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osteochondritisOrthopedics Inflammation of bone and joint surfaces–usually aseptic; note: A legacy of the German school of medicine was eponymic immortalization of osteochondritis in each joint
Freiberg's disease–metatarsal head
Köhler's disease–tarsal-navicular bones
Legg-Calve-Perthes disease–femoral head
Osgood-Schlatter disease–tibial tubercle
Panner's disease–humeral head
Thiemann's disease–metacarpal and metatarsal bones
Wegner's disease–osteochondritis with epiphyseal separation–congenital syphilis
1. OSTEOCHONDRITIS of the SCAPHOID bone of the foot. A condition affecting children and adolescents. There is a defect in the blood supply to the bone, from compression of the foot arch, leading to central bone death (necrosis). Weight-bearing must be avoided during the active stage of the disease, but spontaneous healing occurs.
2. Osteochondritis of the head of the bone in the palm articulating with the forefinger (second metatarsal bone). (Alban Kohler, 1874–1947, German radiologist).
|Criterion 1||1. OC of the primary articular epiphysis (e.g. Freiberg's disease of the metatarsal head; Kohler's disease of the navicular)|
2. OC of the secondary articular epiphysis (e.g. osteochondritis dissecans of the talus)
3. OC of the non-articular epiphysis (e.g. Osgood–Schlatter disease of the tibial tuberosity; Iselin's disease of the styloid process of the fifth metatarsal)
|Criterion 2||1. Crushing apophysitis (e.g. Freiberg's disease) where the pressure of the base of the adjacent phalanx causes an ‘eggshell fracture’ of the affected metatarsal head|
2. Traction or distraction apophysitis (e.g. Sever's disease; Iselin's disease; Osgood–Schlatter disease) where traction at the tendon insertion distracts a secondary centre of ossification from the body of the calcaneum, fifth metatarsal or tibia respectively
3. Fragmentation apophysitis (e.g. osteochondritis dissecans) in which the cortical bone overlying the enchondral defect fractures and separates to create a loose body within the joint
|Two criteria may be used to classify osteochondritis:|
• criterion 1 relates to the anatomical location of the enchondral ossification defect
• criterion 2 relates to the effects on the diseased bone brought about by the local forces that act on the bone.
|OC||Site affected||Type||Age of onset (years)|
|Blount's disease||Proximal tibial epiphysis||Underdevelopment of medial epiphysis||1–3; 6–13|
|Buschke's disease||Cuneiforms||Ossification anomaly||11–15|
|Freiberg's disease||Second/third metatarsal head||Crushing OC||12–18|
|Iselin's disease||Base of fifth metatarsal||Traction apophysitis||11–15|
|Kohler's disease||Navicular||Crushing OC||3–7|
|Legg–Calve–Perthe disease||Capital femoral epiphysis||True OC||2–16|
|Osgood–Schlatter disease||Tibial tuberosity||Trauma-related||11–15|
|Osteochondritis dissecans||Talar dome|
Lateral femoral condyle of knee
|Sever's disease||Calcaneal apophysis||Traction apophysitis||10–14|
|Sinding–Larson–Johansson disease||Patella||Traction apophysitis||10–14|
|Treve's disease||Sesamoids (1 MTPJ)||True OC||15–20|
1 MTPJ, first metatarsophalangeal joint.