Osteochondroses

Question 1

What are osteochondroses

Answer 1

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

Question 2

What is Kienböck’s disease

Answer 2

AVN of lunate after injury

Question 3

Kienböck’s disease presentation

Answer 3

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

Question 4

Kienböck’s disease imaging

Answer 4

XR shows sclerotic lunate with flattening in later disease, leads to OA

Question 5

Kienböck’s disease treatment

Answer 5

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

Question 6

What is Panner’s disease (osteochondritis dissecans) of elbow

Answer 6

Disease of capitellum, Panner’s is AVN of ossific nucleus of capitellum
Loose fragments of bone broken off causes most symptoms

Question 7

Panner’s disease (osteochondritis dissecans) of elbow presentation

Answer 7

Typically boys <10yrs

Lateral elbow pain + swelling

Question 8

Panner’s disease (osteochondritis dissecans) of elbow imaging

Answer 8

XR - lucent areas in pieces about to separate, defect from which piece has seperated, loose bodies post-seperation

Question 9

Panner’s disease (osteochondritis dissecans) of elbow treatment

Answer 9

Stable lesions conservative with activity modification
Unstable may need fixation ± removal of loose bodies
Closed wedge resection may cause revascularisation

Question 10

What is Köhler’s disease

Answer 10

Rare, affects navicular

Causes limp as pain felt in mid-tarsal region

Question 11

Köhler’s disease imaging

Answer 11

XR shows dense, deformed navicular

Question 12

Köhler’s disease treatment

Answer 12

Symptomatic - rest foot or wear walking plaster, good prognosis with few long-term issues

Question 13

What is Freiberg’s disease

Answer 13

Essentially osteochondritis dissecans of lesser metatarsal heads (commonly 2nd)

Question 14

Freiberg’s disease treatment

Answer 14

Good shoes ± metatarsal pad
Limit activity for 4-6 wks
Removal of affected bone if severe ± bone graft/arthroplasty + use of walking plaster

Question 15

What is Osgood-Schlatter disease

Answer 15

Tibial tuberosity apophysitis, repeated traction results in inflammation + chronic avulsion of 2˚ ossification centre of tibial tuberosity

Question 16

Osgood-Schlatter disease presentation

Answer 16

Typically 10-15yrs 3x more in boys

Pain below the knee worse on strenuous activity + quadriceps contraction

Question 17

Osgood-Schlatter disease imaging

Answer 17

Tibial tuberosity enlargement ± fragmentation on XR
MRI shows tendonitis
Diagnosis is clinical, not just radiological

Question 18

Osgood-Schlatter disease treatment

Answer 18

Limitation of activity, ice, anti-inflammatories, knee padding + physio
Tibial tuberosity excision once skeletal maturity reached if rest fails

Question 19

What is Sinding-Larsen’s disease (jumper’s knee)

Answer 19

Osgood-Schlatter which presents 1-2 yrs earlier with proximal traction tendinopathy + calcification

Question 20

What is Sever’s disease

Answer 20

Common calcaneal apophysitis from strained attachment of Achilles, shows normal XR

Question 21

Sever’s disease presentation

Answer 21

Typically 8-13 yrs

Pain behind heel ± limping, tenderness over lower posterior calcaneal tuberosity

Question 22

Sever’s disease treatment

Answer 22

Physio + heel raise

Below-knee walking plaster if needed for pain relief, generally self-limiting + resolves after 5 wks