13: Osteochondrosis - Bennett Flashcards
general features of osteochondroses
middle years of growth
boys more than girls
lower limbs
15% bilateral
a group of conditions in which the primary or secondary center of ossification undergo aseptic necrosis
osteochondroses
freiberg disease ***
avascular necrosis of metatarsal head
13-18 female
unilateral
second met 68%, third met 27%
ddx: stress fx, synovitis/capsulitis, tendonitis, metatarsalgia, morton’s neuroma, JRA
smillie: secondary to traumatic process
braddock: secondary to fx modified by its proximity to epiphyseal plate
s/s: local pain, tenderness, swelling, limitation of mpj motion
widening of jt space with effusion, initial fx, collapse of laterall margin
tx: below knee walking cast, metatarsal pad
*** kohler’s disease
osteochondrosis of the navicular
males 3-7
ossification (18-24 mo for females and 24-30 mo in males)
may occur simultaneously with legg-perthes
s/s: antalgic gait, local pain and tenderness over navicular, post tib tendon inflamed at insertion site
flattened navicular radiographically
tx: below knee walking cast with foot in varus and equinus 6-8 wk
buschke’s disease
osteochondrosis of the cuneifrombone
5-13
thiemann’s disease
osteochondrosis of the phalanges at proximal epiphyses
sever’s disease ***
osteochondrosis of calcaneus
normal ossification 8-13
contributing factors: gastroc-soleus equinus, excessive pronation, cavus foot, obesity, inflammatory conditions
ddx: fracture, lytic lesion, infection, tendonitis
compare contralateral with radiographs
s/s pain, tenderness to palpation, antalgic gait, activity worsens, no pain morning after rest
tx: short leg cast, NSAIDS, control pronation
islen’s disease
osteochondrosis of the styloid process
due to traction apophysitis from the peroneus brevis, metatarsus adductus
*** leff-calve-perthes disease
ischemic necrosis of the femoral head capital ossification center
males 4-8
self-limited disease
may be due to excessive fluid pressure or inflammatory of traumatic
s/s pain in region of the hip antalgic gait limited ROM disuse atrophy
tx: abduction cast/brace
4 stages: femoral head becomes more dense with possible fracture of supporting bone; fragmentation and reabsorption of bone; reossification when new bone has regrown; healing
*** osgood-schlatter’s disease
osteochondrosis of the tibial tuberosity
males 10-15
dx: pain at insertion of patellar tendon and soft tissue edema, enlargement of tibial tuberosity; may be secondary to trauma
ddx: tendonitis, osteogenic sarcoma, infection, tibial tubercle fx
tx: rest, ice, etc. NOT steroids
type I: tibial tuberosity prominent and irregular
type II: tibial tuberosity prominent and irregular w/ sm free particl located at ant. tuberosity
type III: normal tuberosity w/ bone particle
describe the early phase of necrosis (1)
AVASCULARITY
- osteocytes and bone marrow cells die
- ossific nucleus of the epiphysis ceases to grow
- articular cartilage remains alive and grows
- disuse atrophy (osteoporosis)
- asymptomatic
phase of revasularization w/bone deposition and resorption (2)
stage represents a vascualr reaction of surrounding tissue to dead bone
- ossificationof the thickened pre-osseous cartilage resumes and new bone is laid down on dead trabeculae
- combination of irregular areas of bone deposition and resorption provides radiographic appearance of fragmentation
- most vulnerable stage of osteochondrosis*
phase of bone healing (3)
bone resorption ceases, but bone depositon continues
-newly formed bone still exhibits biological plasticity
phase of residual deformity (4)
- once bony healing of the epiphysis is complete its contour relatively remains unchanged
- if any residual deformity is present, it will remain, as well as the associated complications
classification of freiberg disease
I: epiphyseal fissure fx II: central portionof bone reabsorpiton III: metatarsal head begins to flatten IV: articular loose body V: complete flattening of metatarsal
