self made

1. Dr (Major) Parthasarathy S
Junior Resident,MS Orthopaedics
Stanley Medical College,Chennai
Ref: Chapman’s orthopaedic surgery 3rd
edn
Apley’s system of orthopaedics and
fractures 9th
edn
Davidson’s textbook of medicine
Harshmohan textbook of pathology

3.  Osteitis deformans
 Disturbance in rate of bone turn over
 Initiated by early increase in bone
resorption(osteoclasts)
 Excessive & pathologic bone
formation(osteoblast)
 Result
 Distorted bone
 Thick cortex
 Coarse rabeculations
 Immature woven appearance

4. Can affect any bone
Commonly affects
Pelvis & tibia (commonest)
Femur
Spine 75%
 Lumbar common
 Cervical rare
Cranium
Monostotic or polyostotic
Symtomatic or asymptomatic

5.  Unknown
 Familial clustering
 14%-30% + family history
 Autosomal dominant
 Some HLA correlation
 ? Viral etiology –Rebel et al 1980
 Inclusion bodies resembling nuclear
capsule(osteoclast)
 Resembles paramyxo/measles virus

6.  D/D
 Familial expansile osteolysis
 Expansile skeletal hyperphosphatasia
 Idiopathic hyperphosphatasia
 Early onset PDB

7.  3:2 sex ratio M:F
 >50 yrs
 3-4% >45yrs / 8% >80yrs prevalence in USA
 Common in Europe(north> south)/North
America/Australia/Newzealand
 Uncommon in Asians

8.  Starts at one end & progresses leaving a trail
of altered architecture
 Tends to start at muscle insertion points on
bone
 Marked increase in osteoclast & osteoblast
activity

9. Burned out pattern

13.  Steal syndrome –blood diverted from vital
organs to skeletal circulation
 Cerebral impairement
 Spinal cord ischaemia

14.  Asymptomatic 10-20%
 Bone pain
 Rest
 Motion
 Warmth of bone/skin over bone
 Back pain
 Spinal stenosis
 Compression #
 Paraplegia -secondary GCT
 Skull size increased
 Hearing loss(otosclerosis)

16.  Long bones bend
 Tibia –Ant
 Femur – Antlateral
 Kyphosis
 Becomes shorter
 Ape like
 Arms hanging infront
 Cranial nerve/spinal cord/nerve root
compression
 Pathological #
 Cardiac failure-high output

19.  Pathological #
 10% patients
 most common complication
 Femur tibia forearm
 Nonunion common
 Femoral neck/subtrochanteric #
 75-90% non-union rate
 With these exceptions # heals by abundant callus
 Secondary sarcoma # 5-20%
 Short/oblique/transverse
 Delayed/non-union-common in burned out phase

20.  2-4% in symptomatic
 0.1% overall
 Humerus –common site for malignant change
 Benign tumor
 GCT
 Sensitive to steroid therapy
 Malignant
 Osteogenic sarcoma(poor prognosis)
 Fibrosarcoma
 chondrosarcoma

23.  Signs
 More painful/tender/swollen
 New pain
 New site
 New Lytic area in sclerotic bone

25.  OA-atrophic
 Nerve compression
 High output cardiac failure
 Hypercalcemia

26.  Lab
 Serum Ca normal
 Serum phosphorous normal
 Hypercalcemia(immobilised patients)
 Serum ALP increased(osteoblast)
 90% cases
 May be normal-single bone
 24 hour urinary hydroxyproline & N
Telopeptide(osteoclast)
 Serum Pyridinoline increased

27.  X rays
 Transverse lucencies/pseudofractures
On the convex surface of weight bearing bone
 Focal bone resorption
 Disorded trabecular pattern
 Expanded bone
 Cortex thick
 Flame shaped/blade of grass osteolytic wedge
 sclerosis
 Pathological #

29.  Skull
 Circumscribed patch of osteoporosis in skull
 Osteoporosis circumscripta
 Cotton wool appearance
 Mixed
 Diploic widening
 Tam o'Shanter sign
 frontal bone enlargement, with the appearance of the
skull falling over the facial bones, like a Tam o'
Shanter hat

33.  Spine
 Picture frame sign
 Ivory vertebra
 Squaring on lateral view
 Vertical trabecular thickening

36.  A banana fracture
 Complete
 horizontally oriented pathological fracture
 seen in deformed bones affected
 incremental fractures
 A type of insufficiency fracture.

38.  Gallium bone scan
 Extent
 Tumor differentiation

39.  Biopsy
 Definitive
 Rarely indicated
 only when malignant transformation is suspected

40.  Asymptomatic
 Who do not have disease in weight bearing bone
 Periodic monitoring
 Symptomatic
 Pain
 Neurologic deficit
 Surgery
 Cardiac failure
 Severe polyostotic
 ALP/bone marker elevated twice normal with
disease in weight bearing bone

41.  Biphosphonates
 Preferred
 Inhibit bone resorption
 Bind to hydroxyapatite crystals
 prolonged remission
 Ca & Vit D given along(Osteomalacia)

42.  Calcitonin
 Decrease number & activity of osteoclast
 Daily dose till pain controlled & ALP reduced &
stabilised
 Maintenance once/twice weekly
 Injection/nasal spray
 Dry nares 2%

45.  Mithramycin
 Extremely cytotoxic
 Strong inhibitor of
 Osteoblast
 Osteoclast
 Recommended only in Paget’s paraplegia
 15mg/kg/day for 10days
 Osteotomy to treat deformity

46.  Fracture
 NOF
 Prosthetic replacement
 Subtrochateric femur
 Intramedullary system
 Corrective osteotomy
 Most pathological long bone #
 Intramedullary system
 Even after union protective bracing for 3-6
months
 Because remodelling is slow

48.  Severe disabling arthritis
 THR
 Significant varus deformity
 Bowing
 Acetabular protrusion
 Increased blood loss
 Distorted medullary cavity
 Sclerosis
 Heterotrophic ossification