Musculoskeletal X-Rays for Medical Students and Trainees

Dr Andrew Brown is a Consultant Rheumatologist and Senior Lecturer in Medical Education at Hull York Medical School, and as such is involved in all aspects of undergraduate and postgraduate education with an emphasis on his clinical discipline of musculoskeletal medicine. Dr David King is a Consultant Musculoskeletal Radiologist based at The York Teaching Hospital. He teaches musculoskeletal radiology to medical students, trainees in radiology, orhopaedics and emergency medicine, as well as professionals allied to medicine.

Preface, vii

Acknowledgements, viii

Part 1: Introduction, 1

1 Musculoskeletal X-rays, 3

Introduction, 3

Basic principles of requesting plain radiographs of bones and joints, 4

Basic principles of examining and reporting plain radiographs of bones and joints, 6

Normal anatomy on musculoskeletal X-rays, 8

Part 2: Pathology, 21

2 Trauma, 23

Bone and joint injuries, 23

Specific injuries, 41

Spine, 58

Paediatric fractures, 67

Fractures in child abuse, 73

Further reading, 76

3 Arthritis, 77

Osteoarthritis, 77

Rheumatoid arthritis, 80

Crystal arthropathy, 83

Gout, 83

Calcium pyrophosphate disease, 86

Psoriatic arthritis, 91

Axial spondyloarthritis (ankylosing spondylitis), 95

4 Tumours and tumour-like lesions, 98

Radiological evaluation of the patient, 98

X-rays – general principles, 101

Malignant tumours, 105

Bone metastases, 105

Multiple myeloma, 107

Plasmacytoma, 108

Osteosarcoma, 110

Chondrosarcoma, 111

Ewing’s sarcoma, 113

Benign tumours, 114

Exostosis (Osteochondroma), 115

Osteoid osteoma, 116

Tumour-like lesions, 117

Simple bone cyst, 118

Infection, 119

5 Metabolic bone disease, 120

Osteoporosis, 120

Osteomalacia, 121

Hyperparathyroidism, 122

Chronic kidney disease metabolic bone disorder, 124

Haemochromatosis, 126

6 Infection, 128

Routes of spread, 128

Causative organisms, 128

Osteomyelitis, 129

Septic arthritis, 134

Infective discitis, 136

7 Non-traumatic paediatric conditions, 138

Developmental dysplasia of the hip, 138

Perthes’ disease, 140

Tarsal coalition, 141

Osteochondritis dissecans, 143

8 Other bone pathology, 144

Paget’s disease of bone, 144

Hypertrophic Osteoarthropathy (HOA), 147

Avascular necrosis, 147

9 Joint replacement, 149

Hardware failure and aseptic loosening, 149

Infection, 154

Malalignment and instability, 155

Periprosthetic fracture, 156

Part 3, 157

Self-assessment questions, 159

Self-assessment answers, 172

Index, 185