osteochondroses

·      heterogenous group of eponymous conditions

·      usually involve epiphysis or apophysis of immature skeleton

·      usually occurs at time of greatest growth

·      common radiological features of

·      sclerosis

·      fragmentation

·      decrease in size of ossification centre

·      affected portion of bone has features of osteonecrosis

·      some progress to osteoarthritis

·      some are self-healing

·      thought to be due to recurrent minor trauma

·      three types

·      crushing

·      pulling

·      splitting

Crushing

·      seen in adolescence

·      spontaneous necrosis of

·      ossific nucleus of long bone

·      cuboidal bone of wrist or foot

·      pathological changes of osteonecrosis

·      bone death

·      fragmentation

·      distortion and collapse

·      new bone formation

Kohler

·      of navicular

·      age 4-6 yrs

·      M:F = 5:1

·      bilateral in 20%

·      sclerotic, fragmented and flattened navicular

·      usually reconstitutes without disability after 18 mths to 3 yrs

·      may treat with SLPOP for 8-10 wks to decrease pain

Freiberg

·      of metatarsal head, esp. 2nd

·      age 10-15 yrs

·      F:M = 3:1

·      bilateral in 10%

·      may be predisposed by abnormally long MT

·      enlarged flattened MT head

·      leads to MTP jt arthritis

·      treat with MT head excision if symptoms severe

Panner

·      of capitellum of humerus

·      age 4-16 yrs

·      usually boys

·      more common in baseball pitchers

·      pain with throwing

·      epiphysis condensed and fragmented

·      usually reconstitutes without disability

·      may need to excise loose body

Kienboch

·      of lunate

·      age 20-40 yrs

·      may lead to carpal osteoarthritis

Pulling

·      excessive traction by large tendon to unfused apophysis

·      repetitive microtrauma

·      bone necrosis does not occur

·      apophysis becomes painful

·      may be tenosynovitis

Osgood-Schlatter

·      of tibial tubercle

·      age 11-14 yrs

·      esp. athletic boys

·      bilateral in 25%

·      pain and swelling and difficulty kneeling

·      fragmented tibial tuberosity with soft tissue swelling

·      treated with enough restriction of activities to control symptoms

·      may require isometric exercises to prevent quads atrophy

·      steroid injections contraindicated as weaken tendon

·      usually resolves in 1-2 yrs

·      discrete ossicle and overlying bursa occurs in 10%

·      may require excision

Sever

·      of calcaneum

·      age 9-11 yrs

·      fragmentation and sclerosis of 2o ossification centre of calcaneum

·      treated with activity restriction

·      usually resolves

Sinding-Larsen-Johansson

·      of lower pole of patella

·      age 10-14 yrs

·      avulsion fracture

·      settles spontaneously