Osteochondrosis- Bennett

Question 1

general features of osteochondroses

Answer 1

middle years of growthboys more than girlslower limbs15% bilateral

Question 2

a group of conditions in which the primary or secondary center of ossification undergo aseptic necrosis

Answer 2

osteochondroses

Question 3

freiberg disease ***

Answer 3

avascular necrosis of metatarsal head13-18 femaleunilateralsecond met 68%, third met 27%ddx: stress fx, synovitis/capsulitis, tendonitis, metatarsalgia, morton’s neuroma, JRAsmillie: secondary to traumatic processbraddock: secondary to fx modified by its proximity to epiphyseal plates/s: local pain, tenderness, swelling, limitation of mpj motion widening of jt space with effusion, initial fx, collapse of laterall margintx: below knee walking cast, metatarsal pad

Question 4

*** kohler’s disease

Answer 4

osteochondrosis of the navicularmales 3-7ossification (18-24 mo for females and 24-30 mo in males)may occur simultaneously with legg-perthess/s: antalgic gait, local pain and tenderness over navicular, post tib tendon inflamed at insertion siteflattened navicular radiographicallytx: below knee walking cast with foot in varus and equinus 6-8 wk

Question 5

buschke’s disease

Answer 5

osteochondrosis of the cuneifrombone5-13

Question 6

thiemann’s disease

Answer 6

osteochondrosis of the phalanges at proximal epiphyses

Question 7

sever’s disease ***

Answer 7

osteochondrosis of calcaneusnormal ossification 8-13contributing factors: gastroc-soleus equinus, excessive pronation, cavus foot, obesity, inflammatory conditionsddx: fracture, lytic lesion, infection, tendonitiscompare contralateral with radiographss/s pain, tenderness to palpation, antalgic gait, activity worsens, no pain morning after resttx: short leg cast, NSAIDS, control pronation

Question 8

islen’s disease

Answer 8

osteochondrosis of the styloid processdue to traction apophysitis from the peroneus brevis, metatarsus adductus

Question 9

*** leff-calve-perthes disease

Answer 9

ischemic necrosis of the femoral head capital ossification centermales 4-8self-limited diseasemay be due to excessive fluid pressure or inflammatory of traumatics/spain in region of the hipantalgic gaitlimited ROMdisuse atrophytx: abduction cast/brace4 stages: femoral head becomes more dense with possible fracture of supporting bone; fragmentation and reabsorption of bone; reossification when new bone has regrown; healing

Question 10

*** osgood-schlatter’s disease

Answer 10

osteochondrosis of the tibial tuberositymales 10-15dx: 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 irregulartype II: tibial tuberosity prominent and irregular w/ sm free particl located at ant. tuberositytype III: normal tuberosity w/ bone particle

Question 11

describe the early phase of necrosis (1)

Answer 11

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

Question 12

phase of revasularization w/bone deposition and resorption (2)

Answer 12

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*

Question 13

phase of bone healing (3)

Answer 13

bone resorption ceases, but bone depositon continues-newly formed bone still exhibits biological plasticity

Question 14

phase of residual deformity (4)

Answer 14

• 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

Question 15

classification of freiberg disease

Answer 15

I: epiphyseal fissure fxII: central portionof bone reabsorpitonIII: metatarsal head begins to flattenIV: articular loose bodyV: complete flattening of metatarsal

Question 16

diaz diseasetreve disease

Answer 16

osteochondrosis of talusosteochondrosis of sesamoids

Question 17

osteochondrosis dessican

Answer 17

basic disturbance to epiphyseal developmentknee join most commmonly affected also medial femoral condyle, femoral head, and taluss/s itnermittent pain in jt, stiffness, swelling, clicking and locking, giving wayobserve a fragment of subchondral bonetx: cast or arthrotomy and insertion of graft