Osteochondritis

INTRODUCTION:
  • Frieberg’s disease - Head of 2nd and 3rd metatarsal
  • Perthes disease - Osteochondritis of femoral head & Hip, Presents at 5 – 10 years of age & Management is conservative 
  • Kienbock disease - Lunate bone
  • Kohler’s disease - Navicular bone
Osgood-Schlatter disease
  • Osgood schlatter disease is osteochondritis of Tibial tuberosisty
  • It is a common cause of knee pain in growing adolescents. It is an inflammation of the area just below the knee where the tendon from the kneecap (patellar tendon) attaches to the shinbone (tibia)
  •  Locking of knee joint can be caused by Osgood shalter Calves vertebral 
compressin (vertebra plana;vertebral osteochondritis):
  • Whereas in scheuermann’s disease it is the vertebral ring epiphyses that are affected,calve’s disease affects the central bony nucleus of a vertebral body .it is generally confined to a single vertebra.it is uncommon.
CLINICAL FEATURES:
  • The affection occurs in children of 2-10 years of age.The complaint is of pain ,usually in the thoracioc region of the spine .

On examination:
  • There may be slight localised kyphosis .Percussion of the spinal column reveals deep tenderness in the affected region . Movement of the spine as a whole are impaired little ,if at all.
Radiographic features:
  1.  Raidiographs show the characteristic extreme flattening of the affected vertebral body,which appears greatly increased in density 
TREATMENT:
  • Calve’s disease is non progressive, and in practice treatment is required only for as long as the symptoms last. 
  • If pain is severe the child should be kept recumbent in bed, but in most case he may safely resume an active life without external support within a few weeks.
Osteochondritis dissecans of the elbow (general descriptions of osteochondritis of dissecans)
  • After the knee, the elbow is the most frequent site of osteochondritis dissecans.
  • The disorder is charecterised by necrosis of part of the articular cartilage & of the underline bone,with eventual seperation of the fragment to form an intra articular loose body
ETIOLOGY:
  • The precise cause is unknown.
  • Impairment of blood supply to the affected segment of bone & cartilage by thrombosis of an end artery has been suggested. 
  • Injury probably plays a part

CLINICAL FEATURES:

  • In the early stage ,before the fragment has seperated,the symptoms are those of mild mechanical irritation of the joint-namely, aching after use and intermittent swelling (from fluid effusion).
  • When a loose body has separate,the main features are recurrent sudden painfull locking of the elbow & subsequent effusion of fluid
IMAGING:
  • Plain radiographs in the early stages show an area of irregularity on the affected subchondral bone,usually of the capitulum. Later a shallow cavity,whose margins are demarcated clearly from the bone within it.eventually the bony fragment separated from the cavity and lies free within the joint,usually in the lateral compartment.
  • MR scanning in the earlier stages of the disease may be valuable in determining the possibilty of operative treatment prior to separation of the bony fragment.
Treatment:
  • If the fragment is small and cartilage is ripe fragment is then removed. 
  • If the fragment is large and is identified prior to separation it may be fixed in place with a fine screw or pin until fixation to the underling bone occurs.
KIENBOCK’S DISEASE (Osteochondritis of the lunate bone):
  • Kienbock’s disease is an uncommon affection of the lunate bone characterised by temporary softening,fragmentation,and liability to deformation .
  • It tends to predispose to the later development of osteochondritis of the wrist.
Clinical features:
  • There is pain in the wrist ,most marked at the centre of the joint over the lunate area.the pain is worse during active use of the wrist . Because of the pain ,the strength of grip is impaired.
  • On examination:
  1. There is discomfort on pressure over the lunate bone . An important sign is that movements of the wrist are substantially restricted and cause pain if forced.
Radiographs:
  • Early stages the lunate bone appears slightly more dense than the surrounding bones
  • Later,the bone has a fragmented appearance ,small areas of increased density being scattered through it,and the flattening of the bone becomes obvious. Later still signs of osteoarthritis of the wrist are evident
Treatment:
  • Earliest stage plaster for two or three months
  • If the wrist is free from arthritis it is probably best to excise the lunate bone and replace it with a metal prosthesis.
  • This probably gives better results than excision alone,without replacement but the long-term results are nevertheless uncertain.
  • In the late cases ,if severe osteoarthritis is already present,excision of the lunate bone is of no avail. 
  • Treatment should then be the same as for osteoarthritis of the wrist.
Legg-Calve-Perthes disease (also called coxa plana)
  • It is ischemic necrosis that leads to eventual flattening of the head of the femur caused by vascular interruption. It occurs in five stages: 
  1. Growth arres
  2. Subchondral fracture 
  3. Reabsorption/Fragmentation/Necrosis,
  4. Reossification/healing stage,
  5. Residual stage. It presents at 5–10 years of age. The child presents with pain in groin with limp. It can be diagnosed by an MRI. Management is conservative.
Exam Question of:
  • Kienbock's disease - lunate
  • Freiberg's disease is a recognised osteochondritis which affects Head of 2nd and 3rd Metatarsal
  • Perthe’s disease Osteochondritis of femoral head, Presents at 5 – 10 years of age & Management is conservative
  • Locking of knee joint can be caused by Osgood shalter 
  • Osgood schlatter disease is osteochondritis of Tibial tuberosisty
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