Orthopedic Imaging

Osteoid Osteoma
• Usually develops in the
long bones of the body
• They have characteristic
lucent nidus <2 cm and
surrounding solid
periosteal reaction and
classically cause night-
pain that is relieved by
the use of salicylate
analgesia
• X-ray  May be normal or
may show a solid
periosteal reaction with
cortical thickening. The
nidus is sometimes visible
as a well circumscribed
lucent region, occasionally
with a central sclerotic
dot.
 Osteoid Osteoma
• An osteoid osteoma is
composed of three
concentric parts 1:
1. nidus
a) meshwork of dilated
vessels, osteoblasts,
osteoid and woven
bone
b) may have a central
region of
mineralisation 2
2. fibrovascular rim
3. surrounding reactive
sclerosis
 Osteochondroma

• An osteochondroma is an outgrowth of the growth plate and is

made up of both bone and cartilage
• Can develop as a single tumor (osteocartilaginous exostosis) or as
many tumors (multiple osteochondromatosis).
• Can be either sessile or pedunculated
• Seen in the metaphyseal region typically projecting away from
the epiphysis.
• Often associated broadening of the metaphysis.
• The cartilage cap is variable in appearance. It may be thin and
difficult to identify, or thick with rings and arcs calcification and
irregular subchondral bone.
Peduncuated vs Sessile
 Aneurysmal
Bone Cyst
• ABCs consist of blood-
filled spaces of variable
size that are separated
by connective tissue
containing trabeculae
of bone or osteoid
tissue and osteoclast
giant cells
• Typically eccentrically
located in the
metaphysis of long
bones, adjacent to an
unfused growth plate.
• X-ray: sharply defined,
expansile osteolytic
lesions, with thin
sclerotic margins
 OSTEOSARCOMA
• Plain radiograph
• Conventional radiography continues to play an
important role in diagnosis. Typical appearances
of conventional high grade osteosarcoma
include:
• medullary and cortical bone destruction
• wide zone of transition, permeative or moth-
eaten appearance
• aggressive periosteal reaction
– sunburst type
– Codman triangle
– lamellated (onion skin) reaction: less
frequently seen
• soft-tissue mass
• tumour matrix ossification/calcification
– variable: reflects a combination of the
amount of tumour bone production,
calcified matrix, and osteoid
– ill-defined "fluffy" or "cloud-like" cf. to the
rings and arcs of chondroid lesions
OSTEOSARCOMA
 CHONDROSARCOMA
• lytic (50%)
• intralesional calcifications: ~70%
(rings and arcs calcification or
popcorn calcification)
• endosteal scalloping: affecting more
than two thirds of the cortical
thickness (c.f. less than two-thirds in
enchondromas)
• moth eaten appearance or
permeative appearance in higher
grade tumours (see
chondrosarcoma grading),
e.g. myxoid, dedifferentiated and
mesenchymal chondrosarcomas
• cortical remodelling, thickening and
periosteal reaction are also useful in
distinguishing between an
enchondroma and low grade
chondrosarcoma (see enchondroma
vs. low grade chondrosarcoma)
CHONDROSARCOMA
CHONDROSARCOMA
 Pelvic Fracture

• High energy blunt force trauma  unstable pelvic

fractures:
– Anteroposterior compression: result in an open book
or sprung pelvis fractures
– Lateral compression: result in a windswept pelvis
– Vertical shear: results in Malgaigne fracture or bucket
handle fracture
– Combined mechanical: occur when two different force
vectors are involved and results in a complex fracture
pattern
Pelvic Fracture - Malgaigne Fracture
• It comprises of two
ipsilateral pelvic ring
fractures, which are
vertically orientated:
– anterior to
acetabulum
– posterior to
acetabulum
• Most commonly there
is disruption of the
ipsilateral superior and
inferior pubic rami and
sacroiliac joint.
• Common variants
involve the ilium or
sacral wing rather than
the sacroiliac joint
• There is commonly
cephalad displacement
of the hemipelvis
Pelvic Fracture - Open Book Fracture
• Causes disruption
of pubic
symphysis and
the pelvis opens
like a book.
• The pubic rami
may be fractured
in vertical
orientation
instead of the
disruption of the
symphysis pubis.
• This type of
fracture may be
accompanied by
sacroiliac joint
disruption.
Pelvic Fracture - Windswept Fracture
• A combination a
unilateral AP
compression (open
book) injury with a
contralateral lateral
compression injury.
• Occurs when
the internal rotation
of one iliac wing
causes a unilateral
sacral compression
fracture, while the
same forces cause
external rotation of
the opposite
hemipelvis, resulting
in diastasis of the
sacro-iliac joint