Osteochondropathy are a group of cyclical, long–term ongoing diseases, which are based on a violation of the nutrition of bone tissue with its subsequent aseptic necrosis. Secondary clinical and radiological manifestations of osteochondropathy are associated with resorption and replacement of destroyed areas of bone. Osteochondropathy include Legg-Calve-Perthes disease, Ostgood-Schlatter disease, Koehler disease, Sheyerman-Mau disease, Schintz disease, etc. Diagnosis of osteochondropathy is based on ultrasound, radiological and tomographic data. Treatment includes immobilization, physiotherapy, vitamin therapy, physical therapy. According to the indications, surgical treatment is performed.
ICD 10
M93 Other osteochondropathy
Meaning
Disease develop in children and adolescents, more often affect the bones of the lower extremities, are characterized by a benign chronic course and a relatively favorable outcome. There are no confirmed data on the prevalence of osteochondropathy in the medical literature.
Classification
In traumatology , there are four groups of osteochondropathy:
- Osteochondropathy of metaphyses and epiphyses of long tubular bones. This group of osteochondropathy includes osteochondropathy of the sternal end of the clavicle, the phalanges of the fingers, the hip joint, the proximal metaphysis of the tibia, the heads of the II and III metatarsal bones.
- Osteochondropathy of short spongy bones. This group of osteochondropathy includes osteochondropathy of the vertebral bodies, the semilunar bone of the hand, the navicular bone of the foot, as well as the sesamoid bone of the I metatarsophalangeal joint.
- Osteochondropathy of the apophyses. This group of osteochondropathy includes osteochondropathy of the pubic bone, apophysial discs of the vertebrae, calcaneal tubercle and tibial tuberosity.
- Wedge-shaped (partial) osteochondropathy affecting the articular surfaces of the elbow, knee and other joints.
Taking into account the peculiarities of the course of the pathological process , there are four stages of the disease:
- First. Necrosis of bone tissue. Lasts up to several months. The patient is concerned about mild or moderate pain in the affected area, accompanied by impaired limb function. Palpation is painful. Regional lymph nodes are usually not enlarged. Radiological changes during this period may be absent.
- The second. “Compression fracture”. Lasts from 2-3 to 6 months or more. The bone “sags”, the damaged bone beams are wedged into each other. The radiographs reveal a homogeneous darkening of the affected parts of the bone and the disappearance of its structural pattern. When the epiphysis is affected, its height decreases, the expansion of the articular gap is revealed.
- Third. Fragmentation. Lasts from 6 months to 2-3 years. At this stage, the resorption of dead bone areas occurs, their replacement with granulation tissue and osteoclasts. Accompanied by a decrease in bone height. Radiographs reveal a decrease in the height of the bone, fragmentation of the affected parts of the bone with a random alternation of dark and light areas.
- Fourth. Recovery. Lasts from several months to 1.5 years. There is a restoration of the shape and, somewhat later, the structure of the bone.
A full cycle of osteochondropathy takes 2-4 years. Without treatment, the bone is restored with more or less pronounced residual deformation, further leading to the development of deforming arthrosis.
Osteochondropathy
Perthes disease
The full name is Legg–Calve-Perthes disease. Osteochondropathy of the hip joint. Affects the head of the hip bone. It develops more often in boys aged 4-9 years. The occurrence of osteochondropathy may be preceded (not necessarily) by an injury to the hip joint.
Perthes’ disease begins with a slight limp, which is later joined by pain in the area of injury, often radiating to the area of the knee joint. Gradually, the symptoms of osteochondropathy increase, movements in the joint become limited. The examination reveals an indistinct atrophy of the thigh and lower leg muscles, restriction of internal rotation and hip abduction. Possible soreness when loading on a large spit. Shortening of the affected limb by 1-2 cm is often determined, due to the subluxation of the thigh upward.
Osteochondropathy lasts 4-4.5 years and ends with the restoration of the structure of the femoral head. Without treatment, the head becomes mushroom-shaped. Since the shape of the head does not correspond to the shape of the acetabulum, deforming arthrosis develops over time. For diagnostic purposes, ultrasound and MRI of the hip joint are performed.
In order to ensure the restoration of the shape of the head, it is necessary to completely unload the affected joint. Treatment of osteochondropathy is carried out in a hospital in compliance with bed rest for 2-3 years. It is possible to impose skeletal traction. The patient is prescribed physio- vitamin and climatotherapy. Constant exercises in therapeutic gymnastics are of great importance, allowing you to maintain the volume of movements in the joint. In case of violation of the shape of the femoral head, bone-plastic surgery is performed.
Ostgood-Schlatter disease
Osteochondropathy of tibial tuberosity. The disease develops at the age of 12-15 years, boys are more often ill. Gradually, swelling occurs in the affected area. Patients complain of pain that increases when kneeling and walking on the stairs. The function of the joint is not impaired or is slightly impaired.
Treatment of osteochondropathy is conservative, carried out on an outpatient basis. The patient is prescribed a limitation of the load on the limb (with severe pain, a plaster splint is applied for 6-8 weeks), physiotherapy (electrophoresis with phosphorus and calcium, paraffin applications), vitamin therapy. Osteochondropathy proceeds favorably and ends with recovery within 1-1.5 years.
Koehler’s disease-II
Osteochondropathy of the heads of the II or III metatarsal bones. It affects girls more often, develops at the age of 10-15 years. Koehler’s disease begins gradually. Periodic pains occur in the affected area, lameness develops, which passes when the pain disappears. On examination, a slight swelling is detected, sometimes – hyperemia of the skin on the back of the foot. Subsequently, shortening of the II or III finger develops, accompanied by a sharp restriction of movements. Palpation and axial loading are sharply painful.
In comparison with the previous form, this osteochondropathy does not pose a significant threat to the subsequent impairment of limb function and the development of disability. Outpatient treatment with maximum unloading of the affected part of the foot is indicated. Patients are given a special plaster boot, vitamins and physiotherapy are prescribed.
Keller’s Disease-I
Osteochondropathy of the navicular bone of the foot. Develops less frequently than the previous forms. It most often affects boys aged 3-7 years. At first, pain in the foot appears for no apparent reason, lameness develops. Then the skin of the back of the foot turns red and swells.
Treatment of ostechondropathy is outpatient. The patient is limited to the load on the limb, with severe pain, a special plaster boot is applied, physiotherapy is prescribed. After recovery, it is recommended to wear shoes with a supinator.
Shinz ‘s disease
Osteochondropathy of the tubercle of the calcaneus. Shinz’s disease rarely develops, as a rule, affects children aged 7-14 years. Accompanied by the appearance of pain and swelling. Treatment of osteochondropathy is outpatient, includes load limitation, electrophoresis with calcium and thermal procedures.
Sherman-Mau disease
Osteochondropathy of the apophyses of the vertebrae. A common pathology. Sheyerman-Mau disease occurs in adolescence, more often in boys. Accompanied by kyphosis of the middle and lower thoracic spine (round back). The pain may be mild or absent altogether. Sometimes the only reason for contacting an orthopedist is a cosmetic defect. Diagnosis of this type of osteochondropathy is carried out using radiography and CT of the spine. Additionally, an MRI of the spine is performed to study the condition of the spinal cord and the ligamentous apparatus of the spinal column.
Osteochondropathy affects several vertebrae and is accompanied by their pronounced deformity, which remains for life. To maintain the normal shape of the vertebrae, the patient must be provided with rest. Most of the day, the patient should be in bed in a supine position (with severe pain syndrome, immobilization is performed using a back plaster crib). Patients are prescribed abdominal and back muscle massage, therapeutic gymnastics. With timely, correct treatment, the prognosis is favorable.
Calve’s disease
Osteochondropathy of the vertebral body. Calve’s disease develops at the age of 4-7 years. The child, for no apparent reason, begins to complain of pain and a feeling of fatigue in the back. Examination reveals local soreness and standing of the spinous process of the affected vertebra. On radiographs, a significant (up to ¼ of the norm) decrease in the height of the vertebra is determined. Usually one vertebra in the thoracic region is affected. Treatment of this osteochondropathy is carried out only in a hospital. It shows rest, therapeutic gymnastics, physiotherapy. The structure and shape of the vertebra is restored within 2-3 years.
Partial osteochondropathy
They usually develop at the age of 10 to 25 years, they are more common in men. About 85% of partial osteochondropathy develop in the knee joint area. As a rule, a necrosis site appears on a convex articular surface. Subsequently, the damaged area may separate from the articular surface and turn into a “joint mouse” (a freely lying intra-articular body). Diagnosis is carried out by ultrasound or MRI of the knee joint. At the first stages of osteochondropathy, conservative treatment is carried out: rest, physiotherapy, immobilization, etc. With the formation of an “articular mouse” and frequent blockages of the joint, surgical removal of the free intra-articular body is indicated.