Osteochondroses Flashcards
What are osteochondroses
Group of conditions in which there is abnormal endochondral ossification of epiphyseal growth during childhood
All osteochondroses have interruption of blood supply to epiphysis causing bone/cartilage necrosis
What is Kienböck’s disease
AVN of lunate after injury
Kienböck’s disease presentation
Typically 20-40 yr old gymnast
Pain over lunate during active wrist movement following injury (acute or progressive)
Grip impaired due to pain
Ulna projects proximally to radius - negative ulnar variance
Kienböck’s disease imaging
XR shows sclerotic lunate with flattening in later disease, leads to OA
Kienböck’s disease treatment
Early disease symptomatic management - splinting + analgesia, surgery to ease compression by ulnar lengthening/radial shortening if necessary
Late disease - proximal row carpectomy, intercarpal arthrodesis as last resort
What is Panner’s disease (osteochondritis dissecans) of elbow
Disease of capitellum, Panner’s is AVN of ossific nucleus of capitellum
Loose fragments of bone broken off causes most symptoms
Panner’s disease (osteochondritis dissecans) of elbow presentation
Typically boys <10yrs
Lateral elbow pain + swelling
Panner’s disease (osteochondritis dissecans) of elbow imaging
XR - lucent areas in pieces about to separate, defect from which piece has seperated, loose bodies post-seperation
Panner’s disease (osteochondritis dissecans) of elbow treatment
Stable lesions conservative with activity modification
Unstable may need fixation ± removal of loose bodies
Closed wedge resection may cause revascularisation
What is Köhler’s disease
Rare, affects navicular
Causes limp as pain felt in mid-tarsal region
Köhler’s disease imaging
XR shows dense, deformed navicular
Köhler’s disease treatment
Symptomatic - rest foot or wear walking plaster, good prognosis with few long-term issues
What is Freiberg’s disease
Essentially osteochondritis dissecans of lesser metatarsal heads (commonly 2nd)
Freiberg’s disease treatment
Good shoes ± metatarsal pad
Limit activity for 4-6 wks
Removal of affected bone if severe ± bone graft/arthroplasty + use of walking plaster
What is Osgood-Schlatter disease
Tibial tuberosity apophysitis, repeated traction results in inflammation + chronic avulsion of 2˚ ossification centre of tibial tuberosity
Osgood-Schlatter disease presentation
Typically 10-15yrs 3x more in boys
Pain below the knee worse on strenuous activity + quadriceps contraction
Osgood-Schlatter disease imaging
Tibial tuberosity enlargement ± fragmentation on XR
MRI shows tendonitis
Diagnosis is clinical, not just radiological
Osgood-Schlatter disease treatment
Limitation of activity, ice, anti-inflammatories, knee padding + physio
Tibial tuberosity excision once skeletal maturity reached if rest fails
What is Sinding-Larsen’s disease (jumper’s knee)
Osgood-Schlatter which presents 1-2 yrs earlier with proximal traction tendinopathy + calcification
What is Sever’s disease
Common calcaneal apophysitis from strained attachment of Achilles, shows normal XR
Sever’s disease presentation
Typically 8-13 yrs
Pain behind heel ± limping, tenderness over lower posterior calcaneal tuberosity
Sever’s disease treatment
Physio + heel raise
Below-knee walking plaster if needed for pain relief, generally self-limiting + resolves after 5 wks
