osteochondritis

It is a term used to describe the bone damage and necrosis follow trauma or repetitive stress . The affected segment show many features of ischemic necrosis include loss of bone cells , increase vascularity and sclerosis of the surrounding bone . This conditions usually affecting the children and adolescents.

Types of osteochondritis : 3 types 1- crushing type . 2- pulling type . 3- splitting type . Crushing osteochondritis : It is seen in adolescent and characterize by spontaneous necrosis of ossific nucleus in a long bone or one of the bones of the wrist or foot . Clinically : pain and limitation of the joint movement exam. Tenderness is localized to the affected bone . X-ray : increase density in early stage but later there will be distortion and collapse of the necrotic segment .

Koehler’s disease : osteochond. Of the navicular The common examples of crushing osteochondritis 1- Koehler's of the navicular bone . 2- keinbock`s disease of the lunate bone . 3- Schermann`s disease of the thoracic spine . Perthe`s disease now considered as a type of Osteonecrosis rather than as osteochondritis . Koehler’s disease : osteochond. Of the navicular bone affecting children 3-5 years old ; presented as pain and limping ; local tenderness +ve . Treatment : by putting the foot in rest , some time use full p.o.p. for the foot .

Koehler`s disease

Kienbock`s disease : Schermann`s disease : It is osteochond. Of the lunate bone , presented in young adult with painful wrist , stiffness and local tenderness . X-ray : dense fragmented lunate bone and in advanced case osteoarthritic changes seen in the wrist . Treatment : in early stage need splintage only , but later on when the pain become sever arthrodesis of the wrist is indicated . Schermann`s disease : Osteochond. Of the thoracic spine ; vertebral bodies become wedge in shape due to fragmentation of the upper and lower epiphysis of the vertebral body .

Kinnock's disease

The site of pain in kienbock`s disease

Patient presented with smooth , rigid kyphosis of the dorsal spine with back pain ; the disease affecting the adolescent . X-ray : wedging and fragmentation of the upper and lower vertebral end plate . Treatment : Exercise and some time we use brace or splint .

Pulling osteochondritis ( traction ) : Excessive pull by large tendon may damage the unfused apophysis to which it attached and this typically occur in two place : 1-tibial tuberosity (osgood-schlatter`s disease) 2- calcaneal apophysis (sever`s disease ).

Osgood schlutter`s disease : It is osteochondritis of upper tibial tubercle ,affecting children 8-15 years old . The tibial tuberosity become swallown , tender and extension of the knee joint against resistant is painful . X-ray : show irregular fragmentation of apophysis in which infra patellar tendon is inserted . Treatment : spontaneous recovery is usually occur and it is necessary to modified child activity e.g., stop plying foot ball and stop cycling . If pain persist then put in plaster cylinder for about 1-2 months occasionally excision of the fragmented piece by operation is done

Osgood – schlatter disease

Sever`s disease : Osteochondritis of the calcanium which affect child about 10 years old . Patient usually presented with pain and tenderness over the posterior aspect of the heel . X- ray :show fragmentation of the apophysis in which the tendoachillis is inserted into the calcanium . Treatment : restriction of the activity for few weeks and heel raising .

Saver's disease

Splitting osteochondritis (osteochondritis dissecans ) Small fragment of articular cartilage and the subjacent bone may separated (dissect) as an avascular fragment . It is occur in young adult more in male , the commonest site is the knee joint . The cause is repeated minor trauma lead to osteochondral fracture , the fragment loosen its blood supply . Clinically : the patient 15-20 years old complain from intermittent pain , swelling , joint effusion and in case of separation of the piece it will act as a loose body in the joint and this will cause locking of the joint and unexpected episode of giving way .

Osteochondritis dissecans