1. Bone Tumors and Fractures
Stacy Fielding

2. Primary Bone Tumors OSA, CSA, FSA Solitary Metaphyseal location
Long bones
Rich blood supply
“Away from elbow, toward the knee”
Late stage disease
Invade adjacent bones
Cross joints
Adjacent parenchymal organs

3. Primary Bone Tumors Appearance Periosteal reactions Lysis Sclerosis
Mixed
Periosteal reactions
Spiculated & fuzzy= active
Smooth & sharp = inactive
Amorphous = aggressive
Codman’s triangle >

4. Primary Bone Tumors Ddx:
Fungal osteomyelitis
Bacterial osteomyelitis
Consider signalment, history and clinical signs
Biopsy to be sure!
coccidiomycosis

5. Metastatic Bone Tumors
Tumors that spread to bone:
mammary
lung
liver
thyroid
prostate

6. Metastatic Bone Tumors
Locations:
metaphysis OR diaphysis
vertebrae, ribs, femur, humerus
Appearance:
Similar to primary bone tumor
Ddx:
Fungal osteomyelitis
Bacterial osteomyelitis
Hepatozoonosis

7. Approach to Fractures Describe direction & location
Assess soft tissues
open vs. closed
foreign body
swelling
atrophy
Joint involvement
intra-articular fragments
Positional changes
name distal fragment relative to proximal

8. Look carefully!
Images courtesy of Dr. Pack

9. Fracture Types Complete Incomplete (greenstick)
Involves both cortices
Ex) Transverse, oblique, spiral
Displacement, rotation
Reduction may be needed
Incomplete (greenstick)
One cortex involved
Bending force
Does not over-ride
Bending
Stress microfracture, fissure

10. Fracture types – cont’d
Condylar
Distal humerus, femur, proximal tibia,
Medial or lateral
Supracondylar = both fractured
V, Y, T = condyles fracture from shaft and each other

11. Fracture types – cont’d
Depression
Sinuses or skull
Multiple fissure lines join and bone collapses
Lucent or sclerotic line
Avulsion
Forceful pull or muscle traction
Apophyses
+/- bone segment

12. *Comminuted vs. Multiple
≥3 fracture lines meeting at a single point
High energy trauma
Butterfly fragments
Multiple/segmental
≥3 fracture lines not meeting at a single point
Independent of each other

13. *Compression vs. Impaction
Crushing injury
Cancellous bone collapses
Common in vertebrae
Shortened bone length
Impaction
Fragment of bone driven into cancellous bone
End of long bones
Uncommon

14. Salter-Harris