Osteochondritis and Perthes Disease

A group of miscellaneous affections of the growing epiphyses in children and adolescents. Typically , a bony nucleus of the epiphysis affected by osteochondritis is temporarily softened and is likely to get deformed by pressure in this stage.

Osteochondritis is sometimes classified as-

1. Crushing type or Osteochondrosis
2. Osteochondritis dissecans
3. Tractions Osteochondritis or traction apophysistis

Common Osteochnodrites –

1. Perthes’ disease – Head of femur is affected
2. Panner’s disease- Capitulum affected
3. Kienbock’s disease- Lunate bone affected
4. Osgood-shlatter’s disease- Tibial tuberosity Osteochondritis
5. Sever’s disease- Calcaneal tuberosity Osteochondritis
6. Kohler’s disease- Navicular bone affected
7. Freiberg’s Disease- Metatarsal head affected
8. Scheurmann’s disease- Ring epiphyses of vertebra affected
9. Calve’s disease- Centralbody of nucleus of vertebral body affected.

 

Perthes’ Disease:-

Aka. Coxa Plana, Pseudocoxalgia

This is the Osteochondritis of the epiphysis of the femoral head. In the disease, the femoral head becomes partially or completely avascular and deformed as well.

Cause- not exactly known. ? recurrent ischemia of head of femur in susceptible age group. Usually precipitated by Synovitis

Age Group Susceptible- 5- 10 years                          Gender- Boys> Girls

Stages:

1. Stage of synovitis

2.Stage of Trabecular necrosis

3.Stage of healing

Presentation-

• Pain in the hip region, pain may radiate to knees.
• Hipstiffness and limping may be present
• On examination- not much findings, sometimes there is shortening of the affected limb, and the limb may be externally rotated and abducted.

X-Ray- Collapse and sclerosis od the epiphysis of the femoral head. Joint space increased- hip joint.

Bone scan- decreased uptake by femoral head.

Treatment-

Principle- preventing the Head from deforming in the softening phase, while keeping it in acetabulaum while revascularization takes place (Head Containment)

Methods- Plaster, special Braces, Splints, Operation- containment- osteotomy.

Further Reading:

AAOS

Patients Reading: patientcouk