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Paeds > Osteochondroses > Flashcards

Osteochondroses Flashcards

1
Q

Name some articular osteochondroses.

A

Perthes, Kohler’s, Frieberg’s

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2
Q

Name some non-articular osteochondroses.

A

Osgood-Schlatters, Sinnig-Larsen-Johansson lesion, Sever’s, Iselin’s lesion

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3
Q

Name some physical osteochondroses.

A

Sheuermann’s Kyphosis, Blount’s disease

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4
Q

What is a Kohler’s lesion and how is it caused?

A

Avascular necrosis of the navicular caused by repeated micro-trauma disturbing blood flow to the navicular.

The navicular is prone to avascular necrosis as it is the last bone to ossify and is subject to compression forces from surrounding bones.

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5
Q

How is a Kohler’s lesion diagnosed?

A

x-ray and clinical examination

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6
Q

What are the symptoms for a Kohler’s lesion?

A
  • pain localised to the navicular
  • pain with tib post contraction
  • widened/flattened/irregular shaped navicular bone
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7
Q

Does Kohler’s affect boys or girls more?

A

Boys>girls, 4:1

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8
Q

What age is Kohler’s most common?

A

2-9 y.o.

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9
Q

How is Kohler’s treated?

A
  • activity modification
  • orthoses
  • short leg cast 6-8 weeks
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10
Q

What is Frieberg’s lesion and how is it caused?

A

Avascular necrosis of the metatarsal head (usually 2nd met head, sometimes 3rd). Caused by repeated micro-trauma interrupts blood supply to the epiphyseal plate.

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11
Q

What are the symptoms for a Frieberg’s lesion?

A
  • pain on WBing through the forefoot

- longer second ray? - push off through second rather than first

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12
Q

Is Frieberg’s more common in girls or boys?

A

F>M, often 12-15 y.o. dancers

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13
Q

How is Frieberg’s diagnosed?

A

xray, bone scan, MRI, clinical examination

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14
Q

What are DDX for Frieberg’s?

A

stress #, march #, synovitis, neuroma, RA

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15
Q

What are DDX for Kohler’s?

A

accessory navicular, #, trauma

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16
Q

What is the treatment for Frieberg’s?

A
  • activity modification
  • off-loading
  • footwear modifications
  • short leg cast
  • surgery
  • aspirin
17
Q

What is Osgood-Schlatter’s and how is it caused?

A

Pain, tenderness and inflammation at the tibial tuberosity caused my micro-avulsions from tensile forces of quads on the developing secondary ossification centre (proximal tibial apophysis), causing formation of extra bone.

18
Q

What are the clinical signs of Osgood-Schlatter’s?

A
  • symptomatic with exercise but alleviated with rest
  • query muscle strength imbalance or excessive activity load
  • common in sports requiring running and jumping
19
Q

What is the age of onset for Osgood-Schlatters?

A

Boys: 12-15 y.o.
Girls: 10-12 y.o.

20
Q

What are the DDX for Osgood-Schlatters?

A

Osteochondrosis dissecans, RA, meniscus injury

21
Q

What is the treatment for Osgood Schlatters?

A

Spontaneous resolution is common (months to years)

  • activity modification
  • NSAIDs
  • improving muscle imbalance through stretching and strengthening of hamstrings and quads
  • surgical excision of tibial tuberosity
22
Q

What is a Sinding-Larsen-Johansson lesion?

A

Pain at the inferior pole of the patella at the superior attachment of the patella tendon

23
Q

What is the treatment for a Sinding-Larsen-Johansson lesion?

A
  • activity modification (directed through pain)
  • Still need to do some form of activity, but must stop at onset of pain
  • quads tightness may play a role
24
Q

What is a Sever’s lesion?

A

Traction apophysitis of the insertion of the Achilles tendon to the calcaneus.

25
Q

What are the symptoms of Sever’s?

A
  • localised pain around the achilles insertion site

- commonly arise around beginning of sporting seasons

26
Q

Is Sever’s more common in girls or boys?

A

Boys>girls generally 10-12 y.o.

27
Q

How is a Sever’s lesion diagnosed?

A
  • squeeze test (squeeze post heel, should elicit pain)
28
Q

What are the DDX for Sever’s?

A

Retrocalcaneal bursitis, achilles tendinopathy, bone tumour, medial calcanea nerve entrapment, tarsal tunnel syndrome, RA

29
Q

How is Sever’s treated?

A

Usually self-limiting unless the calcaneal ossification centre is ruptured

  • activity modification
  • shoe wear modification
  • heel raises
  • calf stretches/strengthening
30
Q

What is an Iselin’s lesion?

A

traction apophysitis of the tuberosity of the 5th metatarsal

31
Q

What are the clinical signs of Iselin’s lesion?

A
  • pain with eversion (as PL tendon pulls)

- localised pain and swelling

32
Q

How is an Iselin’s lesion diagnosed?

33
Q

What are the DDX for Iselin’s lesion?

A

styloid #, os vesaleanum (accessory bone in the PL tendon), RA

34
Q

What treatment is required for Iselin’s lesion?

A
  • offloading
  • orthoses
  • lateral wedging

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