Osteochondrosis- Bennett Flashcards
general features of osteochondroses
middle years of growthboys more than girlslower limbs15% bilateral
a group of conditions in which the primary or secondary center of ossification undergo aseptic necrosis
osteochondroses
freiberg disease ***
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
*** kohler’s disease
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
buschke’s disease
osteochondrosis of the cuneifrombone5-13
thiemann’s disease
osteochondrosis of the phalanges at proximal epiphyses
sever’s disease ***
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
islen’s disease
osteochondrosis of the styloid processdue to traction apophysitis from the peroneus brevis, metatarsus adductus
*** leff-calve-perthes disease
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
*** osgood-schlatter’s disease
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
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 fxII: central portionof bone reabsorpitonIII: metatarsal head begins to flattenIV: articular loose bodyV: complete flattening of metatarsal
diaz diseasetreve disease
osteochondrosis of talusosteochondrosis of sesamoids
osteochondrosis dessican
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
