Osteochondroses

Synonyms: the ischaemic necroses

What is osteochondroses?¹

The term osteochondrosis is used to describe a group of disorders that affect the immature skeleton. All osteochondroses involve a defect in ossification at either the bone epiphysis (growing plate), the joint surface itself, or at an apophysis (bony projection).

When articular surfaces become ischaemic, osteochondritis develops - this is associated with avascular necrosis and sclerosis.

Aetiology

Osteochondrosis results from abnormal development, injury, or overuse of the growth plate and surrounding ossification centres. Overall, boys are more often affected. It is thought that boys are more often affected because of their greater susceptibility to childhood trauma and overuse injuries.¹

Types of osteochondroses

The osteochondroses are often classified as follows (click on links for separate related articles):

• Articular osteochondroses:
  

  • Perthes' disease: a self-limiting hip disorder caused by varying degrees of ischaemia and subsequent necrosis of the femoral head. Most children with Perthes' disease have good outcomes, but pain, osteoarthritis, and ongoing hip dysfunction are common.

  • Köhler's bone disease: osteochondrosis of the tarsal navicular bone. The course is chronic, but rarely lasts longer than 2 years.[4] Symptoms in treated patients can last for less than 3 months.

  • Freiberg's disease: osteonecrosis of the second metatarsal head. Outcomes of management are good to excellent and most patients are able to return to previous activity

  • Panner's disease: involves the capitulum of the distal humerus. Usually resolution in 1-2 years. Usually complete resolution of symptoms but there may be a persistent loss of elbow extension.

• Non-articular osteochondroses:
  

  • Osgood-Schlatter Disease: self-limiting disorder of the knee, found during adolescence. Nearly half those affected fully recover within 1-2 years. Symptoms disappear when the growth plate closes.

  • Sever's Disease: inflammation of the calcaneal apophysis which occurs in children and adolescents. Normally self-limiting but may recur.

  • Sinding-Larsen and Johansson Syndrome: affects of the distal pole of the patella. Symptoms usually improve but may be present for at least a year.

• Epiphyseal osteochrondroses:
  

  • Scheuermann's Disease: affects the thoracic vertebral bodies causing wedge-shaped vertebrae, and so increased kyphosis, poor posture and backache. There is an increased risk of back pain later in life.

  • Blount's Disease: an asymmetrical disorder of proximal tibial growth that produces deformity, particularly tibia vara (also known as genu varus and bow-leggedness). Without treatment, there may be a poor prognosis, especially in young children due to the growth spurt and the early fusion of the growth plate occurring from the ages of 6 to 8.