Introduction skeletal radiology(11月20.)

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  • stiffness of a joint -ankylosis
  • Introduction skeletal radiology(11月20.)

    1. 1. MUSCULOSKELETAL RADIOLOGY Sun Yat-sen Memorial Hospital SYSU Dr. BILING LIANG
    2. 2. Musculoskeletal Radiology <ul><li>INTRODUCTION </li></ul><ul><ul><li>IMAGING TECHNOLOGY </li></ul></ul><ul><ul><li>NORMAL APPEARANCE </li></ul></ul><ul><ul><li>BASIC X-RAY SIGN </li></ul></ul><ul><ul><li>RADIOLOGY DIAGNOSIS OF COMMON DISEASES </li></ul></ul>
    3. 3. Imaging technology <ul><li>X-ray : plain film </li></ul><ul><ul><li>Very good X-ray density resolution in bone & joint , the resolution of soft tissue not enough </li></ul></ul><ul><li>CT : as X-ray, but good for positioning </li></ul><ul><li>MR : </li></ul><ul><ul><li>advantage : very good soft tissue resolution </li></ul></ul><ul><ul><li>disadvantage : not sensitivity to display calcification </li></ul></ul><ul><li>US : </li></ul><ul><ul><li>Non-invasive image method, easy to perform </li></ul></ul><ul><ul><li>Can evaluate the soft tissue abnormalities </li></ul></ul>
    4. 4. <ul><li>Skeletal CT </li></ul><ul><ul><li>Soft tissue window : </li></ul></ul><ul><ul><ul><li>Bone </li></ul></ul></ul><ul><ul><ul><li>muscle </li></ul></ul></ul><ul><ul><li>Bone window: </li></ul></ul><ul><ul><ul><li>Cortical : </li></ul></ul></ul><ul><ul><ul><li>Trabecula : network </li></ul></ul></ul><ul><ul><ul><li>Bone marrow cavity : </li></ul></ul></ul><ul><ul><ul><li>low density </li></ul></ul></ul>
    5. 5. X-ray plain film & arthrogram
    6. 6. Normal X-ray appearances <ul><li>Bone – structure & development </li></ul><ul><li>Joint </li></ul><ul><li>Spine </li></ul><ul><li>Soft tissue </li></ul>
    7. 7. Normal X-ray appearances <ul><li>Bone structure & development </li></ul><ul><ul><li>Structure : </li></ul></ul><ul><ul><ul><li>Cortical bone (compact ) </li></ul></ul></ul><ul><ul><ul><li>Cancellous bone (Trabecula ) </li></ul></ul></ul><ul><ul><li>Development : </li></ul></ul><ul><ul><ul><li>intramembranous ossification </li></ul></ul></ul><ul><ul><ul><li>Endochondral ossification </li></ul></ul></ul>Same histologic structure Different arrangement Cartilage -> bone formation -> remodel -> trabecular bone
    8. 8. Normal X-ray appearances cortex trabecula
    9. 9. Normal pediatric X-ray appearances 4 years , distal femur metaphysis epiphysis Epiphyseal plate
    10. 10. Normal pediatric X-ray appearances 9 m , distal femur 增殖带 成熟带 肥大带 退变带 成骨带 静止细胞带 {
    11. 11. Normal pediatric skeletal development 6M 1Y 2Y 3Y 4Y
    12. 12. Normal adult X-ray appearances Diaphysis shaft
    13. 13. Normal pediatric X-ray appearances <ul><li>The ossification centers & the secondary ossification display & fusion, will occur at certain time of the life, refer to as bone age </li></ul>Bone age yrs ±1 New born
    14. 14. Normal X-ray appearances <ul><li>The types of skeleton: </li></ul><ul><ul><li>Long bone </li></ul></ul><ul><ul><ul><li>Pediatric : diaphysis 、 metaphysis 、 epiphysis 、 epiphyseal plate </li></ul></ul></ul><ul><ul><ul><li>Adult : diaphysis (shaft) 、 </li></ul></ul></ul><ul><ul><li>Short bone </li></ul></ul><ul><ul><li>Flat bone – hematopoiesis </li></ul></ul><ul><ul><li>Irregular bone </li></ul></ul><ul><li>Joint </li></ul>
    15. 15. <ul><li>Short bone </li></ul>Normal appearances pediatric adult
    16. 16. <ul><li>Flat bone </li></ul>Normal appearances
    17. 17. <ul><li>Spine </li></ul>Normal appearances
    18. 18. Normal X-ray appearances <ul><li>Bone </li></ul><ul><li>Joint -- structure </li></ul><ul><li>Spine </li></ul><ul><li>Soft tissue </li></ul>
    19. 19. Normal X-ray appearances <ul><li>Joint </li></ul><ul><ul><li>Synovial joint -- knee </li></ul></ul><ul><ul><li>Fibrous joint -- </li></ul></ul><ul><ul><li>Cartilaginous joint -- SI </li></ul></ul><ul><ul><li>Synostosis joint – skull </li></ul></ul>
    20. 20. <ul><li>Joint is an organ </li></ul><ul><ul><li>Articular capsule </li></ul></ul><ul><ul><li>synovium </li></ul></ul><ul><ul><li>cartilage </li></ul></ul><ul><ul><li>Cortical bone </li></ul></ul><ul><ul><li>Ligament & tenden </li></ul></ul><ul><ul><li>Fluid </li></ul></ul><ul><li>Joint space </li></ul><ul><ul><li>cartilage </li></ul></ul>Articular cartilage Epiphyseal cartilage Fibrocartilage dics X-ray
    21. 22. Normal hip <ul><ul><li>bony articular surface </li></ul></ul><ul><ul><li>joint space </li></ul></ul>
    22. 23. Normal joint structure <ul><li>Elbow -- Synovial joint </li></ul><ul><li>SI joint -- Cartilaginous joint </li></ul>
    23. 24. <ul><li>wrist </li></ul>Normal joint structure
    24. 25. Basic X-ray signs <ul><li>Osteoporosis </li></ul><ul><li>Osteomalacia </li></ul><ul><li>Bone destruction </li></ul><ul><li>Osteosclerosis </li></ul><ul><li>Periosteal reaction </li></ul><ul><ul><li>Calcification </li></ul></ul><ul><ul><li>Bone necrosis </li></ul></ul><ul><ul><li>Mineral sedimentation </li></ul></ul><ul><ul><li>Bone deformity </li></ul></ul><ul><ul><li>Soft tissue abnormalities </li></ul></ul>Musculoskeletal system Bone Joint <ul><li>Joint swellen </li></ul><ul><li>Joint dislocation </li></ul><ul><ul><li>Joint destruction </li></ul></ul><ul><ul><li>Joint bony/fibrous ankylosis </li></ul></ul>
    25. 26. Osteoporosis <ul><li>Definition : </li></ul><ul><ul><li>The bone matrix or osteoid specific deficiency </li></ul></ul><ul><ul><li>Both of the organic material & calcium are decreased, but the ratio of them still normal </li></ul></ul><ul><li>X-ray appearance : </li></ul><ul><ul><li>Bone density decreased, local / general </li></ul></ul><ul><ul><li>The cortex become thinner , the trabeculae become thin and decreased number </li></ul></ul><ul><ul><li>Pathological fracture </li></ul></ul><ul><li>Etiology : </li></ul><ul><ul><li>Common : elderly , immobilization </li></ul></ul><ul><ul><li>Path : hormonal / vitamine deficiency </li></ul></ul>Basic X-ray signs
    26. 27. <ul><li>Spine oteoporosis </li></ul><ul><ul><li>Vertibral body deformity as “ fish vertibral ” </li></ul></ul><ul><ul><li>Bone density decreased </li></ul></ul><ul><ul><li>Trabecula thinner </li></ul></ul>Osteoporosis Basic X-ray signs normal c
    27. 28. <ul><li>Thallassaemia </li></ul><ul><ul><li>Chronic haemolytic anaemias cause widening of the spongiosa / cortex thinning in the proximal ends of long bone </li></ul></ul>Osteoporosis Basic X-ray signs
    28. 29. Osteomalacia <ul><li>Definition : </li></ul><ul><ul><li>Insufficient mineralization of the osteiod </li></ul></ul><ul><ul><li>Lack of calcium for bone formation </li></ul></ul><ul><li>X-ray appearance : </li></ul><ul><ul><li>Bone density decreased generally, bone become softened and bend or even break, vertebral bodies biconcave (fish vertebrae) </li></ul></ul><ul><ul><li>The cortex become thinner, “ ground glass ” change, deficient bone formation </li></ul></ul><ul><ul><li>Pseudo-fracture, Pathological fracture </li></ul></ul><ul><li>Etiology : </li></ul><ul><ul><li>Deficient Vitamine D, Calcium (inadequate intake) </li></ul></ul><ul><ul><li>Excessive loss of calcium in renal disease </li></ul></ul>Basic X-ray signs
    29. 30. <ul><li>Rickets </li></ul><ul><ul><li>Bone density decreased </li></ul></ul><ul><ul><li>Bone softening & bend </li></ul></ul><ul><ul><li>Metaphysis </li></ul></ul><ul><ul><li>splaying & the epiphyseal plate widening </li></ul></ul>Osteomalasia Basic X-ray signs
    30. 31. <ul><li>Rickets </li></ul><ul><ul><li>Bone density decreased </li></ul></ul><ul><ul><li>Bone softening & bowed </li></ul></ul>Osteomalasia Basic X-ray signs
    31. 32. Bone destruction Basic X-ray signs <ul><li>Definition : </li></ul><ul><ul><li>The pathologic tissue replaced the normal bone structure (cortex or spongiosa) </li></ul></ul><ul><li>X-ray appearance : </li></ul><ul><ul><li>Bone density decreased, rarefaction of bone </li></ul></ul><ul><ul><li>The cortex erosion </li></ul></ul><ul><li>Etiology : </li></ul><ul><ul><li>Inflammation or granuloma </li></ul></ul><ul><ul><li>Tumor or tumor-like lesion </li></ul></ul>
    32. 33. <ul><li>Simple bone cyst : </li></ul><ul><ul><li>Massive bone destruction / radiolucency area in proximal femur with well-defined margin, the cortex become thinning </li></ul></ul>Bone destruction Basic X-ray signs
    33. 34. <ul><li>Giant cell tumor </li></ul><ul><ul><li>Eccentric expanding (cystic) translucency area in the proximal fibilar bone , with multi-locular appearance </li></ul></ul>Bone destruction Basic X-ray signs
    34. 35. <ul><li>Giant cell tumor </li></ul><ul><ul><li>Eccentric expanding (cystic) translucency area in the distal radial bone </li></ul></ul>Bone destruction Basic X-ray signs
    35. 36. <ul><li>Tuberculosis of right hip </li></ul><ul><ul><li>Moth-eaten pattern bone destruction in cortex & trabeculae </li></ul></ul><ul><ul><li>Joint space narrowing </li></ul></ul>Bone destruction Basic X-ray signs
    36. 37. Osteosclerosis /hyperostosis Basic X-ray signs <ul><li>Definition : </li></ul><ul><ul><li>Increase of amount of bone matrix in given volume of bone </li></ul></ul><ul><li>X-ray appearance : </li></ul><ul><ul><li>Bone density increased </li></ul></ul><ul><ul><ul><li>Cortex thicken – periosteal growing </li></ul></ul></ul><ul><ul><ul><li>Bone marrow cavity narrowing – endostosis growing and trabecular thickening </li></ul></ul></ul><ul><li>Etiology : </li></ul><ul><ul><li>Inflammation or granuloma (chronic) </li></ul></ul><ul><ul><li>Trauma & fracture </li></ul></ul><ul><ul><li>Tumor or tumor-like lesion </li></ul></ul>
    37. 38. <ul><li>Chronic osteomyelitis : </li></ul><ul><ul><li>Med-low part of the tibia </li></ul></ul><ul><ul><li>Cortex thickening </li></ul></ul><ul><ul><li>Bone marrow cavity narrowing and obliteraed </li></ul></ul>Osteosclerosis Basic X-ray signs
    38. 39. <ul><li>Chronic osteomyelitis </li></ul><ul><ul><li>Osteosclerosis of the bone between the areas of destruction </li></ul></ul><ul><ul><li>Bone marrow cavity narrowing & obliteration </li></ul></ul>Osteosclerosis Basic X-ray signs
    39. 40. <ul><li>Osteosarcoma </li></ul><ul><ul><li>Osteosclerosis inside the lesion </li></ul></ul>Osteosclerosis Basic X-ray signs
    40. 41. <ul><li>Osteosarcorma </li></ul><ul><ul><li>Osteosclerosis inside the lesion </li></ul></ul><ul><ul><li>Periosteal reaction </li></ul></ul>Osteosclerosis Basic X-ray signs
    41. 42. <ul><li>Spinal metestasis </li></ul><ul><ul><li>T11 verteble body bone density increased </li></ul></ul>Osteosclerosis Basic X-ray signs
    42. 43. <ul><li>骨质斑驳症 </li></ul>Osteosclerosis Basic X-ray signs <ul><li>Osteopetrosis </li></ul>
    43. 44. Periosteal reaction / periostosis Basic X-ray signs <ul><li>Definition : </li></ul><ul><ul><li>Periosteal new bone formation cause by various condition stimulated </li></ul></ul><ul><li>X-ray appearance : </li></ul><ul><ul><li>The newly developed periosteal bone in different form: </li></ul></ul><ul><ul><li>lamellae (onion peel) , spicules (sunrays) , lacelike , spurs , et al. </li></ul></ul><ul><li>Etiology : </li></ul><ul><ul><li>Inflammation or granuloma (chronic) </li></ul></ul><ul><ul><li>Trauma & fracture </li></ul></ul><ul><ul><li>Tumor or tumor-like lesion </li></ul></ul>Codman ’ s triangle: The new periosteal bone become eroded centrally leaving triangle areas of New bone at the edges
    44. 45. <ul><li>Subacute osteomyelitis </li></ul><ul><ul><li>Smoth lamellae Periosteal reaction </li></ul></ul>Periosteal reaction / periostosis Basic X-ray signs normal
    45. 46. <ul><li>Lacelike & spicules periosteal reaction </li></ul>Periosteal reaction / periostosis Basic X-ray signs
    46. 47. <ul><li>Fracture unhealing </li></ul><ul><ul><li>Massive periosteal reaction surrounding the ulnar fracture area </li></ul></ul>Periosteal reaction / periostosis Basic X-ray signs
    47. 48. <ul><li>Osteosarcoma </li></ul><ul><ul><li>lamellae & spicules periosteal reaction, formed Codman ’ s triangle </li></ul></ul>Periosteal reaction / periostosis Basic X-ray signs
    48. 49. <ul><li>periosteal reaction destructed by tumor </li></ul><ul><li>Formed Cordmen ’ s triangle </li></ul>Periosteal reaction / periostosis Basic X-ray signs
    49. 50. Calcification within bone/cartilage Basic X-ray signs <ul><li>X-ray appearance : </li></ul><ul><ul><li>The high X-ray density spot inside bone /soft tissue /mass </li></ul></ul><ul><li>Etiology : </li></ul><ul><ul><li>Inflammation or granuloma or degeneration , or bone necrosis (chronic) </li></ul></ul><ul><ul><ul><li>Irregular shape </li></ul></ul></ul><ul><ul><li>Cartilage tumor </li></ul></ul><ul><ul><ul><li>Ring shape / half-ring shape </li></ul></ul></ul>
    50. 51. <ul><li>chondrosarcoma </li></ul><ul><ul><li>The cartilage calcification (ring-shape) inside the tumor </li></ul></ul>Calcification with bone/cartilage Basic X-ray signs
    51. 52. chondrosarcoma
    52. 53. <ul><li>Calcification after hematoma </li></ul><ul><ul><li>Left shoulder surrounded by massive irregular high density shadow </li></ul></ul>Calcification with bone/cartilage Basic X-ray signs
    53. 54. Bone necrosis Basic X-ray signs <ul><li>Definition : </li></ul><ul><ul><li>The death of bone tissue caused by gradual vascular impairment </li></ul></ul><ul><ul><li>ceasation of metabolism of local bone tissue </li></ul></ul><ul><li>X-ray appearance : </li></ul><ul><ul><li>Sequestrum – fragment of dense/necrotic bone be separated , the X-ray density “ high ” (sequestrum is normal density , cause by the surrounding bone osteoporosis) </li></ul></ul><ul><li>Etiology : </li></ul><ul><ul><li>Inflammation or granuloma (chronic) </li></ul></ul><ul><ul><li>Trauma & fracture </li></ul></ul>
    54. 55. <ul><li>Femoral capital epiphysis </li></ul><ul><ul><li>Slightly increased density of the epiphysis </li></ul></ul><ul><ul><li>The epiphysis becomed fragment and flattened </li></ul></ul><ul><ul><li>Osteoporosis of the neighbouring part of the femur </li></ul></ul>Bone necrosis Basic X-ray signs
    55. 56. <ul><li>Chronic osteomyelitis </li></ul><ul><ul><li>Osteosclerosis of the bone between the areas of destruction </li></ul></ul><ul><ul><li>The separated “ high ” density fragments against the surrounding osteo-translucency zone </li></ul></ul><ul><ul><li>Sequestra – lost blood supply and then the calcium content remain intact </li></ul></ul>Bone necrosis Basic X-ray signs
    56. 57. Mineral sedimentation Basic X-ray signs <ul><li>X-ray appearance : </li></ul><ul><ul><li>Mineral material , (lead , phosphorus , et al.) excessive sedimentation in bone </li></ul></ul><ul><ul><ul><li>Dense bands at metaphyseal end </li></ul></ul></ul><ul><ul><li>High concentrations of fluorine compounds </li></ul></ul><ul><ul><ul><li>Stimulates endosteal & periosteal osteoblastic activity and bone formation </li></ul></ul></ul>
    57. 58. <ul><li>Skeletal fluorosis </li></ul><ul><ul><li>The lumbar spine and pelvis increased bone density </li></ul></ul>Mineral sedimentation Basic X-ray signs
    58. 59. Deformity of bone Basic X-ray signs <ul><li>May be localized or generalized </li></ul>
    59. 60. <ul><li>Multiple exostoses </li></ul>Deformity of bone Basic X-ray signs <ul><li>Enlongated finger </li></ul>
    60. 61. Soft tissue abnormalities Basic X-ray signs <ul><li>May cause by trauma / tumor </li></ul><ul><li>/ infection …… </li></ul>
    61. 63. Basic X-ray signs <ul><li>Osteoporosis </li></ul><ul><li>Osteomalacia </li></ul><ul><li>Bone destruction </li></ul><ul><li>Osteosclerosis </li></ul><ul><li>Periosteal reaction </li></ul><ul><ul><li>Calcification </li></ul></ul><ul><ul><li>Bone necrosis </li></ul></ul><ul><ul><li>Mineral sedimentation </li></ul></ul><ul><ul><li>Bone deformity </li></ul></ul><ul><ul><li>Soft tissue abnormalities </li></ul></ul>Musculoskeletal system Bone Joint <ul><li>Joint swellen </li></ul><ul><li>Joint dislocation </li></ul><ul><li>Joint degeneration </li></ul><ul><ul><li>Joint destruction </li></ul></ul><ul><ul><li>Joint bony/fibrous ankylosis </li></ul></ul>
    62. 64. Joint destruction <ul><li>Cartilage destruction – joint space narrowing </li></ul><ul><li>Cortex destruction – bone destruction & impairment, may cause subluxation / deformity </li></ul>
    63. 65. Joint ankylosis <ul><li>Joint bony / fibrous ankylosis </li></ul>
    64. 66. Joint dislocation The displacement of the any body part from its normal position
    65. 68. MUSCULOSKELETAL RADIOLOGY TRAUMA Sun Yat-sen Memorial Hospital SYSU Dr. BILING LIANG
    66. 69. <ul><li>Fracture : complete or inconplete break in the continuity of bone or cartilage , this requires a loading force applied to bone </li></ul><ul><ul><li>Traumatic fracture </li></ul></ul><ul><ul><li>Stress fracture </li></ul></ul><ul><ul><li>Pathologic fracture </li></ul></ul><ul><li>May acompany severe soft tissue torn / bleeding / important organ torn </li></ul>Fracture & dislocation Trauma
    67. 70. <ul><li>Purpose of Radiology </li></ul><ul><ul><li>Evaluated fracture / dislocation </li></ul></ul><ul><ul><ul><li>position </li></ul></ul></ul><ul><ul><ul><li>Apposition </li></ul></ul></ul><ul><ul><ul><ul><li>Anatomical apposition </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Displacement </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Lack of apposition </li></ul></ul></ul></ul><ul><ul><ul><li>Alignmemt </li></ul></ul></ul><ul><ul><ul><li>Rotation </li></ul></ul></ul><ul><ul><li>The result of reduction </li></ul></ul><ul><ul><li>Healing of fracture & callus formation </li></ul></ul><ul><ul><ul><li>Un-union & delayed union </li></ul></ul></ul><ul><ul><ul><li>Infection </li></ul></ul></ul><ul><ul><ul><li>Ossificatory myositis </li></ul></ul></ul><ul><li>Imagine technique </li></ul><ul><ul><li>X-ray </li></ul></ul><ul><ul><li>CT </li></ul></ul><ul><ul><li>MRI </li></ul></ul><ul><ul><li>US </li></ul></ul><ul><ul><li>SCINTIGRAPHY </li></ul></ul>fracture & dislocation Trauma The state of contact of the fracture fracgment ends The relationship of the long axes of the fracture fragments
    68. 71. <ul><li>X-ray : </li></ul><ul><ul><li>Fracture line : the break of bone shows a irregular translucent line (separated – translucent </li></ul></ul><ul><ul><li>overlap - dense) </li></ul></ul><ul><ul><ul><li>Transverse fracture / oblique fracture / spiral fracture </li></ul></ul></ul><ul><ul><ul><li>Compression / crush fracture </li></ul></ul></ul><ul><ul><ul><li>Comminution fracture ( > 2) / segmental fracture </li></ul></ul></ul><ul><ul><li>Incomplete fracture : </li></ul></ul><ul><ul><li>Fracture in children </li></ul></ul><ul><ul><ul><li>Greenstick fracture : </li></ul></ul></ul><ul><ul><ul><li>Epiphyseal separation </li></ul></ul></ul>fracture & dislocation Trauma
    69. 72. <ul><li>The fracture types </li></ul>Fracture & dislocation Trauma spiral fracture Transverse fracture Compressive fracture Comminution fracture oblique fracture
    70. 73. <ul><li>The distal third of the tibia & fibula Comminution fracture </li></ul>Fracture & dislocation Trauma
    71. 74. <ul><li>X-ray : </li></ul><ul><ul><li>Fracture line : the break of bone shows a irregular translucent line </li></ul></ul><ul><ul><ul><li>Transverse fracture / oblique fracture / spiral fracture </li></ul></ul></ul><ul><ul><ul><li>Comprese fracture </li></ul></ul></ul><ul><ul><ul><li>Comminution fracture ( > 2) / segmental fracture </li></ul></ul></ul><ul><ul><li>Incomplete fracture : </li></ul></ul><ul><ul><li>Fracture in children </li></ul></ul><ul><ul><ul><li>Greenstick fracture : </li></ul></ul></ul><ul><ul><ul><li>Epiphyseal separation </li></ul></ul></ul>fracture & dislocation Trauma angling or buckling of the cortex without the lucent fracture line Epiphysis & cartilage plate separated from the metaphysis
    72. 75. <ul><li>Linear fracture of the skull </li></ul>Fracture & dislocation Trauma
    73. 76. Healing of fracture & callus formation Acute phase 2W 2M
    74. 77. <ul><li>Lower humerus fracture – deformity of union </li></ul>Fracture & dislocation Trauma
    75. 78. <ul><li>Middle tibia & fibela fracture – deformity of union </li></ul>Fracture & dislocation Trauma Apposition Alignmemt
    76. 79. <ul><ul><ul><li>Un-union & delayed union </li></ul></ul></ul>Fracture & dislocation Trauma
    77. 80. <ul><li>Hip dislocation </li></ul>Fracture & dislocation Trauma <ul><li>Elbow dislocation </li></ul>
    78. 81. <ul><li>Colles ’ fracture </li></ul><ul><ul><li>A transverse fracture through the distal radius </li></ul></ul><ul><ul><li>With dorsal displacement & angulation of the distal radial fragment </li></ul></ul><ul><ul><li>Malalignment as “ silver fork ” deformity </li></ul></ul><ul><ul><li>The ulnar styloid is often detached </li></ul></ul>Fracture & dislocation Trauma
    79. 82. <ul><li>Epicondylar fracture of humerus </li></ul><ul><ul><li>A transverse fracture above the condyles of the humerus </li></ul></ul>Fracture & dislocation Trauma
    80. 83. <ul><li>Epicondylar fracture of humerus </li></ul><ul><ul><li>A transverse fracture above the condyles of the humerus </li></ul></ul>Fracture & dislocation Trauma
    81. 84. <ul><li>Compression / wedge fracture </li></ul>Fracture & dislocation Trauma
    82. 85. <ul><li>Compression / wedge fracture </li></ul>Fracture & dislocation Trauma
    83. 87. <ul><li>Normal intervertebral disc </li></ul>Protrusion of the intervertebral disc (discal herniation) Annulus fibrosis Nucleus pulposus
    84. 88. Protrusion of the intervertebral disc (discal herniation) <ul><li>Normal intervertebral disc </li></ul>Annulus fibrosis Nucleus pulposus Vertebral end plate Stablilize the spine
    85. 89. <ul><li>CT : normal intervertebral disc </li></ul>Protrusion of the intervertebral disc (discal herniation)
    86. 90. Protrusion of the intervertebral disc (discal herniation) bulge protrusion
    87. 91. <ul><li>disc herniation </li></ul>Protrusion of the intervertebral disc (discal herniation) Space occupying lesion
    88. 92. Disc herniation MRI normal
    89. 93. <ul><li>Schmorl ’ s nodule </li></ul>Protrusion of the intervertebral disc (discal herniation) Annulus fibrosis Nucleus pulposus protruded into the end plate – form the Schmorl ’ s nodule
    90. 94. Thank you

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