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
diaz disease
treve disease
osteochondrosis of talus
osteochondrosis of sesamoids
osteochondrosis dessican
basic disturbance to epiphyseal development
knee join most commmonly affected
also medial femoral condyle, femoral head, and talus
s/s itnermittent pain in jt, stiffness, swelling, clicking and locking, giving way
observe a fragment of subchondral bone
tx: cast or arthrotomy and insertion of graft
