Osteochondroses

Osteochondroses

 

Definition

Osteochondroses is a group of diseases of children and adolescents in which localized tissue death (necrosis) occurs, usually followed by full regeneration of healthy bone tissue. The singular term is osteochondrosis.

Description

During the years of rapid bone growth, blood supply to the growing ends of bones (epiphyses) may become insufficient resulting in necrotic bone, usually near joints. The term avascular necrosis is used to describe osteochondrosis. Since bone is normally undergoing a continuous rebuilding process, the necrotic areas are most often self-repaired over a period of weeks or months.
Osteochondrosis can affect different areas of the body and is often categorized by one of three locations: articular, non-articular, and physeal.
Physeal osteochondrosis is known as Scheuermann's disease. It occurs in the spine at the intervertebral joints (physes), especially in the chest (thoracic) region.
Articular disease occurs at the joints (articulations). One of the more common forms is Legg-Calvé-Perthes disease, occurring at the hip. Other forms include Köhler's disease (foot), Freiberg's disease (second toe), and Panner's disease (elbow). Freiberg's disease is the one type of osteochondrosis that is more common in females than in males. All others affect the sexes equally.
Non-articular osteochondrosis occurs at any other skeletal location. For instance, Osgood-Schlatter disease of the tibia (the large inner bone of the leg between the knee and ankle) is relatively common.
Osteochondritis dissecans is a form of osteochondrosis in which loose bone fragments may form in a joint.

Causes and symptoms

Many theories have been advanced to account for osteochondrosis, but none has proven fully satisfactory. Stress and ischemia (reduced blood supply) are two of the most commonly mentioned factors. Athletic young children are often affected when they overstress their developing limbs with a particular repetitive motion. Many cases are idiopathic, meaning that no specific cause is known.
The most common symptom for most types of osteochondrosis is simply pain at the affected joint, especially when pressure is applied. Locking of a joint or limited range of motion at a joint can also occur.
Scheuermann's disease can lead to serious kyphosis (hunchback condition) due to erosion of the vertebral bodies. Usually, however, the kyphosis is mild, causing no further symptoms and requiring no special treatment.

Diagnosis

Diagnosis can be confirmed by x-ray findings.

Treatment

Conservative treatment is usually attempted first. In many cases, simply resting the affected body part for a period of days or weeks will bring relief. A cast may be applied if needed to prevent movement of a joint.
Surgical intervention may be needed in some cases of osteochondritis dissecans to remove abnormal bone fragments in a joint.

Prognosis

Accurate prediction of the outcome for individual patients is difficult with osteochondrosis. Some patients will heal spontaneously. Others will heal with little treatment other than keeping weight or stress off the affected limb. The earlier the age of onset, the better the prospects for full recovery. Surgical intervention is often successful in osteochondritis dissecans.

Prevention

No preventive measures are known.

Resources

Books

Eilert, Robert E., and Gaia Geogopoulos. "Orthopedics." In Current Pediatric Diagnosis and Treatment, edited by W. W. Hay, Jr., et al. Stamford: Appleton & Lange, 1997.
References in periodicals archive ?
The osteochondroses, with emphasis on the Legg-Calve-Perthes syndrome, Instr Course Lect, 1956;13:24-44.