1. Bone infection

2. Osteomylitis
Definition:- inflammation of the bone or bone marrow caused by infection.
Two types:-
Pyogenic
T.B osteomylitis

3. Pyogenic osteomylitis
Causetive organisms:-
Staphylococcus aureus
Age :-
Infants and children
Organisms may infect bone through:-
1- Bloodstream, from local areas of infection (as in cellulitis).
2- Penetrating trauma e.g joint replacements or internal fixation of fractures.

4. Pyogenic osteomylitis
Site of affection :-
The most common site is tubular bones as they have the most rapid growth and the largest metaphysis
Clinical picture:-
With acute osteomyelitis, the presenting complaint is usually local pain, swelling, and warmth, often associated with fever and malaise.
Affect children

5. Radiographic appearance of Osteomyleitis
Radiographic changes after days after onset of infection.
Soft tissue swelling ( the earliest sign).
Cortical thickening
Irregularity of cortices
Sclerosis

6. Radiographic appearance of Osteomyleitis
Bone destruction in the metaphysis.
Periosteal reaction, may become very extensive and surround the bone to form an involucrum.

7. Radiographic appearance of Osteomyleitis
A part of original bone may die and form a separate dense fragment called sequestrum.

8. Radiographic appearance of Osteomyleitis
Brodie’s abscess:
It occurs when osteomylitis is partially treated .
Brodie’s abscess is a spherical region of bone destruction, filled with pus or connective tissue,
Oval translucency larger than 1cm surrounded by a heavily reactive sclerosis near end of long bones (metaphysis).
Small sequestrum may be present.
Loss of differentiation between the cortex and the medulla.

9. Brodie’s abscess Typical appearance of a Brodie's abscess is :-
Lucency within the distal metaphysis with surrounding reactive sclerosis.

11. Role of radionuclide image
Much more sensetive for detecting early disease
Increased uptake after two to three days.

12. Role of ultrasound
Demonstrate subperiosteal collection of pus well before bone changes on plain x-ray,

13. Role of MRI Shows the changes early as bone edema and pus accumuation.
Detect the extent of the infection better than other modalities.

14. Role of CT
May be used in selected cases to show sequestra

15. How to D.D between osteomyelitis and tumor
It is not always possible.
Clinical history .
Initial films
Ct and MRI , may be better in D.D as they detect the lesion better.
Biopsy is needed in some cases.

16. T.B osteomyelitis Spine, followed by large joints.
Produce large area of bone destruction.
May be asymptomatic in early changes.

17. Alteration of trabecular pattern of bone

18. Paget’s disease Chronic progressive focal disease of bone.
Characterized by excessive resorption followed by excessive formation of bone, with abnormal bone remodeling.
The bone that is formed is abnormal, enlarged, and prone to fracture.
This process results in extensive local vascularity and increased fibrous tissue in the bone marrow.
Involvement is usually polyostotic and asymmetric.
Sites of affection :- Pelvis, spine, skull, femur, and tibia.

19. Paget’s disease Clinical presentation:- Unknown aetiology
Eldery patient
Clinical presentation:-
Majority are asymptomatic and diagnosed as an incidental finding
Bone pain
Fracture
Deformity ( bowing ) of long bones

20. Paget’s disease Radiological features Long bones:- Cortical thickning
Sclerosis
Coarsened trabecular pattern
Increase size of the bone
Bowing of long bone

21. Paget’s disease Dense sclerosis involving the femoral head and neck .
This is a high-risk area for insufficiency fracture.

22. Paget’s disease
Late-stage Paget disease reveals a transverse fracture through the proximal femoral shaft (banana fracture).

23. Paget’s disease Skull :-
A large lytic well defined area (osteoprosis circumscripta).

24. Paget’s disease

25. Paget’s disease Skull :-
Many circumscribed patches of sclerotic bone in the calvarium giving a motteled appearance (cotton wool appearance).

26. Paget’s disease Advanced Paget's disease of the skull.
Thickened inner and outer tables, new bone deposition (cotton-wool patch(

27. Paget’s disease Spine :-
Picture Frame vertebral body (enlarged square vertebral body with peripheral sclerosis and inner lucency).

28. Paget’s disease Spine :-
Densely sclerotic vertebral body (ivory vertebra)

29. Paget’s disease Pelvis :- Coarsened trabecular pattern
Cortical thickning
Enlargment of the pubis and ischium.

30. Paget’s disease
Patchy sclerosis and coarsened trabecula characteristic of late-stage Paget disease.
A fracture of the ischium inferior to the acetabulum (arrows) is present.

31. Paget’s disease
Complications:-
Pathological fracture
Osteosarcoma

32. Generalized decrease in bone density (osteopenia)

33. Osteopenia is a nonspecific radiographic finding that indicates increased radiolucency of bone .
Bone density may be difficult to assess because of technical factors (Kvp , mA)

34. Causes of generalized decrease in bone density (osteopenia)
Osteoprosis
Osteomalacia
Hyperparathyrodism
Multiple myeloma

35. Osteoprosis
Reduction of calcium content due to deficiency of osteoid (unmineralized portion of the bone matrix forms prior to the maturation of bone tissue ).
Increase % of fractures especially in the vertebral bodies and hips.

36. Causes of osteoprosis 1- Idiopathic :-
Juvenile.
Postmenopausal .
Senile .
2- Cushing syndrome and steroid therapy.
3- D.M .
4- Arthritis.
5-Pregnancy.
6- Fracture.

37. Osteoprosis Clinical presentation:- Asymptomatic Bone pain
Skeletal fracture

38. Radiographic diagnosis
Most commonly seen in the spine.
Overall decrease in bone density except the cortex still clear.
Collapse of the vertebral bodies , so they appearing as wedged or biconcave .
Widened of the intervertebral disc spaces , if Several vertebral bodies are affected.
In long bones, there is thinning of the cortices.

39. Osteoprosis

40. Osteoprosis
An osteoporotic spine, showing compression fractures in the L1 and L3 vertebral bodies.

41. Osteoprosis
Two views of the lumbar spine taken 1 year apart demonstrate rapidly developing osteoporosis and multiple compression fractures .

42. Ricketes

43. Ricketes
Rickets is a softening of bones in children leading to fractures and deformity
Occur before epiphyseal closure., It is caused by a failure of osteoid to calcify (unmineralized portion of the bone matrix forms prior to the maturation of bone tissue ).

44. Ricketes Causes of rickets:-
Dietery deficiency of vitamine D, or lack of exposure to sunlight , resulting in decreased production of endogenous vitamine D which is important for absorption of calcium , resulting in hypocalcemia
Malabsorption leading to impaired absorption of calcium or vitamine D.
Renal disease where rickets develops despite normal amount of vitamine D (vitamin D resistant rickets).
Chronic renal faliure .

45. Ricketes Clinical picture :- Delayed growth
Pain in the spine, pelvis and legs
Bowed legs
Abnormally curved spine

46. Radiological features of ricketes
Commonly seen at the knee,wrists , and ankles.
Fraying and indistinct margins of the metaphysis, causing a cupped appearance
Increased distance between the visible epiphysis and calcified portion of metaphysis.

47. Ricketes
Bowing and curvature of the bones occur because the undermineralized bone is soft
Bulbous enlargement of the anterior ends of the ribs producing a (ricketry rosary appearance ).
Greenstick fracture is common.

48. Osteomalacia

49. Osteomalacia
Occurs in adults due to failure of osteoid to calcify .

50. Osteomalacia Radiological features Loss of bone density.
Thinning of the cortex.
Bone deformity due to bone softening e.g bowed of the femora and triradiate pelvis (bent inwards).
The vertebral bodies are biconcave.

51. Osteomalacia Looser’s zone (pseudofractures) :-
Are short lucent bands running through the cortex at right angles .
may have sclertotic margin.
Location :- scapula , femoral necks and pubic rami.

52. Ostomalacia
Losser’s zone in the femoral neck

53. Generalized increase in bone density

54. Generalized increase in bone density
Conditions that cause generalized increase in bone density :-
Sclerotic metastasis
Osteopetrosis
Myelosclerosis

55. Osteopetrosis (marble bone disease)
Congenital disorder of bone formation .
The bones are densely sclerotic .
The bones are brittle and may fracture but heal easily.

56. Osteopetrosis
AP and lateral knee in a patient with osteopetrosis

58. Thank you