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Principles of Bone X-Ray Diagnosis - 2nd Edition - ISBN: 9781483167831, 9781483195315

Principles of Bone X-Ray Diagnosis

2nd Edition

Author: George Simon
eBook ISBN: 9781483195315
Imprint: Butterworth-Heinemann
Published Date: 1st January 1965
Page Count: 226
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Principles of Bone X-Ray Diagnosis follows the method set by Principles of Chest X-ray Diagnosis (Simon, 1956) in placing more value in the grouping of x-ray material according to the type of x-ray shadow rather than the clinical disease label. Biochemical and hematological values quoted throughout the book, especially in the captions to figures, are all from the Department of Pathology, St. Bartholomew's Hospital. This book is organized into 12 chapters. Much of the original text has been used in this third edition, though some changes of order have been made to give a more logical approach to the description of the bone changes seen in various diseases. A chapter on widespread and regional reduction in bone density has been completely rewritten. This volume provides radiographs to illustrate every condition described. These radiographs were selected to illustrate the principles of bone x-ray diagnosis rather than to make a complete catalogue of all the conditions referred. This book will be of interest to persons dealing with studies on the diagnostic value of bone x-ray.

Table of Contents

Preface to the Third Edition

Preface to the Second Edition



Definition of Terms

Chapter 1 Alterations in Bone Shape

Alterations in Length-Breadth Relationship

Short and Wide—Achondroplasia


Long and Thin—Osteogenesis Imperfecta (Fragilitas Ossium)

Muscular Paralysis

Exaggeration of Size—Acromegaly

Regional Alterations In Shape

Congenital Growth Defects

Regional Deformities due to Disease

Local Enlargement of the Bones of a Limb

Local Bony Protuberance


External Chondroma

Local Bone Deficiency

Collapse of a Single Vertebra

Vertebral Osteochondritis

Xanthomatous Deposit

Traumatic and Post-Traumatic Collapse

Vascular Lesion

Hydatid Cyst

Neoplastic Secondary Deposit

Neoplastic Secondary Deposit with Disc Intrusion

Benign Tumor

Developmental Defect

Inflammatory Lesion (Non-Tuberculous) with Collapse

Tuberculous Lesion with Vertebral Collapse

Paget's Disease

Spinal Osteoporosis with Collapse of a Single Vertebra

Deformity from Softening of the Bones

Triradiate Pelvis

Protrusio Acetabulae

Bowing of the Long Bones

Chapter 2 Alterations in the Position of a Bone

Congenital Elevation of the Scapulae

Depressed Sternum

Genu Valgum


Congenital Dislocation of the Hip

Displaced Patella

Congenital Vertical Talus

Hallux Valgus


Chapter 3 Abnormalities in the Region of the Epiphyses

Alteration in the Maturity of the Epiphyses

Acceleration of Epiphyseal Maturity

Retardation of Epiphyseal Maturity

Acceleration or Retardation of Epiphyseal Fusion

Generalized Abnormalities in the Region of the Epiphyses

Developmental Defects

Endocrine Epiphyseal Defects

Epiphyseal Disorders and Osteomalacia

Epiphyseal Disorders due to Enzyme Defect

Dietetic Epiphyseal Disorders with Osteoporosis

Metaphyseal Disorders from Heavy Metal Deposition

Delayed Growth

Abnormality of a Single Epiphyseal Region

Osteochondritis of the Femoral Head (Perthes' Disease)

Slipped Upper Femoral Epiphysis (Adolescent Coxa Vara)

Osteochondritis of the Tibial Tuberosity (Osgood-Schlatter Disease)

Osteochondritis of a Metatarsal Epiphysis

Osteochondritis of the Navicular (Köhler's Disease)

Osteochondritis of the Primary Center of a Vertebral Body

Osteochondritis of the Secondary Center of a Vertebral Body (Scheuermann's

Uncommon Sites of Epiphyseal Fragmentation (Osteochondritis, Epiphysitis)

Chapter 4 Increase in Bone Density

Generalized Increase In Bone Density

Developmental Osteopoikilosis




Secondary Deposits

Paget's Disease

Increase in Bone Density Confined to Metaphyseal Region

Heavy Metal Deposition

Renal Osteosclerosis and Hyperparathyroidism

Increase In Density of a Single Vertebra

Secondary Deposit of Carcinoma

Hodgkin's Disease

Paget's Disease

Local Vascular Disorder

Low-Grade Chronic Osteomyelitis

Benign Tumor or Developmental Defect

Primary Bone Sarcoma

Isolated Increase in Bone Density in a Limb Bone, Rib or Pelvis

Developmental Defect

Deep Bone Infarct

Healing Cyst

Avascular Necrosis or Osteochondritis

Secondary Deposit

Sclerosing Osteitis and Sarcoma

Condensans Ilii

Osteoid Osteoma

Isolated Increase In Density in the Skull or Facial Bones

Anatomical Variations

Hyperostosis Frontalis


Inflammatory Lesion

Secondary Deposit

Fibrous Dysplasia and Ossifying Fibroma

Leontiasis Ossea

Paget's Disease

Chapter 5 New Bone and Calcification outside the Cortex (Periosteal Shadow or Periostitis)

Post-Traumatic Periosteal Shadow

Infantile Non-Traumatic Cortical Hyperostosis

Non-Traumatic Haematoma

Stress, Fatigue and Pseudo-Fracture

Stress Fracture of a Metatarsal (March Fracture)

Stress or Fatigue (Pseudo-Fracture) of the Tibia in Children and Athletes

Stress Fracture of a Rib

Pseudo-Fracture (Looser Zone)

Post-Irradiation Fractures

Inflammatory Conditions

Pyogenic or Typhoid Bone Infections

Syphilitic Bone Lesions

Tuberculous Bone Lesions

Fungus Infections of Bone

Benign Neoplasm

Osteoid Osteoma

Malignant Neoplasm

Vascular Disorders

Varicose Veins and Arterial Occlusion

Pulmonary Osteoarthropathy

Associated with General Diseases

Idiopathic Hypertrophie Osteoarthropathy


Developmental Periosteal Bone Thickening

Melorheostosis (Leri)

Chapter 6 Widespread and Regional Reduction in Bone Density

Diagnostic Criteria and Techniques

Widespread Reduction in Bone Density

Mechanisms Leading to Reduction in Bone Density

Diseases Causing Widespread Reduction in Bone Density

Coarsened Trabecular Pattern Associated with Decrease in Bone Density


Haemoglobinopathy (Hereditary Abnormalities of Haemoglobin)

Alimentary Tract Disorders

Heritable Enzyme Defect

Paget's Disease

Patchy Decrease in Bone Density

Multiple Secondary Deposits from a Carcinoma

Multiple Myelomatosis

Old Age

Haemopoietic Diseases

Decreased Bone Density in One Region or Group or Bones

Spinal Under-Mineralization

Decrease In Bone Density in Part of a Limb due to Disuse or Sepsis

Post-Traumatic and Idiopathic Atrophy (Südeck)

Chapter 7 A Relatively Transradiant Area in a Bone


Well-Demarcated Transradiant Area within a Bone

Simple Cysts of Uncertain Aetiology

Osteitis Fibrosa Cystica in Hyperparathyroidism


Developmental Defects


Histiocyte and Non-Specific Granulomas

Histiocytosis (Gaucher's Disease)


Infective Conditions

Hydatid Cysts

Post-Traumatic Cyst-Like Transradiancy

Haemophilia with Haemorrhagic Bone Cyst

Cyst-Like Transradiancy in Association with Arthritis

Well-Demarcated Transradiant Area with Cortical Thinning and Gross Bone Expansion

Simple Cyst of Uncertain Origin

Hyperparathyroidism (Osteitis Fibrosa Cystica)

Developmental Defects



Well-Demarcated Erosion of the Surface of a Bone

Pressure Erosion

Developmental Defect and Implantation Dermoid


Urate Deposit

Rheumatoid Arthritis

Surface Absorption of the Tip of a Terminal Phalanx

Surface Erosion of the Articular Cortex—Osteochondritis Dissecans

Poorly-Demarcated Transradiant Area within the Bone

Malignant Neoplasm—Primary Bone or Secondary Deposit

Fibrous Dysplasia


Xanthomatous Granuloma

Tuberculous Lesion

Poorly-Demarcated Erosion of the Surface of a Bone Intercostal Arteries

Malignant Neoplasm

Xanthomatous Granuloma


A Transradiant Area in the Vault of the Skull

Anatomical Variations

Development Defects

Acquired Lesions

Response to an Intracranial Lesion

Direct Invasion from Scalp Neoplasm

Chapter 8 Combination of Shadows

Periosteal Opacity and Erosion

Pyogenic Inflammation

Tuberculous Inflammation


Fungus Infection

Cysts and Innocent Tumors

Malignant Neoplasm

Differential Diagnosis

Periosteal Shadow and Sclerosis

Low-Grade Chronic Osteomyelitis

Diaphyseal Dysplasia (Engelmann)

Osteoid Osteoma


Malignant Neoplasm

Periosteal Opacity with Erosion and Sclerosis

Chronic Osteomyelitis

Chronic Localized Bone Abscess

Osteoid Osteoma

Malignant Neoplasm

Chapter 9 Alterations in the Bone Architecture

Paget's Disease

Paget's Disease and Sarcoma of Bone

Chapter 10 Alterations in Joint Space (Arthritis) and Associated Bone Changes


The Diminished Joint Space

Associated Bone Changes

Difficulties of Classification

Arthritis of Known Cause

Pyogenic Arthritis (Septic Arthritis)

Gonococcal Arthritis

Virus Arthritis

Tuberculous Arthritis

Haemophilia with Arthritis (Hemorrhage into a Joint)

Arthritis of Unknown Cause

Classical Rheumatoid Arthritis

Unusual Manifestations of Rheumatoid Arthritis

Arthritis in Association with Other Diseases

Ankylosing Spondylitis (Rheumatoid Spondylitis—U.S.A.)

Arthritis of Partly-Known Origin


Intra-Articular Loose Bodies

Neuropathic Arthritis

Metabolic Defect with Arthritis

Narrowing of the Intervertebral Disc Spaces

Chapter 11 Some Hints on X-Ray Technique

Plain Radiographs

To Acquire Good Detail

To Acquire Good Contrast

Good Positioning

Measurement of Bone Length


Selection and Spacing of Layers

Simultaneous Multisection Tomography

Value of Tomography

Injection of Sinuses

Avoidance of Excessive Radiation

Chapter 12 Bone in Unusual Sites and Calcifications in or near a Joint

Bone in Muscles and Tendons

Myositis Ossificans

Ossification in a Tendon

Calcifications in Structures in or near a Joint

Calcification in a Joint Cartilage

Calcification in a Joint Capsule

Calcification in or near a Joint Ligament

Calcification in or near the Supraspinatus Tendon

Calcifications near The Finger Joints

Calcification in Tuberculous Synovitis

Calcification in a Bursa Over a Joint or a Synovial Cyst

Calcifications in Tumors near Bone

Calcification or Ossification in a Joint

Calcifications in Muscles

Appendix—Additional Tables




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© Butterworth-Heinemann 1965
1st January 1965
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About the Author

George Simon

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