all about orthopaedic pathology

8/14/2019 ALL ABOUT Orthopaedic Pathology

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(Medical Student Education Series: Core Orthopaedics)

ALL ABOUT

Orthopaedic

Pathologycopyright 2008 eugene [sic] with Conor


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Pagets disease

Pagets(osteitis deformans) is probably a viralinfection of bone where there is disorderedformation of bone resulting in deformity, weakened

bone and 2 OA.It is common in the UK, Australia and NZ. Patientsmay also develop cardiac problems and nerveentrapment.


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Pagets disease(51M, pain and stiffness for years)

Large head, 2 OA,coarse trabeculae,

ossification psoasTHR

LARGE HEAD, 2OA, COARSETRABECULATION, OSSIFICATIONOF PSOAS.

BROAD TRABECULAR, ACTIVEOSTEOBLASTS, CEMENT LINES &FIBROUS VASC. TISSUE.


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Infection

Infections in orthopaedics can be devastating. Theinfection maybe of bone(osteomyelitis,OM-1/haematogenous or 2-post trauma /ORIF) or in jointsseptic arthritis).XR changes of OM are soft tissueswelling,demineralization,sequestra(dead bone) andinvolucrum(periosteal new bone). Treatment is rest,hydration, identifying the causative organism andsurgery.


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Osteomyelitis (with sequestrum)(21M , post MVA, open tibia #)

SEQUESTRUM,DEAD BONE

OPEN # TIBIA

OPEN # TIBIA

OPEN REDN &EXT FIX.

POST-OPINFECTION


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Gout

Gout is a disorder of metabolismwhereby there is hyperuricemiaresulting in deposition of uric acidcrystals in soft tissue olecranonbursitis) and in/around joints.

XR changes of punched-out erosionsare typical.

Punched out erosions

Pseudo gout crystalsin knee


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Gouty olecranon bursitis

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Picture7

43 yo NZ Maori

P icture 10 P icture 12

TophusExcising gout tophus


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Loose bodies in joint(70F, pain and locking of knee)

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xx LOOSEBODIES

OA KNEEPicture7

Removing LBat arthroscopy


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Mortons

metatarsalgia/neuromaIs from repetitive microtrauma to foot digital nerves.

Usually the common digital nerve to the 3 rd webspace.

Patient has forefoot pain, feels walking on pebble.

Treatment is better shoes and maybesurgery/neurectomy.


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Mortons(Betts) metatarsalgia(33F, pain in 2/3 space)

EXCISED NEUROMAPAIN USUALSPACE

EXCISION,Dorsal appr


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Freibergs disease foot(78F, pain over 2nd metatarsal head)

Excised 2 nd metatarsalhead

Sclerosis 2 nd met head &collapse joint surface. Arrow

Stress overload to 2nd metatarsal head. Can be extremely painful. May need to be excised .


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Dupuytrens disease An autosomal dominance disease characterized by

abnormal proliferation of myofibroblasts andfibroblasts resulting in contractures of the

hands/digits,feet and penis.Treatment is largely surgery(fasciectomy and rarely amputation).


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Dupuytrens-straighten but if toodeformed then amputate.


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Osteoarthritis(OA)OA is a loss of the articular

cartilage. Often the longterm result of damage ( egtrauma).

It maybe 1 or 2.2 from abnormal cartilage(e.g. ochronosis),abnormalbone ( e.g.radionecrosis,AVN) or abnormal loads( egdeformity from childhood-Perthes, SUFE, DDH andPagets).The XR changes are loss of

joint space, sclerosis andosteophytes.

Knee replacement

OA=loss articular cartilage;seen at arthroscopy


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OA-causes

DDH. 36F.PAINFUL HIPS.Childhood surgery.2OA. Bil THR.

Bil 2 OA

PERTHES.LARGE DEFORMED HEAD.2OA. Needed THR.


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OA-causesRADIONECROSIS. 64m post-radiotherapy for testicular Ca.Needed THR.

SEGMENTALAVN post slidingscrew plate for #NOF. 35M.Needed THR.

DERMATOMYOSITIS 43F with painful hip. 2OA. Needed THR.


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OA-causes

SUFE

2 OA as adult.Needed THR

SUFE, left side, aschild

Pin-in-situ; but still wentonto 2OA as adult

pistol-gripshape


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AVN hip(42F,on steroids for pemphigus, to THR)

LARGE FLAP HIP FLAP IS CARTILAGE & BONE

COLLAPSE OF SURFACEWITH 2 OA

THR


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Meniscus


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=Left meniscus(with permission JBJS(B). Fig 1, p 1550, Dec., 2006)


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Ochronosis/alkaptonuria(68F, pain and stiff knee)

Black staining fromxx homogentisic acid deposits

Black colouration of knee from xx homogentisicacid acid deposits into joint.

2 OA

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