Bone Tumors and Fractures

Bone Tumors and Bone Tumors and FracturesFractures

Stacy FieldingStacy Fielding

Primary Bone TumorsPrimary Bone Tumors OSA, CSA, FSAOSA, CSA, FSA SolitarySolitary Metaphyseal locationMetaphyseal location

Long bonesLong bones Rich blood supplyRich blood supply

““Away from elbow, toward Away from elbow, toward the knee”the knee”

Late stage diseaseLate stage disease Invade adjacent bonesInvade adjacent bones Cross jointsCross joints Adjacent parenchymal organsAdjacent parenchymal organs

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Primary Bone TumorsPrimary Bone Tumors AppearanceAppearance

LysisLysis SclerosisSclerosis MixedMixed

Periosteal reactionsPeriosteal reactions Spiculated & fuzzy= Spiculated & fuzzy=

activeactive Smooth & sharp = Smooth & sharp =

inactiveinactive Amorphous = aggressiveAmorphous = aggressive Codman’s triangle Codman’s triangle >>

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Primary Bone TumorsPrimary Bone Tumors Ddx:Ddx:

Fungal osteomyelitisFungal osteomyelitis Bacterial osteomyelitisBacterial osteomyelitis

Consider signalment, Consider signalment, history and clinical history and clinical signssigns

Biopsy to be sure!Biopsy to be sure!

coccidiomycosiscoccidiomycosiswww.veterinaryradiology.newww.veterinaryradiology.nett

Metastatic Bone TumorsMetastatic Bone Tumors Tumors that spread to Tumors that spread to

bone:bone: mammarymammary lunglung liverliver thyroidthyroid prostateprostate

Metastatic Bone TumorsMetastatic Bone Tumors Locations:Locations:

metaphysis OR diaphysismetaphysis OR diaphysis vertebrae, ribs, femur, vertebrae, ribs, femur,

humerushumerus Appearance:Appearance:

Similar to primary bone Similar to primary bone tumortumor

Ddx:Ddx: Fungal osteomyelitisFungal osteomyelitis Bacterial osteomyelitisBacterial osteomyelitis HepatozoonosisHepatozoonosis

Approach to FracturesApproach to Fractures Describe direction & locationDescribe direction & location Assess soft tissues Assess soft tissues

open vs. closedopen vs. closed foreign bodyforeign body swellingswelling atrophyatrophy

Joint involvement Joint involvement intra-articular fragmentsintra-articular fragments

Positional changes Positional changes name distal fragment relative to proximalname distal fragment relative to proximal

Look carefully!Look carefully!

Images courtesy of Dr. PackImages courtesy of Dr. Pack

Fracture TypesFracture Types CompleteComplete

Involves both corticesInvolves both cortices Ex) Transverse, oblique, Ex) Transverse, oblique,

spiralspiral Displacement, rotation Displacement, rotation Reduction may be neededReduction may be needed

Incomplete (greenstick)Incomplete (greenstick) One cortex involvedOne cortex involved Bending forceBending force Does not over-rideDoes not over-ride BendingBending

Stress microfracture, fissureStress microfracture, fissure

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Fracture types – cont’dFracture types – cont’d CondylarCondylar

Distal humerus, femur, proximal tibia,Distal humerus, femur, proximal tibia, Medial or lateralMedial or lateral Supracondylar = both fracturedSupracondylar = both fractured V, Y, T = condyles fracture from shaft and each otherV, Y, T = condyles fracture from shaft and each other

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Fracture types – cont’dFracture types – cont’d DepressionDepression

Sinuses or skullSinuses or skull Multiple fissure lines Multiple fissure lines

join and bone collapsesjoin and bone collapses Lucent or sclerotic lineLucent or sclerotic line

AvulsionAvulsion Forceful pull or muscle Forceful pull or muscle

tractiontraction ApophysesApophyses +/- bone segment+/- bone segment

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*Comminuted vs. Multiple*Comminuted vs. Multiple ComminutedComminuted

≥≥33 fracture lines meeting fracture lines meeting at a at a singlesingle pointpoint

High energy traumaHigh energy trauma Butterfly fragmentsButterfly fragments

Multiple/segmentalMultiple/segmental ≥≥3 fracture lines 3 fracture lines not not

meeting at a single pointmeeting at a single point Independent of each Independent of each

otherother

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*Compression vs. Impaction*Compression vs. Impaction CompressionCompression

Crushing injuryCrushing injury Cancellous bone collapsesCancellous bone collapses

Common in vertebraeCommon in vertebrae Shortened bone lengthShortened bone length

ImpactionImpaction Fragment of bone driven Fragment of bone driven

into cancellous boneinto cancellous bone End of long bonesEnd of long bones UncommonUncommon

Salter-HarrisSalter-Harris

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