Radiographic examination is the key to the diagnosis of many skeletal abnormalities. It is essential that each bone be examined in its entirety, including the cortex, medullary canal (cancellous bone or spongiosa), and articular ends. The position and alignment of joints are determined. In children, the epiphysis and epiphyseal line or physis must be observed. The adjacent soft tissues are examined.
Obliteration of normal soft-tissue lines and the presence of a joint effusion are of particular importance. When disease is present, it is important to determine whether the process is limited to a single bone or joint or whether multiple bones or joints are involved. The distribution of disease is also a consideration. The presence and type of bone destruction and bone production, the appearance of the edges or borders of the lesion, and the presence or absence of cortical expansion and periosteal reaction are also noted. The radiographic findings are then correlated with the clinical history and the age and sex of the patient to arrive at a logical diagnosis. The diagnosis may be firm in some instances; in other cases, a differential diagnosis is offered because the exact diagnosis cannot be determined.
[...] SKELETAL GROWTH AND MATURATION Ossification of the Skeleton The process of bone formation in cartilage, known as endochondral ossification, causes bones to grow in length. Some bones are formed in membrane by a process known as membranous bone formation; the bones of the cranial vault are the principal example. Ossification occurs in both cartilage and membrane in the mandible and clavicle. The tubular bones grow in transverse diameter by bone formation within the osteogenic cells of the inner layer of the periosteum. [...]
[...] The soft-tissue window setting allows visualization of surrounding soft tissue but is suboptimal for the bony skeleton MAGNETIC RESONANCE IMAGING MRI is of great value in the evaluation of the skeletal system, particularly in the detection and evaluation of joint disorders, tumors, infection, bone infarction, and ischemic necrosis. Because the image is dependent on the presence of hydrogen, which is abundant in marrow fat, MRI visualizes the bone marrow exquisitely. However, the hydrogen content of cortical bone is very low, and MRI therefore is not as sensitive as CT for the evaluation of cortical bone. [...]
[...] Childhood diseases and disorders that cause growth abnormalities produce differences between bone age and chronologic age. Deficiencies of thyroid and growth hormones cause the most severe degree of bone age retardation. Conditions such as thyrotoxicosis, sexual precocity, and even simple exogenous obesity advance bone age. The most well known and widely accepted method of determining skeletal bone age or skeletal maturation is that of Greulich and Pyle, described in their book, Radiographic Atlas of Skeletal Development of the Hand and Wrist. [...]
[...] Disturbance in Skeletal Growth and Maturation The relation of the endocrine glands to skeletal growth and maturation is very important. Roentgen examination of the growing skeleton may yield valuable information concerning thyroid, pituitary, and gonadal disturbances. Delay in appearance or fusion or retardation of epiphyseal centers may result from deficient secretion by one or more of these glands, and hypersecretion may accelerate these processes. Acceleration or deceleration of growth may be generalized and may involve all ossification centers, or it may be focal and limited to one ossification center. [...]
[...] In girls, there may be precocious sexual development, rapid skeletal growth, and early fusion of the epiphyses; as a result, female patients usually show some degree of dwarfism. These changes usually do not occur in boys. Granulosa Cell Tumor of the Ovary. Granulosa cell tumor of the ovary causes precocious puberty, and the skeletal system responds by early closure of the epiphyses. Hyperfunction of the Adrenal Cortex in Childhood. Hyperfunction of the adrenal cortex may affect patients of either sex. [...]
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