG VAN DIAGNOSE Gesofistikeerde spesiale onder... First page Back Continue Last page Summary Graphics DISKUS DEGENERASIE Begin by ouderdom 17 jaar Progressiewe water verlies fasette Osteofiet form... First page Back Continue Last page Summary Graphics Notes: First page Back Continue Last page Summary Graphics Notes: Skoliose 20-02-04 Click here to start Table of Contents PPT Slide Skoliose Skoliose Skoliose Kifose / Lordose Skoliose Skoliose Skoliose Idiopatie... Prof GJ Vlok 18 Februarie 2003 Skoliose 3 Dimensionele Deformiteit: Angulasie Rotasie Kifose / Lordose Skoliose Skoliose Kifose / Lordose Gebruik ... 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Skoliose Klassifikasie: Struktureel ?? 3 Dimensionele Deformiteit Funksioneel - Spierspasma - Kort been - Postureel Previous slide Next slide Back... Skoliose Previous slide Next slide Back to first slide View graphic version Skoliose Klassifikasie volgens Etiologie: Idiopaties Paralities Kongenitaal Neurofibromatose Mesengimaal Previous slide Next slide Back to first s... Idiopaties Infantiel &#060 4 jr of Vroeë of laat Juveniel 4 – 11 jr aanvang Adolesent 11 - ± 18 jr 5 jaar oud Degeneratief - Volwassenes afsnypunt... Skoliose Kongenitaal: - Vertebraal - Wigwerwels Ekstra Vertebraal - Afwesig / Kolasie ribbe Previous slide Next slide Back to first slide View gra... PPT Slide Previous slide Next slide Back to first slide View graphic version Skoliose Neurofibromatose: Distrofies - “Pencilling” ribbes Café Au Lait vlekke Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version Skoliose Paralities: Neuropaties-OMN -BMN Miopaties-Spierdistrofie Benodig vroeë diagnose en behandeling veral spierdistrofie Previous slide Next ... Skoliose Paralities Previous slide Next slide Back to first slide View graphic version Skoliose Infantiel &#060 30 ş klaar op &#062 30 ° met rotasie (Rib vertebrale hoek &#062 20°) Previous slide Next slide Back to first slide View g... PPT Slide Previous slide Next slide Back to first slide View graphic version Skoliose Wat voorspel verergering: Groei Graad van kurwe Rotasie Previous slide Next slide Back to first slide View graphic version Skoliose Groei: Volgroei:Vrouens &#062 15˝ jaar -kronologiese oudMans &#060 17˝ jaar L Pols (Grenlich / Pyle Atlas Risser Teken (AP Bekken) Previo... PPT Slide Previous slide Next slide Back to first slide View graphic version Skoliose Graad van kurwe: Cobbs metode Previous slide Next slide Back to first slide View graphic version Skoliose: Rotasie Posisie Pedikels 1 - 4 Previous slide Next slide Back to first slide View graphic version Skoliose Kliniese Evaluasie: Trek klere uit Volle Neurologiese / Fisiese ondersoek X-strale Previous slide Next slide Back to first slide View gra... Skoliose Previous slide Next slide Back to first slide View graphic version Skoliose : X-strale 36 “ AP / Lat staande AP Pelvis Buig opnames AP L pols Tomogramme Previous slide Next slide Back to first slide View graphic v... Skoliose 36” AP Risser Previous slide Next slide Back to first slide View graphic version Skoliose Verdere Beelding Studies: Miëlogram / MRI / Tomogramme NET AS: Neurologies aantasting en ander Neurologies stigmata het Previous slide Ne... Skoliose BEHANDELING: Goeie evaluasie Bewys progressie / 4-6 maandeliks Volwassene-pyn -onstabiliteit Previous slide Next slide Back to first slid... Skoliose / Behandeling &#060 20° Geen 20 - 45° Stutte &#062 45° Chirurgie Previous slide Next slide Back to first slide View graphic version Skoliose: Stutte 3 Punt Stut Milwaukee Stut Previous slide Next slide Back to first slide View graphic version Skoliose: Milwaukee Stut Previous slide Next slide Back to first slide View graphic version Skoliose Chirurgie: Torakale Kurwe &#062 45° Lumbale kurwe &#062 60° Volwassene-Pyn -Onstabiliteit Previous slide Next slide Back to first slide V... Skoliose: Chirurgie Previous slide Next slide Back to first slide View graphic version Skoliose Geen werwelkolom kan 100% reguit gemaak word nie. Previous slide Next slide Back to first slide View graphic version Skoliose: Resultaat Chirurgie Previous slide Next slide Back to first slide View graphic version Skoliose Kyk vir ander afwykings, bv onstabiele Lumbo / Sakrale aansluiting Previous slide Next slide Back to first slide View graphic version Skoliose 15 jr Spondilolistese Rugpyn Kurwe ? 60° Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version Skoliose Gesonde kinders Kan normale lewe lei Previous slide Next slide Back to first slide View graphic version Kifose Postureel Scheuerman se siekte Kongenitaal Trauma Metabolies Neoplasties Previous slide Next slide Back to first slide View graphic version PPT Slide Normale Kurwe Torakaal 37° Kifose Previous slide Next slide Back to first slide View graphic version Scheuerman’s Kifose • Beserings groeiplate • &#062 10° wigting werwels • &#062 45° Torakale Kifose Previous slide Next slide Back to first slide V... PPT Slide Previous slide Next slide Back to first slide View graphic version Kifose: Trauma 40° van werwel Anterior saamgeval CHIRURGIE Previous slide Next slide Back to first slide View graphic version Kongenitale Kifose Torako lumbaal Progressief Hoë insidensie Neurologiese uitval CHIRURGIE – ANTERIOR / POSTERIOR Previous slide Next slide Back t... PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Die Einde! Previous slide Back to first slide View graphic version Spinal links a page of links to spinal websites Onderste ledemaat pyn in die atleet Dr PJ Daneel Patologie Sagteweefsel tendon bursae spier Been/gewrigte Evaluasie Geskiedenis Kliniese ondersoek... Contents Tumor page Select page Xray Self Evaluation Handout -Bone Tumor Links Spinal mets. page Name Comment Xray Self Evaluation Picture & list ... ICM Robertson ‹header› ‹date/time› Click to edit Master text styles Second level Third level Fourth level Fifth level ‹footer› ‹#› ‹header› ‹date/time› ‹footer› ‹#› Click to edit Master title style Click to edit Master text styles Second level Third level Fourth level Fifth level ‹date/time› ‹footer› ‹#›  Notes Slide Show Outline 1 ONCOLOGICAL CONDITIONS OF THE MUSCULOSKELETAL SYSTEM THEME 11 PROF. JOHANN W SCHNEIDER DEPARTEMENT OF ANATOMICAL PATHO... ONCOLOGICAL CONDITIONS OF THE MUSCULOSKELETAL SYSTEM THEME 11 PROF. JOHANN W SCHNEIDER DEPARTEMENT OF ANATOMICAL PATHOLOGY UNIVERSITY OF STELLENBO... Background knowledge lPrinciples of carcinogenesis and neoplasia lTumour nomenclature lDifferences: benign and malignant neoplasia lTumour differe... Incidence and etiology lUncommon = 0,5% of cancer deaths l40% of bone tumours = malignant lUsually no obvious cause l Introduction lBone tumours: primary and secondary tumours lPrimary – develop de novo in bone lSecondary – §metastatic tumours §contiguous spread f... Classification of primary bone tumours symplified A.Benign 1.Osteoblastic – bone matrix producing ŘOsteoma ŘOsteoid osteoma ŘOsteoblastoma  - occa... Classification of primary bone tumours symplified C. C.Other primary bone tumours 1.Soft tissue sarcoma 2.Chordoma* 3.Adamantinoma* l*Note differe... Classification of primary bone tumours symplified B.Malignant 1.Osteoblastic ŘOsteosarcoma 2.Chondroblastic ŘChondrosarcoma 3.Ewing’s sarcoma / PN... Primary bone tumours - age lPredominate in the first 3 decades of life §greatest skeletal growth activity § lPatient age is very important! §good ... Malignant lesions Benign lesions Patient age Metastatic tumors Myeloma Leukemia Chondrosarcoma Osteosarcoma (Paget's) MFH Chordoma Osteoma > 40 ye... Malignant lesions Benign lesions Patient age Osteosarcoma Ewing's sarcoma Adamantinoma Non-ossifying fibroma Fibrous dysplasia Simple bone cyst An... Primary bone tumours – diagnostic pathology lEssential clinicopathological information in the diagnosis of bone tumours: §Patient age §Clinical fe... Tumour-like conditions of bone symplified lPossible confusion with neoplasia clinical /XR lSometimes associated syndromes eg. fibrous dysplasia an... Tumour-like conditions of bone symplified lBone cysts §Simple bone cyst §Aneurysmal bone cyst lFibrous-osseous lesions §Fibrous dysplasia lEosinop... Site of tumour lCommonest site of primary tumour §distal femur and proximal tibia (high growth rate) lSite is of great diagnostic value §Some tumo... Clinical features of bone tumours Pain lNon-specific, but NB in differential diagnosis lBenign lesions usually asymptomatic and incidental finding... Clinical features of bone tumours Pain - example lEnchondroma vs. grade 1 chondrosarcoma §histology very similar §distinction depends on clinical ... Primary bone tumours – diagnostic pathology lEssential clinicopathological information in the diagnosis of bone tumours: §Patient age §Clinical fe... Primary bone tumors – diagnostic pathology lEssential clinicopathological information in the diagnosis of bone tumours: §Patient age §Clinical fea... Primary bone tumors – diagnostic pathology lEssential clinicopathological information in the diagnosis of bone tumours: §Patient age §Clinical fea... Epiphyseal centered lesions lChondroblastoma A §rare tumor : children and adolescents §open growth plates lGiant Cell Tumor B §most common tumor o... Metaphyseal intramedullary lesions lOsteosarcoma lChondrosarcoma and fibrosarcoma losteoblastoma lenchondroma lfibrous dysplasia lsimple bone cyst... Metaphyseal lesions centered in the cortex lNon-ossifying fibroma – very characteristic lOsteoid osteoma – often lOsteochondroma l Diaphysis Metap... Diaphyseal intramedullary lesions lEwing's sarcoma lLymphoma, myeloma lFibrous dysplasia lEnchondroma l lDiaphyseal cortical lesions lAdamantinoma...  Radiology lSite of the lesion – single or multifocal §type of bone §cortex / medulla; epiphysis, metaphysis, diaphysis lUnderlying bone pathology... Radiology lImaging of bone tumours §= study of macroscopic pathology lMany tumours display typical features lEssential in the diagnosis of bone tu... Primary bone tumors – diagnostic pathology lEssential clinicopathological information in the diagnosis of bone tumours: §Patient age §Clinical fea... Bone biopsy lUsually required for a specific diagnosis lCareful planning by an experienced surgeon lBiopsy site – best left to experienced surgeon... Ewing’s sarcoma / PNET lES and PNET - "small round blue cell" tumour lchildren and young adults l80% of patients 5 to 20 years old lextremely rare... Ewing’s sarcoma / PNET lintramedullary, diaphyseal - lfemur, tibia, humerus, pelvis, ribs lill-defined, permeative pattern of bone destruction lpe... Ewing’s sarcoma / PNET lsheets of infiltrative round cells with very scant cytoplasm + abundant glycogen lImmunostains – CD99 positive lElectron m... Ewing’s sarcoma / PNET CD99 Ewing’s sarcoma / PNET lAggressive, fast growing lMetastasises early to lungs, brain, elsewhere l lSignificant improvement in survival with modern... Other small cell tumours in bone lLymphoma lSmall cell osteosarcoma lMesenchymal chondrosarcoma lMetastatic neuroblastoma lMetastatic rhabdomyosar... Chondrosarcoma lmalignant, cartilage-producing tumour lolder patients (30-50 years) lextremely rare in children (almost never <10) lsecond most co... Chondrosarcoma lprimary – de novo in bone l lsecondary at sites of - §radiation §malignant transformation of benign bone lesions (osteochondroma) Chondrosarcoma lwell- to poorly differentiated cartilage (matrix) linvasive and poorly circumscribed lcalcifications l lhistologic grading can pre... Chondrosarcoma l Dense calcifications in cartilaginous matrix. Locally destructive growth with soft tissue extension.* * Lobular cartilagenous tum... Chondrosarcoma Invasive malignant cartilage* Host bone * * * Note cartilaginous matrix* - Grade 2 * Chondrosarcoma lLow-grade (Grades 1 and 2) tumours §locally aggressive §low metastatic potential §recurrences common §recurrences may show higher ... Osteosarcoma lmalignant tumor of mesenchymal cells §produce osteoid + immature bone lmorphology variable §minimal osteoid (like sarcoma NOS) §abun... Osteosarcoma lmost common primary sarcoma of bone lpeak incidence in the second decade §period of active skeletal growth. l < 5% osteosarcomas in ... Osteosarcoma lLocally aggressive and invasive with bone destruction lusually intramedullary lrapidly invades cortex and spread to soft tissue lper... Osteosarcoma lYoung patients – preference for rapid growing skeletal areas §distal femur + proximal tibia (50% of cases) §proximal humerus l usual... Osteosarcoma - macroscopic lIll-defined destructive tumour in metaphysis lElevation of periosteum – Codman’s triangle Osteosarcoma - histopathlogy lpleomorphic malignant cells with osteoid production lanaplastic cellular features and mitotic activity Osteosarcoma - prognosis lConventional osteosarcoma is extremely aggressive with a poor prognosis §Metastases to lungs, bones, liver, extremely co... Osteosarcoma - types lConventional osteosarcoma §intramedullary §osteoblastic, chondroblastic, fibroblastic, others lOthers §telangiectatic – very... Giant cell tumour of bone l5% of bone tumours llocally aggressive neoplasm lskeletally mature individuals lF > M,  20 to 50 years of age lextremel... GCT - location llong bones - distal femur, proximal tibia and distal radius lcentered in the epiphysis lBrown tumors of hyperparathyroidism simula... GCT - prognosis lComplications §pathologic fractures §malignant transformation (dedifferentiation) – usually previous radiation lrarely self-limit... GCT - pathology lgeographic pattern of bone destruction lfocal cortical erosion llack of a sclerotic rim l lcellular tumour lnumerous multinucleat... Osteochondroma lPatients <20 years old lPerichondral proliferation of cartilage with transformation to bone §bony stalk with cartilaginous cap §po... Osteochondroma lMay be multiple (osteochondromatosis) lVery large or intra-articular tumours §functional disturbance lMalignant transformation of ... ll Osteochondroma bony stalk cartilagenous cap GCT - histopathology Chondroma lBenign cartilaginous tumour §patients 20 – 50 years old, M>F §multiple lesions = Ollier’s disease Řrisk for chondrosarcoma lIntramedull... Osteoid osteoma lmost common in diaphysis of femur or tibia lvery painful – worse at night lradiology §radiolucent zone surrounded by sclerotic bo... Metastatic tumours lmost frequent malignant tumors in bone ltwo age groups §over 40 years of age §children in the first decade of life l Metastatic tumours lMultifocal usually §occasionally solitary lesions (particularly lung, kidney and thyroid cancer). l predilection for the hemat... Metastatic tumours lTumours that commonly cause skeletal metastases: lAdults §> 75% of skeletal metastases from carcinomas of the prostate, breast... Metastatic tumours lRadiographic appearance §osteolytic (kidney, lung, colon, melanoma) §osteoblastic (prostate and breast carcinoma) §mixed lytic... GCT – macroscopic pathology lWellcircumscribed tumour in epihysis and metaphysis lLytic defect with cortical expansion lResidual bone trabeculae =... Metastatic tumours lVertebral metastases – breast carcinoma Metastatic tumours l l lVertebral metastases – breast carcinoma Soft tissue tumours & tumour-like conditions lFat tissue lFibrous lFibrohistiocytic lSkeletal muscle lSmooth muscle lPeripheral nerves lBlood- and... The figure of the crab called cancer in Latin Incidence and etiology lIonising radiation lBone infarcts lPaget’s disease lChronic osteomyelitis lFibrous dysplasia lRetinoblastoma (genetic) lSy... CLINICOPATHOLOGICAL FEATURES OF BONE TUMOURS lOnly the more common bone tumours lEmphasis on features of clinicopathological importancelNot all th... Soft tissue tumours lNomenclature – see Module 4 Phase 2 lBenign = ***oma §fat = lipoma §fibroblasts = fibroma §smooth muscle = leiomyoma §blood v... This page uses frames, but your browser doesn't support them. End of slide show, click to exit. ONCOLOGICAL CONDITIONS OF THE MUSCULOSKELETAL SYSTEM THEME 11 Background knowledge Introduction Incidence and etiology Incidence and etiology Clas... ONCOLOGICAL CONDITIONS OF THE MUSCULOSKELETAL SYSTEM THEME 11 PROF. JOHANN W SCHNEIDER DEPARTEMENT OF ANATOMICAL PATHOLOGY UNIVERSITY OF STELLENBO... ONCOLOGICAL CONDITIONS OF THE MUSCULOSKELETAL SYSTEM THEME 11 PROF. JOHANN W SCHNEIDER DEPARTEMENT OF ANATOMICAL PATHOLOGY UNIVERSITY OF STELLENBO... Background knowledge l Principles of carcinogenesis and neoplasia l Tumour nomenclature l Differences: benign and malignant neoplasia l Tumour dif... Incidence and etiology l Uncommon = 0,5% of cancer deaths l 40% of bone tumours = malignant l Usually no obvious cause Introduction l Bone tumours: primary and secondary tumours l Primary – develop de novo in bone l Secondary – § metastatic tumours § contiguous spr... Classification of primary bone tumours symplified A. Benign 1. Osteoblastic – bone matrix producing Ř Osteoma Ř Osteoid osteoma Ř Osteoblastoma  -... Classification of primary bone tumours symplified C. Other primary bone tumours 1. Soft tissue sarcoma 2. Chordoma* 3. Adamantinoma* *Note differe... Classification of primary bone tumours symplified B. Malignant 1. Osteoblastic Ř Osteosarcoma 2. Chondroblastic Ř Chondrosarcoma 3. Ewing’s sarcom... Primary bone tumours - age l Predominate in the first 3 decades of life § greatest skeletal growth activity l Patient age is very important! § goo... Patient age Benign lesions Malignant lesions 20 - 40 years Enchondroma Giant cell tumor Chondrosarcoma > 40 years Osteoma Metastatic tumors Myelom... Patient age Benign lesions Malignant lesions 0 - 10 years Simple bone cyst Eosinophilic granuloma Ewing's sarcoma Leukemia Neuroblastoma metastase... Primary bone tumours – diagnostic pathology l Essential clinicopathological information in the diagnosis of bone tumours: § Patient age § Clinical... Tumour-like conditions of bone symplified l Possible confusion with neoplasia clinical /XR l Sometimes associated syndromes eg. fibrous dysplasia ... Tumour-like conditions of bone symplified l Bone cysts § Simple bone cyst § Aneurysmal bone cyst l Fibrous-osseous lesions § Fibrous dysplasia l E... Site of tumour l Commonest site of primary tumour § distal femur and proximal tibia (high growth rate) l Site is of great diagnostic value § Some ... Clinical features of bone tumours Pain l Non-specific, but NB in differential diagnosis l Benign lesions usually asymptomatic and incidental findi... Clinical features of bone tumours Pain - example l Enchondroma vs. grade 1 chondrosarcoma § histology very similar § distinction depends on clinic... Primary bone tumours – diagnostic pathology l Essential clinicopathological information in the diagnosis of bone tumours: § Patient age § Clinical... Primary bone tumors – diagnostic pathology l Essential clinicopathological information in the diagnosis of bone tumours: § Patient age § Clinical ... Primary bone tumors – diagnostic pathology l Essential clinicopathological information in the diagnosis of bone tumours: § Patient age § Clinical ... Epiphyseal centered lesions l Chondroblastoma A § rare tumor : children and adolescents § open growth plates l Giant Cell Tumor B § most common tu... Metaphyseal intramedullary lesions l Osteosarcoma l Chondrosarcoma and fibrosarcoma l osteoblastoma l enchondroma l fibrous dysplasia l simple bon... Metaphyseal lesions centered in the cortex l Non-ossifying fibroma – very characteristic l Osteoid osteoma – often l Osteochondroma Diaphysis Meta... Diaphyseal intramedullary lesions l Ewing's sarcoma l Lymphoma, myeloma l Fibrous dysplasia l Enchondroma Diaphyseal cortical lesions l Adamantino...  Radiology l Site of the lesion – single or multifocal § type of bone § cortex / medulla; epiphysis, metaphysis, diaphysis l Underlying bone patho... Radiology l Imaging of bone tumours § = study of macroscopic pathology l Many tumours display typical features l Essential in the diagnosis of bon... Primary bone tumors – diagnostic pathology l Essential clinicopathological information in the diagnosis of bone tumours: § Patient age § Clinical ... Bone biopsy l Usually required for a specific diagnosis l Careful planning by an experienced surgeon l Biopsy site – best left to experienced surg... Ewing’s sarcoma / PNET l ES and PNET - "small round blue cell" tumour l children and young adults l 80% of patients 5 to 20 years old l extremely ... Ewing’s sarcoma / PNET l intramedullary, diaphyseal - l femur, tibia, humerus, pelvis, ribs l ill-defined, permeative pattern of bone destruction ... Ewing’s sarcoma / PNET l sheets of infiltrative round cells with very scant cytoplasm + abundant glycogen l Immunostains – CD99 positive l Electro... Ewing’s sarcoma / PNET CD99 Ewing’s sarcoma / PNET l Aggressive, fast growing l Metastasises early to lungs, brain, elsewhere l Significant improvement in survival with moder... Other small cell tumours in bone l Lymphoma l Small cell osteosarcoma l Mesenchymal chondrosarcoma l Metastatic neuroblastoma l Metastatic rhabdom... Chondrosarcoma l malignant, cartilage-producing tumour l older patients (30-50 years) l extremely rare in children (almost never <10) l second mos... Chondrosarcoma l primary – de novo in bone l secondary at sites of - § radiation § malignant transformation of benign bone lesions (osteochondroma) Chondrosarcoma l well- to poorly differentiated cartilage (matrix) l invasive and poorly circumscribed l calcifications l histologic grading can p... Chondrosarcoma * Dense calcifications in cartilaginous matrix. Locally destructive growth with soft tissue extension.* Lobular cartilagenous tumou... Chondrosarcoma * * * Invasive malignant cartilage* Host bone * Note cartilaginous matrix* - Grade 2 Chondrosarcoma l Low-grade (Grades 1 and 2) tumours § locally aggressive § low metastatic potential § recurrences common § recurrences may show hi... Osteosarcoma l malignant tumor of mesenchymal cells § produce osteoid + immature bone l morphology variable § minimal osteoid (like sarcoma NOS) §... Osteosarcoma l most common primary sarcoma of bone l peak incidence in the second decade § period of active skeletal growth. l  < 5% osteosarcomas... Osteosarcoma l Locally aggressive and invasive with bone destruction l usually intramedullary l rapidly invades cortex and spread to soft tissue l... Osteosarcoma l Young patients – preference for rapid growing skeletal areas § distal femur + proximal tibia (50% of cases) § proximal humerus l  u... Osteosarcoma - macroscopic l Ill-defined destructive tumour in metaphysis l Elevation of periosteum – Codman’s triangle Osteosarcoma - histopathlogy l pleomorphic malignant cells with osteoid production l anaplastic cellular features and mitotic activity Osteosarcoma - prognosis l Conventional osteosarcoma is extremely aggressive with a poor prognosis § Metastases to lungs, bones, liver, extremely ... Osteosarcoma - types l Conventional osteosarcoma § intramedullary § osteoblastic, chondroblastic, fibroblastic, others l Others § telangiectatic –... Giant cell tumour of bone l 5% of bone tumours l locally aggressive neoplasm l skeletally mature individuals l F > M,  20 to 50 years of age l ext... GCT - location l long bones - distal femur, proximal tibia and distal radius l centered in the epiphysis l Brown tumors of hyperparathyroidism sim... GCT - prognosis l Complications § pathologic fractures § malignant transformation (dedifferentiation) – usually previous radiation l rarely self-l... GCT - pathology l geographic pattern of bone destruction l focal cortical erosion l lack of a sclerotic rim l cellular tumour l numerous multinucl... Osteochondroma l Patients <20 years old l Perichondral proliferation of cartilage with transformation to bone § bony stalk with cartilaginous cap ... Osteochondroma l May be multiple (osteochondromatosis) l Very large or intra-articular tumours § functional disturbance l Malignant transformation... Osteochondroma cartilagenous cap bony stalk GCT - histopathology Chondroma l Benign cartilaginous tumour § patients 20 – 50 years old, M>F § multiple lesions = Ollier’s disease Ř risk for chondrosarcoma l Intram... Osteoid osteoma l most common in diaphysis of femur or tibia l very painful – worse at night l radiology § radiolucent zone surrounded by scleroti... Metastatic tumours l most frequent malignant tumors in bone l two age groups § over 40 years of age § children in the first decade of life Metastatic tumours l Multifocal usually § occasionally solitary lesions (particularly lung, kidney and thyroid cancer). l  predilection for the he... Metastatic tumours l Tumours that commonly cause skeletal metastases: l Adults § > 75% of skeletal metastases from carcinomas of the prostate, bre... Metastatic tumours l Radiographic appearance § osteolytic (kidney, lung, colon, melanoma) § osteoblastic (prostate and breast carcinoma) § mixed l... GCT – macroscopic pathology l Wellcircumscribed tumour in epihysis and metaphysis l Lytic defect with cortical expansion l Residual bone trabecula... Metastatic tumours l Vertebral metastases – breast carcinoma Metastatic tumours l Vertebral metastases – breast carcinoma Soft tissue tumours & tumour-like conditions l Fat tissue l Fibrous l Fibrohistiocytic l Skeletal muscle l Smooth muscle l Peripheral nerves l Blo... The figure of the crab called cancer in Latin Incidence and etiology l Ionising radiation l Bone infarcts l Paget’s disease l Chronic osteomyelitis l Fibrous dysplasia l Retinoblastoma (geneti... CLINICOPATHOLOGICAL FEATURES OF BONE TUMOURS l Only the more common bone tumours l Emphasis on features of clinicopathological importance l Not al... Soft tissue tumours l Nomenclature – see Module 4 Phase 2 l Benign = ***oma § fat = lipoma § fibroblasts = fibroma § smooth muscle = leiomyoma § b... ONCOLOGICAL CONDITIONS OF THE MUSCULOSKELETAL SYSTEM THEME 7 10-Feb-04 Click here to start Table of Contents ONCOLOGICAL CONDITIONS OF THE MUSCULO... ONCOLOGICAL CONDITIONS OF THE MUSCULOSKELETAL SYSTEM THEME 7 PROF. JOHANN W SCHNEIDER DEPARTEMENT OF ANATOMICAL PATHOLOGY UNIVERSITY OF STELLENBOS... 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JOHANN W SCHNEIDER DEPARTEMENT OF ANATOMICAL PATHOLOGY UNIVERSITY OF STELLENBOS... Background knowledge Principles of carcinogenesis and neoplasia Tumour nomenclature Differences: benign and malignant neoplasia Tumour differentia... Incidence and etiology Uncommon = 0,5% of cancer deaths 40% of bone tumours = malignant Usually no obvious cause Ionising radiation Predisposing c... Introduction Bone tumours: primary and secondary tumours Primary – develop de novo in bone Secondary – metastatic tumours contiguous spread of adj... Tumour-like conditions of bonesymplified Possible confusion with neoplasia clinical /XR Sometimes associated syndromes eg. fibrous dysplasia and A... Tumour-like conditions of bonesymplified Bone cysts Simple bone cyst Aneurysmal bone cyst Fibrous-osseous lesions Fibrous dysplasia Eosinophilic g... Classification of primary bone tumourssymplified Benign Osteoblastic – bone matrix producing Osteoma Osteoid osteoma Osteoblastoma - occasionally ... Classification of primary bone tumourssymplified Malignant Osteoblastic Osteosarcoma Chondroblastic Chondrosarcoma Ewing’s sarcoma / PNET Previous... Classification of primary bone tumourssymplified Hematological tumours Extranodal lymphoma Myeloma (plasmacytoma) Langerhans’ cell histiocytosis O... Primary bone tumours - general Malignant change in benign lesion: dedifferentiation enchondroma or low-grade chondrosarcoma transforming into a hi... Primary bone tumours – diagnostic pathology Essential clinicopathological information in the diagnosis of bone tumours: Patient age Clinical featu... Primary bone tumours - age Predominate in the first 3 decades of life greatest skeletal growth activity Patient age is very important! good correl... PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version Primary bone tumours – diagnostic pathology Essential clinicopathological information in the diagnosis of bone tumours: Patient age Clinical featu... Clinical features of bone tumoursPain Non-specific, but NB in differential diagnosis Benign lesions usually asymptomatic and incidental findings P... Clinical features of bone tumoursPain - example Osteoid osteoma small cortical tumour in long bones irritates adjacent tissues severe night pain v... Clinical features of bone tumoursPain - example Enchondroma vs. grade 1 chondrosarcoma histology very similar distinction depends on clinical beha... Primary bone tumors – diagnostic pathology Essential clinicopathological information in the diagnosis of bone tumours: Patient age Clinical featur... Site of tumour Commonest site of primary tumour distal femur and proximal tibia (high growth rate) Site is of great diagnostic value Some tumours ... PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version Epiphyseal centered lesions Chondroblastoma A rare tumor : children and adolescents open growth plates Giant Cell Tumor B most common tumor of epi... Metaphyseal intramedullary lesions Osteosarcoma Chondrosarcoma and fibrosarcoma osteoblastoma enchondroma fibrous dysplasia simple bone cyst aneur... Metaphyseal lesions centered in the cortex Non-ossifying fibroma – very characteristic Osteoid osteoma – often Metaphyseal exostosis Osteochondrom... Diaphyseal intramedullary lesions Ewing's sarcoma Lymphoma, myeloma Fibrous dysplasia Enchondroma Diaphyseal cortical lesions Adamantinoma, Osteoi... Primary bone tumors – diagnostic pathology Essential clinicopathological information in the diagnosis of bone tumours: Patient age Clinical featur... Radiology Imaging of bone tumours = study of macroscopic pathology Many tumours display typical features Essential in the diagnosis of bone tumour... Radiology Site of the lesion – single or multifocal type of bone cortex / medulla; epiphysis, metaphysis, diaphysis Underlying bone pathology bone... Benign + slow growing lesions well circumscribed well-defined area of lysis geographic pattern of bone destruction sclerotic rim sufficient time f... Locally aggressive- and low-grade malignant tumours = more rapid growth still well-defined area of bone destruction no sclerotic rim continued exp... Rapidly growing lesions ill-defined pattern of permeative (infiltrative) bone destruction "moth-eaten" = coalescence of multiple small radiolucent... Focal periosteal reaction against a bone tumour Characteristic of slow-growing tumours focal cortical thickening eg. osteoid osteoma Previous slid... Rapidly growing lesions = Codman's triangle Penetrates through cortex Elevates periosteum New reactive bone formation Significant elevation and in... Periosteal reaction patterns to rapidly growing bone lesions ‘onion-skinning’ layers of reactive bone surround tumour typical in Ewing’s sarcoma s... Matrix production - Osteoid Osteosarcoma - photo ill-defined densities with irregular mineralization (cloud-like) Benign bone-forming lesions eg. ... Matrix production - chondroid focal stippled or flocculent densities, or lobulated rings or arcs of calcifications. suggests cartilagenous nature ... Primary bone tumors – diagnostic pathology Essential clinicopathological information in the diagnosis of bone tumours: Patient age Clinical featur... Bone biopsy Usually required for a specific diagnosis Careful planning by an experienced surgeon Biopsy site – best left to experienced surgeon ad... Osteoid osteoma most common in diaphysis of femur or tibia very painful – worse at night radiology radiolucent zone surrounded by sclerotic bone c... Osteosarcoma most common primary sarcoma of bone peak incidence in the second decade period of active skeletal growth. &#060 5% osteosarcomas in c... Osteosarcoma malignant tumor of mesenchymal cells produce osteoid + immature bone morphology variable minimal osteoid (like sarcoma NOS) abundant ... Osteosarcoma Young patients – preference for rapid growing skeletal areas distal femur + proximal tibia (50% of cases) proximal humerus usually in... Osteosarcoma Locally aggressive and invasive with bone destruction usually intramedullary rapidly invades cortex and spread to soft tissue periost... Osteosarcoma - macroscopic Ill-defined destructive tumour in metaphysis Elevation of periosteum – Codman’s triangle Previous slide Next slide Back... Osteosarcoma - histopathlogy pleomorphic malignant cells with osteoid production anaplastic cellular features and mitotic activity Previous slide ... Osteosarcoma - types Conventional osteosarcoma intramedullary osteoblastic, chondroblastic, fibroblastic, others Others telangiectatic – very vasc... Osteosarcoma - prognosis Conventional osteosarcoma is extremely aggressive with a poor prognosis Metastases to lungs, bones, liver, extremely comm... Osteochondroma Patients &#06020 years old Perichondral proliferation of cartilage with transformation to bone bony stalk with cartilaginous cap po... Osteochondroma bony stalk cartilagenous cap Previous slide Next slide Back to first slide View graphic version Osteochondroma May be multiple (osteochondromatosis) Very large or intra-articular tumours functional disturbance Malignant transformation of cart... Chondroma Benign cartilaginous tumour patients 20 – 50 years old, M&#062F multiple lesions = Ollier’s disease risk for chondrosarcoma Intramedulla... Chondrosarcoma malignant, cartilage-producing tumour older patients (30-50 years) extremely rare in children (almost never &#06010) second most co... Chondrosarcoma primary – de novo in bone secondary at sites of - radiation malignant transformation of benign bone lesions (osteochondroma) Previo... Chondrosarcoma well- to poorly differentiated cartilage (matrix) invasive and poorly circumscribed calcifications histologic grading can predict a... Chondrosarcoma Dense calcifications in cartilaginous matrix. Locally destructive growth with soft tissue extension.* * Lobular cartilagenous tumou... Chondrosarcoma Invasive malignant cartilage* Host bone * * * Note cartilaginous matrix* - Grade 2 * Previous slide Next slide Back to first slide ... Chondrosarcoma Low-grade (Grades 1 and 2) tumours locally aggressive low metastatic potential recurrences common recurrences may show higher grade... Giant cell tumour of bone 5% of bone tumours locally aggressive neoplasm skeletally mature individuals F &#062 M, 20 to 50 years of age extremely ... GCT - location long bones - distal femur, proximal tibia and distal radius centered in the epiphysis Brown tumors of hyperparathyroidism simulate ... GCT - pathology geographic pattern of bone destruction focal cortical erosion lack of a sclerotic rim cellular tumour numerous multinucleated gian... GCT – macroscopic pathology Wellcircumscribed tumour in epihysis and metaphysis Lytic defect with cortical expansion Residual bone trabeculae = so... GCT - histopathology Previous slide Next slide Back to first slide View graphic version GCT - prognosis Complications pathologic fractures malignant transformation (dedifferentiation) – usually previous radiation rarely self-limited, ... Ewing’s sarcoma / PNET ES and PNET - "small round blue cell" tumour children and young adults 80% of patients 5 to 20 years old extremely rare in ... Ewing’s sarcoma / PNET intramedullary, diaphyseal - femur, tibia, humerus, pelvis, ribs ill-defined, permeative pattern of bone destruction perios... Ewing’s sarcoma / PNET sheets of infiltrative round cells with very scant cytoplasm + abundant glycogen Immunostains – CD99 positive Electron micr... Ewing’s sarcoma / PNET CD99 Previous slide Next slide Back to first slide View graphic version Other small cell tumours in bone Lymphoma Small cell osteosarcoma Mesenchymal chondrosarcoma Metastatic neuroblastoma Metastatic rhabdomyosarcoma ... Ewing’s sarcoma / PNET Aggressive, fast growing Metastasises early to lungs, brain, elsewhere Significant improvement in survival with modern ther... Metastatic tumours most frequent malignant tumors in bone two age groups over 40 years of age children in the first decade of life Previous slide ... Metastatic tumours Multifocal usually occasionally solitary lesions (particularly lung, kidney and thyroid cancer). predilection for the hematopoi... Metastatic tumours Tumours that commonly cause skeletal metastases: Adults &#062 75% of skeletal metastases from carcinomas of the prostate, breas... Metastatic tumours Radiographic appearance osteolytic (kidney, lung, colon, melanoma) osteoblastic (prostate and breast carcinoma) mixed lytic and... Metastatic tumours Vertebral metastases – breast carcinoma Previous slide Next slide Back to first slide View graphic version Metastatic tumours Vertebral metastases – breast carcinoma Previous slide Next slide Back to first slide View graphic version Multiple myeloma common widespread lytic lesions rarely solitary tumour (plasmacytoma) important to consider in older adults see appropriate lectu... Simple bone cyst Common, non-neoplastic lesion, 1st and 2nd decades of life (80% of cases). usually a unicameral cyst, no epithelial lining filled... Simple bone cyst XR - Single cavity, well circumscribed, lytic Fibrous septa - no epithelial lining Previous slide Next slide Back to first slide ... Aneurysmal bone cyst rapidly growing, locally aggressive, intramedullary, vascular lesion primary (de novo) or secondary pre-existing lesion eg. c... Aneurysmal bone cyst circumscribed, radiolucent lesion with blowout expansion multiloculated cyst blood-filled spaces * * Previous slide Next slid... Fibrous dysplasia children and young adults – 10 to 25 years benign fibro-osseous lesion spindled mesenchymal cells at the growth plate instead of... Fibrous dysplasia single bone involvement = 80% (monostotic) multiple bones = 20% (polyostotic) sometimes with endocrine disorder + precocious pub... Fibrous dysplasia well-defined intramedullary lesion with lytic areas "shepherd's crook" deformity (lateral bowing) sclerotic rim cellular fibrous... Fibrous dysplasia - complications gross deformites cystic changes = aneurysmal bone cyst pathological fractures diagnostic problem confusion with ... Soft tissue tumours Nomenclature – see Module 4 Phase 2 Benign = ***oma fat = lipoma fibroblasts = fibroma smooth muscle = leiomyoma blood vessels... Soft tissue tumours - benign Lipoma most common tumour typical subcutaneous, occasionally deep soft tissue consists of mature fat cells well circu... Soft tissue tumours - benign Hemangioma often poorly circumscribed / infiltrative, but not destructive may recur may be multiple many variants cap... Soft tissue tumours - benign Leiomyoma very common in the uterus deep soft tissue skin angioleiomyoma (from blood vessels) pilar leiomyoma (from a... Soft tissue tumours - malignant Liposarcoma most common Malignant fibrouse histiocytoma – controversial Sarcomas tend to invade, also into blood v... Soft tissue tumours - malignant specific differentiation sometimes difficult may point towards associated condition eg. malignant nerve sheath tum... Tumor-like conditions of soft tissue Fibromatosis progressive invasive tumour of myofibroblasts locally destructive, but no metastases tend to rec... Tumor-like conditions of soft tissue Nodular fascitis rapidly growing mass young adults may simulate sarcoma local excision curative Myositis ossi... PPT Slide The figure of the crab called cancer in Latin Previous slide Back to first slide View graphic version ‹header› ‹date/time› Click to edit Master text styles Second level Third level Fourth level Fifth level ‹footer› ‹#› ‹header› ‹date/time› ‹footer› ‹#› Click to edit Master title style Click to edit Master text styles Second level Third level Fourth level Fifth level ‹date/time› ‹footer› ‹#›  Notes Slide Show Outline 1 ONKOLOGIESE TOESTANDE VAN DIE MUSKULOSKELETALE STELSEL TEMA 11 PROF. JOHANN W SCHNEIDER DEPARTEMENT VAN ANATOMIESE PAT... ONKOLOGIESE TOESTANDE VAN DIE MUSKULOSKELETALE STELSEL TEMA 11 PROF. JOHANN W SCHNEIDER DEPARTEMENT VAN ANATOMIESE PATOLOGIE UNIVERSITEIT VAN STEL... Agtergrondkennis lBeginsels van karsinogenese en neoplasie lTumornomenklatuur lVerskille: benigne en maligne neoplasie lTumordifferensiasie lGrade... Inleiding lBeen tumore: primęre en sekondęre tumore lPrimęr – ontwikkel de novo in been lSekondęr – §metastatiese tumore §direkte verspreiding van... Insidensie en etiologie lOngewoon = 0,5% van kankersterftes lOorgrote meerderheid beentumore = benigne lGewoonlik geen oorsaak nie Klassifikasie van primęre beentumore vereenvoudig A.Benigne 1.Osteoblasties – beenmatriks vormend ŘOsteoom ŘOsteoďd osteoom ŘOsteoblastoom  - soms... Klassifikasie van primęre beentumore vereenvoudig B.Maligne 1.Osteoblasties ŘOsteosarkoom 2.Chondroblasties ŘChondrosarkoom 3.Ewing se sarkoom / P... Klassifikasie van primęre beentumore vereenvoudig C. l C.Ander primęre beentumore 1.Sagteweefsel sarkoom 2.Chordoom* 3.Adamantinoom* l*Let op vers... Primęre beentumore - ouderdom lOorwegend in die eerste 3 dekades van lewe §Maksimum skeletale groei aktiwiteit § lOuderdom van pasiënte is baie be... Maligne letsels Benigne letsels Ouderdom Osteosarkoom Ewing se sarkoom Adamantinoom Nie-ossifiserende fibroom Fibreuse displasie Eenvoudige beensi... Maligne letsels Benigne letsels Ouderdom Metastatiese tumore Miëloom Leukemie Chondrosarkoom Osteosarkoom (Paget) MFH Chordoom Osteoom > 40 jaar C... Primęre beentumore - diagnostiese patologie lNoodsaaklike klinies-patologiese inligting vir die diagnose van beentumore: §Pasiënt ouderdom §Klinie... Tumoragtige toestande van been lKan verwar word met neoplasie klinies / XF lSoms meegaande sindrome bv. fibreuse displasie en Albright se sindroom... Tumoragtige toestande van been vereenvoudig lBeensiste §Eenvoudige beensist §Aneurismale beensist lFibro-ossieuse toestande §Fibreuse displasie lE... Ligging van tumor lAlgemeenste ligging van primęre tumore §distale femur en proksimale tibia (hoogste groeitempo) lLigging is van groot diagnostie... Kliniese beeld van beentumore Pyn lNie-spesifiek, maar belangrik in diagnose lBenigne letsels gewoonlik asimptomaties en toevallige bevindinge lPy... Kliniese beeld van beentumore Pyn - voorbeeld lEnchondroom vs. graad 1 chondrosarkoom §histologie baie soortgelyk §onderskeid hang af van kliniese... Primęre beentumore - Diagnostiese patologie lNoodsaaklike klinies-patologiese inligting vir die diagnose van beentumore: §Pasiënt ouderdom §Klinie... Primęre beentumore - Diagnostiese patologie lNoodsaaklike klinies-patologiese inligting vir die diagnose van beentumore: §Pasiënt ouderdom §Klinie... Primęre beentumore - Diagnostiese patologie lNoodsaaklike klinies-patologiese inligting vir die diagnose van beentumore: §Pasiënt ouderdom §Klinie... Epifise gesentreerde letsels lChondroblastoom A §raar tumor : kinders en volwassenes lReuse sel tumor B §algemeenste epifiseale tumor §volwassenes... Metafiseale intramedullęre letsels lOsteosarkoom lChondrosarkoom lfibrosarkoom losteoblastoom lenchondroom lfibreuse displasie leenvoudige beensis... Metafiseale letsels in die korteks lNie-ossifiserende fibroom – kenmerkendlOsteoďd osteoom – dikwels lOsteochondroom l diafise metafise Groeiplaat... Diafiseale intramedullęre letsels lEwing se sarkoom lLimfoom, miëloom lFibreuse displasie lEnchondroom l lDiafiseale kortikale letsels lAdamantino...  Radiografie = makroskopiese patologie lLigging van letsel en tipe been §korteks / medulla; epifise, metafise, diafise § lOnderliggende beenpatolo... Radiologie lBeelding van beentumore §= studie van makroskopiese patologie lBaie tumore toon kenmerkende beelde lNoodsaaklik in die diagnose van be... Primęre beentumore - Diagnostiese patologie lNoodsaaklike klinies-patologiese inligting vir die diagnose van beentumore: §Pasiënt ouderdom §Klinie... Beenbiopsie lGewoonlik nodig vir spesifieke diagnose lNoukeurige beplanning deur ervare chirurg lBiopsie area – verkieslik deur ervare chirurg §vo... Ewing se sarkoom / PNET lES en PNET - “klein ronde blou-sel tumor" lkinders en jong volwassenes l80% van pasiënte 5 tot 20 jaar oud lbaie skaars >... Ewing se sarkoom / PNET lintramedullęr, diafise - lfemur, tibia, humerus, pelvis, ribbe lswak omskrewe, infiltrerende tipe been vernietiging lperi... Ewing se sarkoom / PNET CD99 Ewing se sarkoom / PNET lAggressiewe, vinnig groeiende tumor lMetastaseer vroeg na longe, brein, ander organe l lOorlewing baie beter met moderne ... Ander kleinsellige tumore in been lLimfoom lKleinsel osteosarkoom lMesenkiemale chondrosarkoom lMetastatiese neuroblastoom lMetastatiese rhabdomio... Chondrosarkoom lmaligne, kraakbeen-produserende tumor louer pasiënte (30-50 jaar) luiters skaars in kinders (byna nooit <10) ltweede algemeenste p... Chondrosarkoom lprimęr – de novo in been l lsekondęr in areas van - §bestraling §maligne transformasie van benigne been letsels (osteochondroom) Chondrosarkoom lgoed- tot swak gedifferensieerde kraakbeen (matriks) linfiltrerend en  swak omskrewe lverkalkings l lhistologiese gradering voorsp... Chondrosarkoom Infiltrerende maligne kraakbeen* Gasheerbeen * * * Let op kraakbeen matriks* - Graad 2 * Chondrosarkoom lLae-graadse (1 en 2) tumore §lokaal aggressief §lae metastatiese potensiaal §algemeen §herhalings kan hoër graad toon § lHoë-graad... Osteosarkoom lalgemeenste primęre sarkoom van been lhoogste insidensie in die tweede dekade §tyd van aktiewe skeletale groei l < 5% osteosarkome i... Osteosarkoom lmaligne tumor van mesenkiemale selle §produseer osteoďd + immature been lmorfologie wissel §minimale osteoďd (soos sarkoom NOS) §bai... Osteosarkoom lLokaal aggressiewe en infiltrerende tumor met beenvernietging lgewoonlik intramedullęr lgroei vinnig met infiltrasie van die korteks... Osteosarkoom lJong pasiënte – voorkeur vir vinniggroeiende skeletale areas §distale femur + proksimale tibia (50%  van gevalle) §proksimale humeru... Osteosarkoom - makroskopies lSwak omskrewe destruktiewe  tumor in metafise lOplig van periosteum – Codman se driehoek Osteosarkoom - histopatologie lpleomorfe maligne selle met osteoďd produksie lanaplastiese sitologie en mitoses Osteosarkoom - prognose lKonvensionele osteosarkoom is baie aggressief met ‘n swak prognose §metastases na longe, been, lewer, baie algemeen §baie... Osteosarkoom - tipes lKonvensionele osteosarkoom §intramedullęr §osteoblasties, chondroblasties, fibroblasties, ander lAnder §telangiëktaties – ba... Reuse sel tumor van been l5% van beentumore llokaal aggressiewe tumor lPasiënte – volwassenes met volgroeide skelet lV > M,  20 tor 50 jaar oud lu... Reuse sel tumor van been - ligging llang bene - distale femur, proksimale tibia en distale radius lgeleë in epifiese lBruintumore van hiperparatir... Reuse sel tumor van been - patologie lgeografiese patroon van beenvernietiging lfokale kortkale vernietiging lgeen sklerotiese rand nie l lsellulę... Reuse sel tumor van been - prognose lKomplikasies §patologiese frakture §maligne transformasie (dedifferensiasie) – gewoonlik vorige bestraling ls... ll Osteochondroom benige steel kraakbeen dekking Osteochondroom lPasiënte <20 jaar oud lPerichondrale proliferasie van kraakbeen met transformasie na been §benige steel met kraakbeen dekking §wys... Osteochondroom lKan veelvuldig wees (osteochondromatose) lBaie groot of intra-artikulęre tumore §funksionle versteuring lMaligne transformasie van... Chondrosarkoom l Digte verkalkings in kraakbeen matriks. Lokaal destruktiewe groei met sagte weefsel uitbreiding.* * Lobulęre kraakbeen tumor met ... RST - histopatologie RST – makroskopiese patolgie lGoedomskrewe tumor in epifiese en metafise lLitiese defek met kortikale ekspansie lOorblywende beentrabekels = seepb... Chondroom lBenigne kraakbeen tumor §pasiënte 20 – 50 jaar oud, M>V §veelvuldige tumore = Ollier se siekte Řrisiko vir chondrosarkoom lIntramedullę... Osteoďd osteoom lmees algemeen in diafise van femur of tibia lbaie pynlik – snags erger lradiologie §radiodeursigtige sone omring deur sklerotiese... Metastatiese tumore lalgemeenste maligne tumore in been ltwee ouderdomsgroepe §> 40 jaar §kinders in eerste dekade van lewe l Metastatiese tumore lMultifokaal gewoonlik §soms enkel letsels (veral long, nier en tiroďed karsinoom) l voorkeur vir die hematopoďetiese murg are... Metastatiese tumore lTumore wat dikwels beenmetastases gee: lVolwassenes §> 75% van skeletale metastases vanaf karsinome van die prostaat, bors, n... Metastatiese tumore lWerwel metastases – mammakarsinoom Metastatiese tumore l l lWerwel metastases – mammakarsinoom Sagte weefseltumore lNomenklatuur – sien Module 4 Fase 2 lBenigne = ***oom §vet = lipoom §fibroblaste = fibroom §gladdespier = leiomioom §bloedvat... The figure of the crab called cancer in Latin Insidensie en etiologie lIoniserende bestraling lBeeninfarkte lPaget se siekte lChroniese osteomiëlitis lFibreuse displasie lRetinoblastoom (genet... KLINIES-PATOLOGIESE KENMERKE VAN BEENTUMORE lSlegs die meer algemene beentumore lKlem op kenmerke van klinies-patologiese belanglNie al die tumore... Sagte weefseltumore & tumoragtige toestande lVet weefsel lFibreuse weefsel lFibrohistiositiese tumore lSkeletspier lGladde spier lPerifere senuwee... This page uses frames, but your browser doesn't support them. End of slide show, click to exit. ONKOLOGIESE TOESTANDE VAN DIE MUSKULOSKELETALE STELSEL TEMA 11 Agtergrondkennis Inleiding Insidensie en etiologie Insidensie en etiologie Klassifi... ONKOLOGIESE TOESTANDE VAN DIE MUSKULOSKELETALE STELSEL TEMA 11 PROF. JOHANN W SCHNEIDER DEPARTEMENT VAN ANATOMIESE PATOLOGIE UNIVERSITEIT VAN STEL... ONKOLOGIESE TOESTANDE VAN DIE MUSKULOSKELETALE STELSEL TEMA 11 PROF. JOHANN W SCHNEIDER DEPARTEMENT VAN ANATOMIESE PATOLOGIE UNIVERSITEIT VAN STEL... Agtergrondkennis l Beginsels van karsinogenese en neoplasie l Tumornomenklatuur l Verskille: benigne en maligne neoplasie l Tumordifferensiasie l ... Inleiding l Been tumore: primęre en sekondęre tumore l Primęr – ontwikkel de novo in been l Sekondęr – § metastatiese tumore § direkte verspreidin... Insidensie en etiologie l Ongewoon = 0,5% van kankersterftes l Oorgrote meerderheid beentumore = benigne l Gewoonlik geen oorsaak nie Klassifikasie van primęre beentumore vereenvoudig A. Benigne 1. Osteoblasties – beenmatriks vormend Ř Osteoom Ř Osteoďd osteoom Ř Osteoblastoom  -... Klassifikasie van primęre beentumore vereenvoudig B. Maligne 1. Osteoblasties Ř Osteosarkoom 2. Chondroblasties Ř Chondrosarkoom 3. Ewing se sarko... Klassifikasie van primęre beentumore vereenvoudig C. Ander primęre beentumore 1. Sagteweefsel sarkoom 2. Chordoom* 3. Adamantinoom* *Let op verski... Primęre beentumore - ouderdom l Oorwegend in die eerste 3 dekades van lewe § Maksimum skeletale groei aktiwiteit l Ouderdom van pasiënte is baie b... Ouderdom Benigne letsels Maligne letsels 0 - 10 jaar Eenvoudige beensist Eosinofiele granuloom Ewing se sarkoom Leukemie Neuroblastoom - metastase... Ouderdom Benigne letsels Maligne letsels 20 - 40 jaar Enchondroom Reuse sel tumor Chondrosarkoom > 40 jaar Osteoom Metastatiese tumore Miëloom Leu... Primęre beentumore - diagnostiese patologie l Noodsaaklike klinies-patologiese inligting vir die diagnose van beentumore: § Pasiënt ouderdom § Kli... Tumoragtige toestande van been l Kan verwar word met neoplasie klinies / XF l Soms meegaande sindrome bv. fibreuse displasie en Albright se sindro... Tumoragtige toestande van been vereenvoudig l Beensiste § Eenvoudige beensist § Aneurismale beensist l Fibro-ossieuse toestande § Fibreuse displas... Ligging van tumor l Algemeenste ligging van primęre tumore § distale femur en proksimale tibia (hoogste groeitempo) l Ligging is van groot diagnos... Kliniese beeld van beentumore Pyn l Nie-spesifiek, maar belangrik in diagnose l Benigne letsels gewoonlik asimptomaties en toevallige bevindinge l... Kliniese beeld van beentumore Pyn - voorbeeld l Enchondroom vs. graad 1 chondrosarkoom § histologie baie soortgelyk § onderskeid hang af van klini... Primęre beentumore - Diagnostiese patologie l Noodsaaklike klinies-patologiese inligting vir die diagnose van beentumore: § Pasiënt ouderdom § Kli... Primęre beentumore - Diagnostiese patologie l Noodsaaklike klinies-patologiese inligting vir die diagnose van beentumore: § Pasiënt ouderdom § Kli... Primęre beentumore - Diagnostiese patologie l Noodsaaklike klinies-patologiese inligting vir die diagnose van beentumore: § Pasiënt ouderdom § Kli... Epifise gesentreerde letsels l Chondroblastoom A § raar tumor : kinders en volwassenes l Reuse sel tumor B § algemeenste epifiseale tumor § volwas... Metafiseale intramedullęre letsels l Osteosarkoom l Chondrosarkoom l fibrosarkoom l osteoblastoom l enchondroom l fibreuse displasie l eenvoudige ... Metafiseale letsels in die korteks l Nie-ossifiserende fibroom – kenmerkend l Osteoďd osteoom – dikwels l Osteochondroom diafise metafise Groeipla... Diafiseale intramedullęre letsels l Ewing se sarkoom l Limfoom, miëloom l Fibreuse displasie l Enchondroom Diafiseale kortikale letsels l Adamanti...  Radiografie = makroskopiese patologie l Ligging van letsel en tipe been § korteks / medulla; epifise, metafise, diafise l Onderliggende beenpatol... Radiologie l Beelding van beentumore § = studie van makroskopiese patologie l Baie tumore toon kenmerkende beelde l Noodsaaklik in die diagnose va... Primęre beentumore - Diagnostiese patologie l Noodsaaklike klinies-patologiese inligting vir die diagnose van beentumore: § Pasiënt ouderdom § Kli... Beenbiopsie l Gewoonlik nodig vir spesifieke diagnose l Noukeurige beplanning deur ervare chirurg l Biopsie area – verkieslik deur ervare chirurg ... Ewing se sarkoom / PNET l ES en PNET - “klein ronde blou-sel tumor" l kinders en jong volwassenes l 80% van pasiënte 5 tot 20 jaar oud l baie skaa... Ewing se sarkoom / PNET l intramedullęr, diafise - l femur, tibia, humerus, pelvis, ribbe l swak omskrewe, infiltrerende tipe been vernietiging l ... Ewing se sarkoom / PNET CD99 Ewing se sarkoom / PNET l Aggressiewe, vinnig groeiende tumor l Metastaseer vroeg na longe, brein, ander organe l Oorlewing baie beter met moderne... Ander kleinsellige tumore in been l Limfoom l Kleinsel osteosarkoom l Mesenkiemale chondrosarkoom l Metastatiese neuroblastoom l Metastatiese rhab... Chondrosarkoom l maligne, kraakbeen-produserende tumor l ouer pasiënte (30-50 jaar) l uiters skaars in kinders (byna nooit <10) l tweede algemeens... Chondrosarkoom l primęr – de novo in been l sekondęr in areas van - § bestraling § maligne transformasie van benigne been letsels (osteochondroom) Chondrosarkoom l goed- tot swak gedifferensieerde kraakbeen (matriks) l infiltrerend en  swak omskrewe l verkalkings l histologiese gradering voor... Chondrosarkoom * * * Infiltrerende maligne kraakbeen* Gasheerbeen * Let op kraakbeen matriks* - Graad 2 Chondrosarkoom l Lae-graadse (1 en 2) tumore § lokaal aggressief § lae metastatiese potensiaal § algemeen § herhalings kan hoër graad toon l Hoë-g... Osteosarkoom l algemeenste primęre sarkoom van been l hoogste insidensie in die tweede dekade § tyd van aktiewe skeletale groei l  < 5% osteosarko... Osteosarkoom l maligne tumor van mesenkiemale selle § produseer osteoďd + immature been l morfologie wissel § minimale osteoďd (soos sarkoom NOS) ... Osteosarkoom l Lokaal aggressiewe en infiltrerende tumor met beenvernietging l gewoonlik intramedullęr l groei vinnig met infiltrasie van die kort... Osteosarkoom l Jong pasiënte – voorkeur vir vinniggroeiende skeletale areas § distale femur + proksimale tibia (50%  van gevalle) § proksimale hum... Osteosarkoom - makroskopies l Swak omskrewe destruktiewe  tumor in metafise l Oplig van periosteum – Codman se driehoek Osteosarkoom - histopatologie l pleomorfe maligne selle met osteoďd produksie l anaplastiese sitologie en mitoses Osteosarkoom - prognose l Konvensionele osteosarkoom is baie aggressief met ‘n swak prognose § metastases na longe, been, lewer, baie algemeen § b... Osteosarkoom - tipes l Konvensionele osteosarkoom § intramedullęr § osteoblasties, chondroblasties, fibroblasties, ander l Ander § telangiëktaties... Reuse sel tumor van been l 5% van beentumore l lokaal aggressiewe tumor l Pasiënte – volwassenes met volgroeide skelet l V > M,  20 tor 50 jaar ou... Reuse sel tumor van been - ligging l lang bene - distale femur, proksimale tibia en distale radius l geleë in epifiese l Bruintumore van hiperpara... Reuse sel tumor van been - patologie l geografiese patroon van beenvernietiging l fokale kortkale vernietiging l geen sklerotiese rand nie l sellu... Reuse sel tumor van been - prognose l Komplikasies § patologiese frakture § maligne transformasie (dedifferensiasie) – gewoonlik vorige bestraling... Osteochondroom kraakbeen dekking benige steel Osteochondroom l Pasiënte <20 jaar oud l Perichondrale proliferasie van kraakbeen met transformasie na been § benige steel met kraakbeen dekking §... Osteochondroom l Kan veelvuldig wees (osteochondromatose) l Baie groot of intra-artikulęre tumore § funksionle versteuring l Maligne transformasie... Chondrosarkoom * Digte verkalkings in kraakbeen matriks. Lokaal destruktiewe groei met sagte weefsel uitbreiding.* Lobulęre kraakbeen tumor met ui... RST - histopatologie RST – makroskopiese patolgie l Goedomskrewe tumor in epifiese en metafise l Litiese defek met kortikale ekspansie l Oorblywende beentrabekels = se... Chondroom l Benigne kraakbeen tumor § pasiënte 20 – 50 jaar oud, M>V § veelvuldige tumore = Ollier se siekte Ř risiko vir chondrosarkoom l Intrame... Osteoďd osteoom l mees algemeen in diafise van femur of tibia l baie pynlik – snags erger l radiologie § radiodeursigtige sone omring deur sklerot... Metastatiese tumore l algemeenste maligne tumore in been l twee ouderdomsgroepe § > 40 jaar § kinders in eerste dekade van lewe Metastatiese tumore l Multifokaal gewoonlik § soms enkel letsels (veral long, nier en tiroďed karsinoom) l  voorkeur vir die hematopoďetiese murg ... Metastatiese tumore l Tumore wat dikwels beenmetastases gee: l Volwassenes § > 75% van skeletale metastases vanaf karsinome van die prostaat, bors... Metastatiese tumore l Werwel metastases – mammakarsinoom Metastatiese tumore l Werwel metastases – mammakarsinoom Sagte weefseltumore l Nomenklatuur – sien Module 4 Fase 2 l Benigne = ***oom § vet = lipoom § fibroblaste = fibroom § gladdespier = leiomioom § bl... The figure of the crab called cancer in Latin Insidensie en etiologie l Ioniserende bestraling l Beeninfarkte l Paget se siekte l Chroniese osteomiëlitis l Fibreuse displasie l Retinoblastoom ... KLINIES-PATOLOGIESE KENMERKE VAN BEENTUMORE l Slegs die meer algemene beentumore l Klem op kenmerke van klinies-patologiese belang l Nie al die tu... Sagte weefseltumore & tumoragtige toestande l Vet weefsel l Fibreuse weefsel l Fibrohistiositiese tumore l Skeletspier l Gladde spier l Perifere s... ONKOLOGIESE TOESTANDE VAN DIE MUSKULOSKELETALE STELSEL TEMA 7 10-Feb-04 Click here to start Table of Contents ONKOLOGIESE TOESTANDE VAN DIE MUSKUL... ONKOLOGIESE TOESTANDE VAN DIE MUSKULOSKELETALE STELSEL TEMA 7 PROF. JOHANN W SCHNEIDER DEPARTEMENT VAN ANATOMIESE PATOLOGIE UNIVERSITEIT VAN STELL... 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JOHANN W SCHNEIDER DEPARTEMENT VAN ANATOMIESE PATOLOGIE UNIVERSITEIT VAN STELL... Agtergrondkennis Beginsels van karsinogenese en neoplasie Tumornomenklatuur Verskille: benigne en maligne neoplasie Tumordifferensiasie Gradering ... Insidensie en etiologie Ongewoon = 0,5% van kankersterftes Oorgrote meerderheid beentumore = benigne Gewoonlik geen oorsaak nie Ioniserende bestra... Inleiding Been tumore: primęre en sekondęre tumore Primęr – ontwikkel de novo in been Sekondęr – metastatiese tumore direkte verspreiding vanaf na... Tumoragtige toestande van been Kan verwar word met neoplasie klinies / XF Soms meegaande sindrome bv. fibreuse displasie en Albright se sindroom S... Tumoragtige toestande van beenvereenvoudig Beensiste Eenvoudige beensist Aneurismale beensist Fibro-ossieuse toestande Fibreuse displasie Eosinofi... Klassifikasie van primęre beentumorevereenvoudig Benign Osteoblasties – beenmatriks vormend Osteoom Osteoďd osteoom Osteoblastoom - soms lokaal ag... Klassifikasie van primęre beentumorevereenvoudig Maligne Osteoblasties Osteosarkoom Chondroblasties Chondrosarkoom Ewing se sarkoom / PNET Previou... Klassifikasie van primęre beentumorevereenvoudig Hematologiese tumore Ekstranodale limfoom Miëloom (plasmasitoom) Langerhanssel histiositose Ander... Primęre beentumore - algemeen Maligne veranderinge in benigne letsels: dedifferensiasie enchondroom of lae-graadse chondrosarkoom transformasie na... Primęre beentumore - diagnostiese patologie Noodsaaklike klinies-patologiese inligting vir die diagnose van beentumore: Pasiënt ouderdom Kliniese ... Primęre beentumore - ouderdom Oorwegend in die eerste 3 dekades van lewe Maksimum skeletale groei aktiwiteit Ouderdom van pasiënte is baie belangr... PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version Primęre beentumore - Diagnostiese patologie Noodsaaklike klinies-patologiese inligting vir die diagnose van beentumore: Pasiënt ouderdom Kliniese ... Kliniese beeld van beentumorePyn Nie-spesifiek, maar belangrik in diagnose Benigne letsels gewoonlik asimptomaties en toevallige bevindinge Pyn in... Kliniese beeld van beentumorePyn - voorbeeld Osteoďd osteoom klein kortikale tumor van langbene irriteer naasliggende weefsel erge nagpyn is baie ... Kliniese beeld van beentumorePyn - voorbeeld Enchondroom vs. graad 1 chondrosarkoom histologie baie soortgelyk onderskeid hang af van kliniese ver... Primęre beentumore - Diagnostiese patologie Noodsaaklike klinies-patologiese inligting vir die diagnose van beentumore: Pasiënt ouderdom Kliniese ... Ligging van tumor Algemeenste ligging van primęre tumore distale femur en proksimale tibia (hoogste groeitempo) Ligging is van groot diagnostiese ... PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version Epifise gesentreerde letsels Chondroblastoom A raar tumor : kinders en volwassenes Reuse sel tumor B algemeenste epifiseale tumor volwassenes met ... Metafiseale intramedullęre letsels Osteosarkoom Chondrosarkoom en fibrosarkoom osteoblastoom enchondroom fibreuse displasie eenvoudige beensist an... Metafiseale letsels gesentreer in die korteks Nie-ossifiserende fibroom – kenmerkend Osteoďd osteoom – dikwels Metafiseale eksostose Osteochondroo... Diafiseale intramedullęre letsels Ewing se sarkoom Limfoom, miëloom Fibreuse displasie Enchondroom Diafiseale kortikale letsels Adamantinoom Osteo... Primęre beentumore - Diagnostiese patologie Noodsaaklike klinies-patologiese inligting vir die diagnose van beentumore: Pasiënt ouderdom Kliniese ... Radiologie Beelding van beentumore = studie van makroskopiese patologie Baie tumore toon kenmerkende beelde Noodsaaklik in die diagnose van beentu... Radiografie = makroskopiese patologie Ligging van letsel – enkel of multifokaal tipe been korteks / medulla; epifise, metafise, diafise Onderligge... Benigne + stadiggroeiende letsels goedomskrewe afgebakende litiese area geografiese patroon van beenvernietiging sklerotiese rand genoeg tyd vir b... Lokaal aggressiewe- en lae-graadse maligne tumore = vinniger groeitempo steeds goedomskrewe area van beenvernietging sklerotiese rand afwesig volg... Vinnig groeiende letsels swak omskrewe area van been vernietging "mot-gevreet" = versmelting van talle klein radiodeursigtige areas kortikale en m... Fokale periosteale reaksie teenoor ‘n beentumor Kenmerkend van stadiggroeiende tumore fokale kortikale verdikking bv. osteoďd osteoom Previous sli... Vinniggroeiende letsels = Codman se driehoek Penetreer deur korteks Lig periosteum op Nuwe reaktiewe been vorm Progressiewe oplig en onderbreking ... Periosteale reaksie patrone teenoor vinniggroeiende beenletsels ‘uieskil voorkoms’ lae reaktiewe been omring tumor tipies in Ewing se sarkoom ‘sun... Matriksproduksie - Osteoďd Osteosarkoom - foto swak gedefinieerde digthede met onreëlmatige mineralisering (wolkagtig) Benigne beenvormende letsel... Matriksproduksie - chondroďd fokale gestippelde of flokkulente digthede, of gelobuleerde ringe of boë van verkalkings dui op kraakbeen aard van di... Primęre beentumore - Diagnostiese patologie Noodsaaklike klinies-patologiese inligting vir die diagnose van beentumore: Pasiënt ouderdom Kliniese ... Beenbiopsie Gewoonlik nodig vir spesifieke diagnose Noukeurige beplanning deur ervare chirurg Biopsie area – verkieslik deur ervare chirurg voldoe... Osteoďd osteoom mees algemeen in diafiese van femur of tibia baie pynlik – snags erger radiologie radiodeursigtige sone omring deur sklerotiese be... Osteosarkoom algemeenste primęre sarkooma van been hoogste insidensie in die tweede dekade tyd van aktiewe skeletale groei &#060 5% osteosarkome i... Osteosarkoom maligne tumor van mesenkiemale selle produseer osteoďd + immature been morfologie wissel minimale osteoďd (soos sarkoom NOS) baie kra... Osteosarkoom Jong pasiënte – voorkeur vir vinniggroeiende skeletale areas distale femur + proksimale tibia (50% van gevalle) proksimale humerus ge... Osteosarkoom Lokaal aggressiewe en infiltrerende tumor met beenvernietging gewoonlik intramedullę groei vinnig met infiltrasie van die korteks en ... Osteosarkoom - makroskopies Swak omskrewe destruktiewe tumor in metafise Oplig van periosteum – Codman se driehoek Previous slide Next slide Back ... Osteosarkoom - histopatologie pleomorfe maligne selle met osteoďd produksie anaplastiese sitologie en mitoses Previous slide Next slide Back to fi... Osteosarkoom - tipes Konvensionele osteosarkoom intramedullęr osteoblasties, chondroblasties, fibroblasties, ander Ander telangiëktaties – baie va... Osteosarkoom - prognose Konvensionele osteosarkoom is baie aggressief met ‘n swak prognose metastases na longe, been, lewer, baie algemeen baie ve... Osteochondroom Pasiënte &#06020 jaar oud Perichondrale proliferasie van kraakbeen met transformasie na been benig steel met kraakbeen dekking wys ... Osteochondroom benige steel kraakbeen dekking Previous slide Next slide Back to first slide View graphic version Osteochondroom Kan veelvuldig wees (osteochondromatose) Baie groot of intra-artikulęre tumore funksionle versteuring Maligne transformasie van kra... Chondroom Benigne kraakbeen tumor pasiënte 20 – 50 jaar oud, M&#062V veelvuldige tumore = Ollier se siekte risiko vir chondrosarkoom Intramedullęr... Chondrosarkoom maligne, kraakbeen-produserende tumor ouer pasiënte (30-50 jaar) uiters skaars in kinders (byna nooit &#06010) tweede algemeenste p... Chondrosarkoom primęr – de novo in been sekondęr in areas van - bestraling maligne transformasie van benigne been letsels (osteochondroom) Previou... Chondrosarkoom goed- tot swak gedifferensieerde kraakbeen (matriks) infiltrerend en swak omskrewe verkalkings histologiese gradering voorspel aggr... Chondrosarkoom Digte verkalkings in kraakbeen matriks. Lokaal destruktiewe groei met sagte weefsel uitbreiding.* * Lobulęre kraakbeen tumor met ui... Chondrosarkoom Infiltrerende maligne kraakbeen* Gasheerbeen * * * Let op na die kraakbeen matriks* - Grade 2 * Previous slide Next slide Back to f... Chondrosarkoom Lae-graadse (1 en 2) tumore lokaal aggressief lae metastatiese potensiaal algemeen herhalings kan hoër graad toon Hoë-graadse (graa... Reuse sel tumor van been 5% van beentumore lokaal aggressiewe tumor Pasiënte – volwassenes met volgroeide skelet V &#062 M, 20 tor 50 jaar oud uit... Reuse sel tumor van been - ligging lang bene - distale femur, proksimale tibia en distale radius geleë in epifiese Bruintumore van hiperparatiroďd... Reuse sel tumor van been - patologie geografiese patroon van beenvernietiging fokale kortkale vernietiging geen sklerotiese rand nie sellulęre tum... RST – makroskopiese patolgie Goedomskrewe tumor in epifiese en metafiese Litiese defek met kortikale ekspansie Oorblywende beentrabekels = seepbor... RST - histopatologie Previous slide Next slide Back to first slide View graphic version Reuse sel tumor van been - prognose Komplikasies patologiese frakture maligne transformasie (dedifferensiasie) – gewoonlik vorige bestraling selde... Ewing se sarkoom / PNET ES en PNET - “klein ronde blou-sel tumor" kinders en jong volwassenes 80% van pasiënte 5 tot 20 jaar oud baie skaars &#062... Ewing se sarkoom / PNET intramedullęr, diafise - femur, tibia, humerus, pelvis, ribbe swak omskrewe, infiltrerende tipe been vernietiging perioste... Ewing se sarkoom / PNET plate infiltrerende ronde selle met min sitoplasma + baie glikogeen Immunokleuring – CD99 positief Elektronmikroskopie t(1... Ewing se sarkoom / PNET CD99 Previous slide Next slide Back to first slide View graphic version Ander kleinsellige tumore in been Limfoom Kleinsel osteosarkoom Mesenkimale chondrosarkoom Metastatiese neuroblastoom Metastatiese rhabdomiosarkoo... Ewing se sarkoom / PNET Aggressiewe, vinnig groeiende tumor Metastaseer vroeg na longe, brein, ander organe Oorlewing baie beter met moderne behan... Metastatiese tumore algemeenste maligne tumore in been twee ouderdomsgroepe &#062 40 jaar kinders in eerste dekade van lewe Previous slide Next sl... Metastatiese tumore Multifokaal gewoonlik soms enkel letsels (veral long, nier en tiroďed karsinoom) voorkeur vir die hematopoďetiese murg areas a... Metastatiese tumore Tumore wat dikwels beenmetastases gee: Adults &#062 75% van skeletale metastases vanaf karsinome van die prostaat, bors, nier,... Metastatiese tumore Radiologie osteolities (nier, long, kolon, melanoom) osteoblasties (prostaat en bors karsinoom) gemeng lities en blasties (alg... Metastatiese tumore Werwel metastases – mammakarsinoom Previous slide Next slide Back to first slide View graphic version Metastatiese tumore Werwel metastases – mammakarsinoom Previous slide Next slide Back to first slide View graphic version Veelvuldige miëlomatose algemeen litiese letsels raar enkel tumor (plasmasitoom) belangrik in ouer volwassenes sien relevante lesings Previous sli... Eenvoudige beensist Algemene nie-neoplastiese letsel 1ste en 2de dekades (80% van gevalle) gewoonlik enkel holte, sonder epiteelbelyning bevat ser... Eenvoudige beensist XF - Enkele holte, goed omskrewe, lities Fibreuse septa sonder epiteelbelyning Previous slide Next slide Back to first slide V... Aneurismale beensist vinnig groeiende, lokaal aggressiewe, intramedullęre gelokulleerde radiodeursigtige letsel met ‘blowout’ ekspansie vaskulęr p... Aneurismale beensist omskrewe, radiodeursigtige letsel met uitbreiding multilolokulęre sist bloed-gevulde spasies * * Previous slide Next slide Ba... Fibreuse displasie kinders en jong volwassenes – 10 tot 25 jaar benigne fibro-ossieuse letsel spoelvormige mesenkiemale selle by die groeiplaat ip... Fibreuse displasie enkel been aantasting = 80% (monostoties) veelvuldige bene = 20% (poli-ostoties) soms met endokrien afwyking + vroeë puberteit ... Fibreuse displasie goed omskrewe intramedullęre letsel met litiese areas "shepherd's crook" deformiteit (laterale buiging) sklerotiese rand sellul... Fibreuse displasie - komplikasies erge misvorming van bene sistiese verandering = aneurismale beensist patologiese frakture diagnostiese probleem ... Sagte weefseltumore Nomenklatuur – sien Module 4 Fase 2 Benigne = ***oom vet = lipoom fibroblaste = fibroom gladdespier = leiomioom bloedvate = he... Sagte weefseltumore - benigne Lipoom algemeenste tumor tipies subkutaan, soms diep sagte weefsel bestaan uit volwasse vet omskrewe, maklik om te v... Sagte weefsel tumore benigne Hemangioom dikwels swak omskrewe / infiltrerend, maar nie destruktief nie kan herhaal Kan veelvuldig wees talle varia... Sagte weefseltumore Leiomioom baie algemeen in die uterus diep sagte weefsel vel angioleiomioom (vanaf bloedvate) pilare leiomioom (vanaf arrector... Sagte weefseltumore - maligne Liposarkoom algemeenste Maligne fibreuse histiositoom – kontroversieel Sarkome neig om te infiltreer, ook in bloedva... Sagte weefseltumore - maligne spesifieke differensiasie soms moeilik kan dui op meegaande toestand bv. maligne senuweeskede tumor en neurofibromat... Tumoragtige toestande van sagte weefsel Fibromatose progressiewe infiltrerende tumor van miofibroblaste lokaal destruktief, maar nie metastases ni... Tumoragtige toestande van sagte weefsel Nodulęre fassďtis vinnig groeiende massa jong volwassenes kan sarkoom goed naboots lokale eksisie genesend... PPT Slide The figure of the crab called cancer in Latin Previous slide Back to first slide View graphic version Benign bone tumors, diagnosis and management Bone Tumors 17-Feb-04 Click here to start Table of Contents Bone Tumors Benign vs. Malignant Common Benign Tumors Benign: Simple bone Cyst Benign:... 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Common Benign Tumors Simple bone cyst Anerysmal bone cyst Fibrous defects, cortical, NOF Enchondroma Osteochondroma Previous slide Next slide Back... Benign: Simple bone Cyst Children Mildly Expansile Migrate to diaphysis Path # Previous slide Next slide Back to first slide View graphic version Benign: Simple bone Cyst Contents: Serous fluid fibrous lining containing Giant cells Previous slide Next slide Back to first slide View graphic v... Simple bone CystTreatment No Fracture Perforate Curettage Bone Graft Fracture Treat Fracture POP ORIF - (Prox Femur) Previous slide Next slide Bac... Benign:Aneurysmal bone Cyst Expansile Age: 2nd Decade Previous slide Next slide Back to first slide View graphic version Benign:Aneurysmal bone Cyst Expansile Age: 2nd Decade Previous slide Next slide Back to first slide View graphic version Benign:Aneurysmal bone Cyst Expansile Age: 2nd Decade Previous slide Next slide Back to first slide View graphic version Benign:Aneurysmal bone Cyst Previous slide Next slide Back to first slide View graphic version Benign Giant Cell Tumor Adults To articular surface Expansile Previous slide Next slide Back to first slide View graphic version Benign (high recurrence rate)Treatment Burr whole cavity Previous slide Next slide Back to first slide View graphic version Operative Technique Cryosurgery open pour technique Cancellous grafting Previous slide Next slide Back to first slide View graphic version Benign:Solitary Enchondroma Age: 2nd - 5th decade Cartilage Often in hand Problem: ? Low Grade Chondrosarcoma Previous slide Next slide Back to fi... Benign:Multiple Enchondroma Ollier’s Disease Angular deformities Previous slide Next slide Back to first slide View graphic version PPT Slide Fibrous tissue Non ossifying Fibroma Previous slide Next slide Back to first slide View graphic version BenignOsteoid Osteoma Previous slide Next slide Back to first slide View graphic version BenignOsteoid Osteoma Night pain relieved by Asprin 1cm or less Nidus Previous slide Next slide Back to first slide View graphic version BenignOsteoid Osteoma Osteoid Vascular Stroma Giant cells Previous slide Next slide Back to first slide View graphic version Chondromyxoid Fibroma Age 2nd - 3rd decade Scalloped well defined edge Eccentric Previous slide Next slide Back to first slide View graphic version Chondromyxoid Fibroma Myxomatous tissue may become chondrosarcoma Previous slide Next slide Back to first slide View graphic version BenignOstechondroma Near growth plate bone with cartilage cap Multiple osteochondromata - &#062malignant change Previous slide Next slide Back to ... Ostechondroma Malignant change: Chondrosarcoma Previous slide Next slide Back to first slide View graphic version TumorPositionsin Bone Previous slide Next slide Back to first slide View graphic version Malignant Tumors:Osteosarcoma Age: 2nd decade Area: Long bones Previous slide Next slide Back to first slide View graphic version Malignant Tumors:Osteosarcoma Commonly near knee Previous slide Next slide Back to first slide View graphic version Malignant Tumors:Osteosarcoma Previous slide Next slide Back to first slide View graphic version Malignant Tumors:Osteosarcoma Previous slide Next slide Back to first slide View graphic version Malignant Tumors:Osteosarcoma Previous slide Next slide Back to first slide View graphic version Malignant Tumors:Osteosarcoma Previous slide Next slide Back to first slide View graphic version Malignant:Ewing’s Age: Under 30yr. Lytic mass “Onion Skin” Periosteal reaction Previous slide Next slide Back to first slide View graphic version Malignant Tumors:Ewings Previous slide Next slide Back to first slide View graphic version Malignant Tumors:Myeloma Age: Over 50 Lytic tumor Previous slide Next slide Back to first slide View graphic version Malignant Tumors:Myeloma Previous slide Next slide Back to first slide View graphic version Malignant Tumors:Myeloma Investigations ESR usually &#062100 mm/hr Serum Electrophoresis Urine Bence Jones Protein Serum immunoelectrophoresis Bon... Pathologicalfractures Common metastatic tumors Breast Prostate Thyroid Lung Previous slide Next slide Back to first slide View graphic version Mirel’s Scoring System SiteUpperLowerPeri-LimbLimbtrocanteric PainMildModerateSevere LesionBlasticMixedLytic Size&#060 1 / 3 -&#062 2 / 3 Points12... When to ORIF a MetastasisMirels score 7 pointsNo ORIF(4% #) 8 pointsBorderline(15% #) 9 pointsORIF Metastatic disease Previous slide Next slide Ba... Management Metastases Occult primary - Investigate Tc Scan - extent of disease No fracture Mirels &#0608 Irradiation / Chemo Mirels &#0628 ORIF & ... Management Malignant Tumors Stage - Xrays, MR CT scan lungs TC Scan - for other bony mets. Biopsy Preop Chemotherapy Excise lesion - block excisio... Enneking staging system StageGradeSiteMetastases IALowIntraNoneBLowExtraNone IIAHighIntraNoneBHighExtraNone IIIRegionalDistant Previous slide Next... Biopsy Open vs closed Choice of site Stay in compartment Plan later surgery incision Avoid reactive bone / necrosis Direct approach Previous slide... Amputation Achieves any margin Less postoperative morbidity ? Cost effective Previous slide Next slide Back to first slide View graphic version Block Excision Previous slide Next slide Back to first slide View graphic version Problems uniqueto South Africa Late presentation Size of tumour Non compliance Previous slide Next slide Back to first slide View graphic version ňo, PPT Slide WebCT Previous slide Back to first slide View graphic version CHONDROSARCOMA 15-Dec-03 Click here to start Table of Contents CHONDROSARCOMA Clinical PPT Slide Central Chondrosarcoma PPT Slide X ray Features -... Slide 1 of 27 Slide 2 of 27 Slide 3 of 27 Slide 4 of 27 Slide 5 of 27 Slide 6 of 27 Slide 7 of 27 Slide 8 of 27 Slide 9 of 27 Slide 10 of 27 Slide 11 of 27 Slide 12 of 27 Slide 13 of 27 Slide 14 of 27 Slide 15 of 27 Slide 16 of 27 Slide 17 of 27 Slide 18 of 27 Slide 19 of 27 Slide 20 of 27 Slide 21 of 27 Slide 22 of 27 Slide 23 of 27 Slide 24 of 27 Slide 25 of 27 Slide 26 of 27 Slide 27 of 27 CHONDROSARCOMA Diagnosis and Treatment ICM Robertson Next slide Back to first slide View graphic version Clinical Age:&#062 40 yr. Slow Growth With or without pain Previous slide Next slide Back to first slide View graphic version PPT Slide Chondrosarcoma Previous slide Next slide Back to first slide View graphic version Central Chondrosarcoma Area Pelvis and flat bones (24%) Long bones metaphysis / diaphysis 16% Prox. femur Previous slide Next slide Back to first ... PPT Slide Previous slide Next slide Back to first slide View graphic version Xray Features - (Central) Large ill defined Expanded Erosion of cortex Circular radiolucencies Fuzzy Ca++ Soft tissue mass Perioseteal reaction Pr... PPT Slide Central Chondrosarcoma Previous slide Next slide Back to first slide View graphic version 60 yr. Male Previous slide Next slide Back to first slide View graphic version SECONDARY CHONDROSARCOMA Osteochondromataesp.. Multiple Enchondromaesp. Olliers (25%) Mafucci (100%) Chondroblastoma Chondromyxiod fibroma Synovia... Borderline cartilage Tumor Gradual onset of pain Enchondroma Previous slide Next slide Back to first slide View graphic version Borderline Cartilage Tumor Xray Features Bone Expands Windblown pattern of Ca++ Scalloping No periosteal reaction Previous slide Next slide Back t... Sarcomatous changeIn Osteochondroma &#060 1% of solitary 10 % of multiple osteocondromas Older patient with pain in preexisting osteochondroma Pre... Malignant change Osteochondroma Growth in older patient &#062 1cm cartilage cap Area of eccentric fluffy density Soft tissue invasion Previous sli... Malignant Change Previous slide Next slide Back to first slide View graphic version MR - Malignant Change Previous slide Next slide Back to first slide View graphic version M. R. Malignant transformation Previous slide Next slide Back to first slide View graphic version Dedifferentiated Chondrosarcoma Transformation to Osteosarcoma or fibrosarcoma Large soft tissue mass Early lung mets. Dismal prognosis 8 of 78 (M... Dedifferentiated Previous slide Next slide Back to first slide View graphic version Suggested Work up Imaging Biopsy - pathologist interprets slides Grade 2 -&#062 en bloc Grade 3 -&#062 More radical surgery e.g.. Amputation ? Sec... Limb sparing surgery Previous slide Next slide Back to first slide View graphic version Resection arthrodesis Previous slide Next slide Back to first slide View graphic version PPT Slide 36 yr. Female Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version PPT Slide Male 60 yr. Previous slide Next slide Back to first slide View graphic version PPT Slide Previous slide Next slide Back to first slide View graphic version PROGNOSIS Determine at 10 yr. not 5 80% 10 yr.. survival Grade 1 31% 10 yr. Grade 3 without complete resection patient will die from the sarcoma d... Giant Cell Tumors:a retrospective study 11-Dec-03 Click here to start Table of Contents Giant Cell Tumors:a retrospective study Overview Problems ... Slide 1 of 23 Slide 2 of 23 Notes: Giant cell tumor (GCT) of the bone is a benign, but locally aggressive and destructive lesion. It is composed of primitive hi... Slide 3 of 23 Notes: Majority occur about the knee. This undermines the joint stability and leads to collapse, angulation and early Osteoarthritis... Slide 4 of 23 Notes: Tygerberg bone tumor records used and all cases of histologically proven giant cell tumor over the last 20 years were include... Slide 5 of 23 Notes: 15 Patients Seen Av. Follow up 33 months - varies from less than 6 months ( 2 deaths) to 84 months. Our policy is to follow t... Slide 6 of 23 Notes: Routine x-rays of the lesion and chest were always done. Most of the lesions were treated in the pre-MTI scan era and this wa... Slide 7 of 23 Notes: The radiological grading system published by Campanucci was used to stage the lesions. Grade 1:L lesion shave a well defined ... Slide 8 of 23 Notes: Curetttage The lesions were deroofed and thoroughly curetted out. The margins were burred with a high speed burr. It is essen... Slide 9 of 23 Notes: In the open pour technique liquid nitrogen is poured into the cavity and allowed to freeze the tumor bed. Dangers include ski... Slide 10 of 23 Notes: Was our oldest patient (70 years and a smoker too!) who was treated with an en bloc resection of his distal radius. A free v... Slide 11 of 23 Notes: Slide shows the wrist arthrodesis with the large free bone graft bridging the excision gap. He remained recurrence free for ... Slide 12 of 23 Notes: This 21 year male presented with advanced stage 3 disease. Biopsy confirmed the diagnosis of GCT. Slide 13 of 23 Notes: En Bloc excision of the whole proximal femur was done. To regain length an arthrodesis was done between the Ischium and the ... Slide 14 of 23 Notes: The pictures are of one of the Tumors about the knee that was packed after cryosurgery with bone chips. She developed a path... Slide 15 of 23 Notes: This is the other proximal tibial tumor we treated without replacement. Cavity was curetted, 80% phenol was then applied to ... Slide 16 of 23 Notes: This lady presented with advanced stage 3 GCT about the elbow. The preoperative photos are lost. I excised the distal humeru... Slide 17 of 23 Notes: GCT can present as a lesion of the greater trocanter. Thjs lesion disappeared afrer cureaatge, cryosurgery and a bone graft. Slide 18 of 23 Notes: This elderly lady presented with a histologically confirmed GCT of the distal femur. The cavity was initally packed with bon... Slide 19 of 23 Notes: A custom made knee replacement was inserted after a block excision. The longevity of the device was never tested as she died... Slide 20 of 23 Notes: This aggessive looking lesion caused our histolgists a headache whenb we did the preooperative boipsy. It was confirmed to b... Slide 21 of 23 Slide 22 of 23 Slide 23 of 23 Giant Cell Tumors:a retrospective study ICM Robertson Tygerberg Hospital September 2003 Next slide Back to first slide View graphic version Overview Benign tumor Ephyseal regions Adults Previous slide Next slide Back to first slide View graphic version Notes: Giant cell tumor (GCT) of ... Problems with Giant cell tumors Undermine joint Late collapse OA Recurrence Pulmonary Metastases Previous slide Next slide Back to first slide Vie... Patients and Methods Retrospective 1982 -2002 Case Studies 15 patients Follow up average 5 yr. Previous slide Next slide Back to first slide View ... Patients Age - av.. 35.4 yr. Follow Up 33.1 m (1) (2) (2) (2) (4) (Other 4) Previous slide Next slide Back to first slide View graphic version Not... Special Investigations X-rays CT lesion and lung MRI - stage 3 lesions Serum calcium Biopsy Previous slide Next slide Back to first slide View gra... Grading ( Campanucci) Grade 1: Well defined margin Grade 2: Definite margin, no radio- opaque rim Grade 3: Indistinct margin (0) (7) (4) Previous ... Operative Technique Curettage13 patients Sclerosis - Cryosurgery 6 - Phenol 3 - None Bone graft13 Bone Cement2 Joint replacement3 Previous slide N... Operative Technique Cryosurgery open pour technique Cancellous grafting Previous slide Next slide Back to first slide View graphic version Notes: ... Case Studies 70 yr. male Previous slide Next slide Back to first slide View graphic version Notes: Was our oldest patient (70 years and a smoker t... Case Studies Excision - arthrodesis Vascularised graft 70 yr Male Previous slide Next slide Back to first slide View graphic version Notes: Slide ... PPT Slide 21 yr. Male Previous slide Next slide Back to first slide View graphic version Notes: This 21 year male presented with advanced stage 3 ... PPT Slide Previous slide Next slide Back to first slide View graphic version Notes: En Bloc excision of the whole proximal femur was done. To rega... PPT Slide 43 yr female Previous slide Next slide Back to first slide View graphic version Notes: The pictures are of one of the Tumors about the k... PPT Slide 32 yr female Reinforced Bone cement (Aboulafia - CORR 307 page 186) Previous slide Next slide Back to first slide View graphic version N... PPT Slide Resection -large GCT of distal humerus Elbow Previous slide Next slide Back to first slide View graphic version Notes: This lady present... Greater Trocanter 30 yr male Cryosurgery and Bone graft Previous slide Next slide Back to first slide View graphic version Notes: GCT can present ... PPT Slide 68 yr. female Previous slide Next slide Back to first slide View graphic version Notes: This elderly lady presented with a histologicall... PPT Slide 68 yr. female Previous slide Next slide Back to first slide View graphic version Notes: A custom made knee replacement was inserted afte... PPT Slide 26 yr male Resection and bone transport (Tsuchiya JBJS 78B 1996 Page 264) Previous slide Next slide Back to first slide View graphic ver... Results Recurrence free14/15 Major complications Amputations 3 death 1 No Pulmonary metastaces Previous slide Next slide Back to first slide View ... Discussion Late presentation - Stage 3 Previous slide Next slide Back to first slide View graphic version Conclusion Recurrence rare need adequate excision Diagnostic - confirm diagnosis Mechanical stability about the knee avoid massive bone grafts Pre... Malignant bone tumors, diagnosis and management Basic operations orthopaedic surgery Malignant bone tumors, diagnosis and management Malignant bone tumors, diagnosis and management ˙Ř˙ŕ Surgical treatment Osteosarcoma 18-Dec-03 Click here to start Table of Contents Surgical treatment Osteosarcoma Biopsy Enneking staging system Sur... Slide 1 of 8 Slide 2 of 8 Notes: Biopsy is only done once the magnetic resonance and other imaging studies are over. The principle of biopsy is to use a direct... Slide 3 of 8 Notes: The Enneking system of staging is similar to the TNM system except that sarcomata do not metastasize to the lymph nodes, so th... Slide 4 of 8 Notes: A surgical margin can be marginal, wide or radical. In Osteosarcoma a marginal excision is not desirable and will lead to recu... Slide 5 of 8 Notes: An amputation is merely a method of removing a tumor. Any type of margin can be achieved depending on how far away from the tu... Slide 6 of 8 Notes: The primary lesion needs to be removed as there is later morbidity from pathological fractures, infection etc from the tumor, ... Slide 7 of 8 Notes: Prognosis is about 40% or worse in South Africa because of late presentation and non compliance. Slide 8 of 8 Notes: Problems in South Africa are the late presentation and many patients who do not follow their chemotherapy regimen as well a s ... Surgical treatment Osteosarcoma I.C.M. Robertson Department of Orthopaedics Faculty of Medicine University of Stellenbosch Next slide Back to firs... Biopsy Open Vs closed Choice of site Stay in compartment Plan later surgery incision Avoid reactive bone / necrosis Direct approach Previous slide... Enneking staging system StageGradeSiteMetastases IALowIntraNoneBLowExtraNone IIAHighIntraNoneBHighExtraNone IIIRegionalDistant Previous slide Next... Surgical margins Marginal Wide Radical Previous slide Next slide Back to first slide View graphic version Notes: A surgical margin can be marginal... Amputation Achieves any margin Less postoperative morbidity ? Cost effective Previous slide Next slide Back to first slide View graphic version No... Stage 3 Sarcoma Surgery Remove primary lesion - always Pulmonary resection Previous slide Next slide Back to first slide View graphic version Note... Prognosis Stage 2B53%(Lindeque) 42%Noncompliant Previous slide Next slide Back to first slide View graphic version Notes: Prognosis is about 40% o... Problems uniqueto South Africa Late presentation Size of tumour Non compliance Previous slide Back to first slide View graphic version Notes: Prob... Page contents Benign bone Tumors Simple Bone Cyst Aneurismal cyst Enchondroma Non ossifying fibroma Fibrous dysplasia Osteoid osteoma Osteochondro... Malignant bone tumors, diagnosis and management Basic operations orthopaedic surgery Malignant bone tumors, diagnosis and management Links to Bone Tumor Sites Hate learning out of books? Visit the interesting and informative sites below: Topic Comment Simple Bone Cyst Wheeless' ... Fracture because of a cyst Treatment of pathological fracture through a simple cyst Most cysts will resolve if treated conservatively. Recommendat... Small or incidental simple bone cysts Not all require treatment Any procedure that decompresses the cyst will work * Steriod injection * Perforati... Recurrent cysts Require surgical treatment Query your initial diagnosis - May be an Aneurysmal bone cyst or malignant tumor Recommended management... Case B Previous Imaging Studies - suspected ostesarcoma The following studies are indicated Straight X-rays - AP and Lateral of lesion Chest X-ray... Case B Previous Blood Tests - suspected ostesarcoma Test Why Done ESR Raised in large (necrotic) tumor Full blood count Exclude sepsis, haematolog... Case B Previous Role of biopsy - suspected ostesarcoma Biopsy is done once the other tests are completed Open or needle biopsy can be done Techniq... Case B Previous Radioisotope Studies - suspected ostesarcoma Technecium whole body scan - The tumor area is warm The main reason for the scan is t... Case B Go back Discussion The femoral condyle,on the medial side, shows a fuzziness, that is due to the cortex being broken through by a malignant... Case B Previous Diagnosis AP Xray Lateral View Magntic Resonance History Age:18 years Sex: Male Pain - gradual onset in L knee over 3 months Case B: Magnetic Resonance Image Back Case B Previous Treatment Treatment Osteosarcoma Chemotherapy - Preoperatively Surgery - remove with good margin Amputation Block resection - limb... Case B Previous The following will have to be done for stageing Type Discussion Blood Tests What tests would you do? Imaging What Imaging studies ... Case 1: Diagnosis Simple bone cyst Treatment Home Case 1: Detail of Case 1 Go back Take note of the perosteal reaction Go back Treatment varies according to the size of the cyst Presume the diagnosis is simple bone cyst in the same child What if: My treatment would be: Pre... Case 1: Treatment Operative The periosteal reaction suggests the cyst is in a pre-fracture stage Curettage and pack cyst with bone chips Go back O... Case 1: Xray Findings Cystic, slightly expansile lesion of the humerus. Not well loculated Detail -shows a periosteal reaction present Go back Dia... CASE 1 Xray Discussion Next Case Xray Detailed view Xray Discussion Age: 6yr Sex: Male Sudden onset past week pain L humerus Xray Detailed view Xr... CASE 1 Xray Discussion Next Case Age: 6yr Sex: Male Sudden onset past week pain L humerus Xray Detailed view Xray Discussion Self StudyBone Tumors 2 cases ICM Robertson Case A: History Age: 6yr Sex: Male Sudden onset past week pain L humerus Case B: Age: 18yr Sex: Male G...