Diagram showing the growth plate fracture types according to the classification by Salter and Harris from Wikipedia. Growth plate fracture with involvement of metaphysis and epiphyis Salter-Harris type IV. Dislocation and Subluxation When the range of normal relationships for a particular joint is slightly exceeded, it is called a subluxation.
When it is grossly exceeded, and the articulating structures are not in contact any more, it is called a dislocation. Joints most frequently affected by a luxation are shoulder, elbow, ankle, hip, and interphalangeal joints. Luxation will usually cause capsule and ligament disruption with soft tissue swelling and loss of fat planes. Associated avulsion fractures are frequently seen. As in fracture imaging exposure in two perpendicular planes are required to correctly visualize and describe a luxation or dislocated fracture.
A Complete dislocation with contraction in the elbow joint.
Ulna and radius are both dislocated and dorsally displaced. Anterior and inferior dislocation of the humerus. Degenerative Joint disease Primary osteoarthritis involves weight bearing joints such as the knee, where changes are seen especially in the medial compartment and the patellofemoral compartment. In the hip changes are seen superolaterally. The tibiotalar joint is rarely significantly involved, except for changes along the anterior margin of the distal articular surface of the tibia.
These are most likely posttraumatic in origin. A Knee joint with degenerative changes.
Note the sclerotic medial tibial plateau and joint space narrowing. A small osteophyte is seen on the medial femoral condyle. Pelvis with marked degeneration of both hip joints. The right femoral head shows lateral osteophyte formation and is deformed. The joint space is narrow with increased subchondral sclerosis of the acetabular roof.
The left hip has a marked joint space narrowing and lateral osteophyte formation. The femoral head shows increased density due to sclerotic areas and irregularity. In the hand there is typically involvement of the trapezium-scaphoidal joint and the first carpal-metacarpal joint. In addition, there is involvement of the distal interphalangeal joints of the fingers with lesser changes at the proximal interphalangeal joints and the metacarpal-phalangeal joints.
Typical degenerative changes in the hand: A Joint space narrowing and subchondral sclerosis of the trapezoidum-scaphoidal joint and the first carpal-metacarpal joint. Degenerative arthritis of the distal interphalangeal joint showing typical osteophyte formation, joint space narrowing and increased sclerosis.
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In the foot there is often involvement of the first metatarsal-phalangeal joint. In addition to joint space narrowing and subchondral sclerosis there is subchondral degenerative cyst formation and osteophyte formation along joint margins. Osteophytes are the sine qua non of osteoarthritis. In degenerative joint disease new bone formation is seen as a response or repair reaction.
In inflammatory arthritis there usually is a destruction of bone and osteophytes are not seen. In the spine, changes are seen in the facet joints throughout and at the uncovertebral joints in the cervical region.
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Degenerative disc disease is also seen with associated osteophyte formation. The traction osteophytes of degenerative annular disease begin several millimeters from the edge of the vertebral body, and tend to be initially oriented horizontally at their attachment to the vertebral bodies. They then often curve slightly and may even form a complete bony bridge across the disc space.
Sacroiliac joint involvement is common. The sclerotic joint margins are sharply defined as opposed to changes seen in inflammatory arthritides. Degenerative osteoarthritis may be secondary to previous infection or trauma. In these cases there is more degenerative change in the particular joint than may be found in corresponding regions elsewhere in the body. Osteophytes can be normal volume prostate gland in both primary and secondary osteoarthritis. They can also be normal volume prostate gland at various entheses, often due to altered or increased stress at the entheses traction osteophytes.
Arthritis Rheumatoid arthritis Rheumatoid arthritis may involve any synovial joint. The sacroiliac joints are involved only infrequently. The greatest involvement is in the small joints of the hands, wrists and feet with sparing of the distal interphalangeal joints. In early stages there may be only soft tissue swelling and juxta-articular osteoporosis.
Next joint space narrowing and early erosive changes are seen. In general, the presence of erosions bespeaks some type of inflammatory disease, whether the erosions are due to synovial hypertrophy, crystalline deposits, or infection.
In rheumatoid arthritis, the erosions follow the development of an inflammatory proliferation of the synovium, called pannus. As this pannus increases in amount, it begins to cause erosions of the chondral surface.
As the pannus increases further in amount, one begins to see erosions at the periarticular "bare" areas. These "bare" areas refer to bone within the synovial space which is not covered by articular cartilage.
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The articular cartilage tends to protect the bone that it covers. The marginal "bare" areas are not covered by cartilage, and the earliest erosions of rheumatoid arthritis are seen here.
Rheumatoid arthritis. A Early erosive changes are seen at the bare areas of the second and thirs metacarpal-pahalangeal joint. In a patient with long standing rheumatoid arthritis marked destruction of carpal bones and styloid process has occurred. Rheumatoid arthritis also involves the cervical spine, with apophyseal joint erosion and malalignment, intervertebral disc space narrowing with endplate sclerosis and without osteophytes, normal volume prostate gland with multiple subluxations, especially at the atlanto-axial junction.
Abnormalities of the thoracolumbar spine and sacroiliac joints are infrequent and less prominent than those of ankylosing spondylitis. Ankylosing Spondylitis Ankylosing spondylitis affects synovial and cartilaginous joints as well as sites of tendon and ligament attachment to bone entheses. An overwhelming predilection exists for involvement of the axial skeleton, especially the sacroiliac, apophyseal, discovertebral, and costovertebral articulations.
Early in ankylosing spondylitis there is sacroiliac joint involvement with prosztatitis eszközei of the joint margins and some normal volume prostate gland sclerosis. Then changes appear at the thoracolumbar and lumbosacral junctions. Therefore, sacroiliitis is the hallmark of ankylosing spondylitis. Although an asymmetric or unilateral distribution can be evident on initial radiographic examination, roentgenographic changes at later stages of the disease are almost invariably bilateral and symmetric in distribution.
This symmetric pattern is an important diagnostic clue in this disease and may permit it differentiation from other disorders that affect the sacroiliac articulation, such as Normal volume prostate gland, psoriasis, Reiter's syndrome, and infection. Changes in the SI joint occur in both the synovial and ligamentous superior portions, and predominate on the iliac side.
Inflammatory synovial changes and subchondral edema are well seen on MRI. MRI is more sensitive and is being used with increased frequency to detect and stage inflammatory nvolvement of the sacroiliac joint in patients with ankylosing spondylitis.
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T1 weighted and STIR images of the sacroiliac joints in a young patient with low back pain. Note the joint space narrowing and the more pronounced subchondral changes in the iliac bone as compared to the sacrum. There is squaring of the vertebral bodies and syndesmophyte formation.
Osteoporosis is generally prominent. Syndesmophytes are generally seen only in the seronegative spondyloarthropathies. These are due to inflammation and ossification of the outer fibers of the annulus fibrosus, known as the Sharpey's fibers.
This is classically seen in ankylosing spondylitis. In the other seronegative spondyloarthropathies, one usually sees paravertebral ossification, which forms in the paravertebral connective tissue at some distance from the spine.
Psoriatic arthritis While many of the changes are similar to those seen in rheumatoid arthritis, the changes in psoriatic arthritis are not always symmetrical. There is greater involvement of the distal interphalangeal joints and joint fusion occurs with higher frequency. Sacroiliac joint involvement may be bilateral or unilateral. Radiographic sacroiliac joint changes include erosions and sclerosis, predominantly on the iliac side, and widening of the articular space.