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Trigger 14 - Radpatho
Trigger 14 - Radpatho
“Fusion”
The patient was a two and a half year-old male at time of presentation
that had been meeting developmental milestones. He had an uneventful
delivery at 34 weeks via C-section due to a breech-presentation. It was
noted that the baby has an abnormally shaped forehead and was
referred by his pediatrician for an emergent pediatric neurosurgical
consultation. At time of admission, a CT scan was obtained and revealed
right frontosphenoid craniosynostosis.
Trigger 14
Guide Questions:
1. Describe the craniosynostosis in terms of its definition, signs and symptoms, radiographic
appearance, and treatment or intervention.
2. Provide examples for each disease classification of skeletal system disorders. Describe the
pathologic process in terms of its definition, signs and symptoms, radiographic appearance, and
treatment or intervention.
A. Congenital and hereditary disease
B. Inflammatory diseases
C. Vertebral column diseases
D. Neoplastic disease
1. Describe the craniosynostosis in terms of its definition, signs and
symptoms, radiographic appearance, and treatment or intervention.
Definition
Surgery is required to release the bones and remodel the skull in order to
treat craniosynostosis. An ear-to-ear incision and the surgical removal,
contouring, and reattachment of the damaged bones have been used to
treat the craniosynostosis. This continues to be the greatest choice on
occasion.
2. Provide examples for each disease classification of skeletal system
disorders. Describe the pathologic process in terms of its definition, signs
and symptoms, radiographic appearance, and treatment or intervention.
A. Congenital and hereditary disease
Achondroplasia
The most common inherited disorder affecting the skeletal system is
achondroplasia, which affects bone in the normal manner, impairing the longitudinal
growth of the bones. Thus, patients with this type of osteochondrodysplasia have a
normal trunk size and shortened extremities.
Signs and Symptoms:
In some instances, ultrasonography may be used for prenatal diagnosis of
achondroplasia. An adult with achondroplasia is usually no more than 4 feet in
height, with lower extremities usually less than half the normal length. Additional
clinical manifestations of this disorder include extreme lumbar spine lordosis,
bowed legs, a bulky forehead with midface hypoplasia, and a narrowing of the
foramen magnum within the skull, which causes neural compression.
Achondroplasia
Radiographic Appearance
Treatment or Intervention
Orthopedic surgery may be necessary in the
management of complications associated
with achondroplasia. The Ilizarov procedure
has also been used in an attempt to lengthen
the shortened limbs. This procedure was
perfected by Dr. Gavriil Ilizarov. It consists of
a corticotomy of the limb, followed by
attachment of an Ilizarov fixator, which
consists of two circular frames that
surround the limb, wires, and rods. By using
this method, bones may be made to grow at
a rate of approximately 1 mm per day.
B. Inflammatory diseases
Osteomyelitis
Is an inflammation or swelling of bone tissue
that is usually the result of an infection. Bone
infection may occur for many different reasons
and can affect children or adults.
Osteomyelitis can also occur from a nearby
infection due to a traumatic injury, frequent
medication injections, a surgical procedure or
use of a prosthetic device.
The source of the blood infection is usually
Staphylococcus aureus, although it may be
caused by a different type of bacteria or fungal
organism
Osteomyelitis
Pathology
In most instances, osteomyelitis results from
hematogenous spread, although direct extension
from trauma and/or ulcers
In the initial stages of infection, bacteria multiply,
triggering a localized inflammatory reaction that
results in localized cell death. With time, the
infection becomes demarcated by a rim of
granulation tissue and new bone deposition.
Symptoms:
• Fever • Fatigue
• Swelling, warmth and• Pain in the area of the
redness over the area of infection
the infection
Radiographic Appearance
Treatment and Intervention
The goal for treatment of osteomyelitis is to cure the infection and minimize any long-
term complications. Treatment may include:
Medications. Administration of intravenous (IV) antibiotics, which may require
hospitalization or may be given on an outpatient schedule. Intravenous or oral antibiotic
treatment for osteomyelitis may be very extensive, lasting for many weeks. It is
important for the patient to continue to take antibiotics for as long as recommended by
the treatment team, even after symptoms of the infection have resolved.
• Monitoring of successive X-rays and blood tests
• Pain management
• Bed rest
• Surgery. In some cases, surgical intervention may be necessary to drain
infectious fluid, or to remove damaged tissue and bone.
C. Vertebral column diseases
Conservative medical management is the preferred choice for treatment before surgical fusion.
• Rest
• chiropractic manipulative therapy
• Surgical intervention - depends on the degree of slippage and is classified as grade I to IV
Grade I being the least severe and grade IV the most severe
Retrospondylolisthesis
Definition:
Opposite of spondylolisthesis. Retrolisthesis is a posterior or backward
slippage, and spondylolisthesis (sometimes called anterolisthesis) is an
anterior or forward slip.
Many varieties of bone tumors are seen in patients of all ages; however,
primary bone tumors are more common in children than in adults, and
metastatic bone lesions far outnumber the incidence of primary bone
neoplasms in the adult.
Characterizations of Benign and Malignant
Characterization of Benign
Benign is a word used to describe tumors that do not
spread to nearby tissues. Being able to permeate the
basal membrane that protects a particular tissue is one
of the most obvious signs that a cell is malignant. Since
they are unable to invade or spread to the surrounding
tissues through the basal membrane, the cells in benign
tumors are not malignant. Therefore, benign tumors are
less concerning and are easily treatable with surgery.
• Slow, Regular growth
• Encapsulated
• Non-Invasive – localized
• Does not metastasize
The most common benign tumors are:
Osteoma
Osteochondroma (Exostosis)
This neoplasm occurs at a younger age than any other primary malignant bone
neoplasm, usually between the ages of 5 and 15 years, and rarely after age 30 years. It is also
more common in boys than in girls and shows a predilection for whites, with blacks rarely
affected.
The primary malignant bone tumors are:
Multiple myeloma
Concept Map
References:
• Craniosynostosis - Symptoms and causes. (2022, September 15). Mayo Clinic. https://www.mayoclinic.org/diseases-
conditions/craniosynostosis/symptoms-causes/syc-20354513
• Osteomyelitis. Johns Hopkins Medicine. (2021, August 8). Retrieved October 10, 2022, from
https://www.hopkinsmedicine.org/health/conditions-and-diseases/osteomyelitis#:~:text=Osteomyelitis%20is
%20inflammation%20or%20swelling,can%20happen%20at%20any%20age.
• Hacking, C. (2022, October 4). Osteomyelitis: Radiology reference article. Radiopaedia Blog RSS. Retrieved October 10, 2022,
from https://radiopaedia.org/articles/osteomyelitis#:~:text=Plain%20radiograph&text=In%20general%2C
%20osteomyelitis%20must%20extend,to%2014%20days%20in%20adults.
• Desimpel, J., Posadzy, M., & Vanhoenacker, F. M. (2017, May 11). Journal of the Belgian Society of Radiology. Retrieved
October 10, 2022, from https://www.jbsr.be/articles/10.5334/jbr-btr.1300/
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