Osteochondrosis refers to bone damage and necrosis caused by trauma or repetitive stress, primarily affecting children and adolescents. It includes various types, such as crushing, pulling, and splitting osteochondritis, each with different clinical presentations and treatments. Management typically involves rest, activity modification, and in some cases, surgical intervention.

1. osteochondrosis
Саллам Мосаад Махмуд
502Б

2. Definition
It is a term used to describe the bone damage and necrosis
follow trauma or repetitive stress .
The affected segment show many features of ischemic
necrosis include loss of bone cells , increase vascularity
and sclerosis of the surrounding bone .
This conditions usually affecting the children and
adolescents.

3. Types of osteochondritis :
3 types
1- crushing type .
2- pulling type .
3- splitting type .
Crushing osteochondritis :
It is seen in adolescent and characterize by spontaneous
necrosis of ossific nucleus in a long bone or one of
the bones of the wrist or foot .
Clinically : pain and limitation of the joint movement
exam. Tenderness is localized to the affected bone .
X-ray : increase density in early stage but later there
will be distortion and collapse of the necrotic
segment .

4. The common examples of crushing osteochondritis
1- Koehler's of the navicular bone .
2- keinbock`s disease of the lunate bone .
3- Schermann`s disease of the thoracic spine .
Perthe`s disease now considered as a type of
Osteonecrosis rather than as osteochondritis .
Koehler’s disease : osteochond. Of the navicular
bone affecting children 3-5
years old ; presented as pain and limping ; local
tenderness +ve .
Treatment : by putting the foot in rest , some time use
full p.o.p. for the foot .

5. Koehler`s disease

6. Kienbock`s disease :
It is osteochond. Of the lunate bone , presented in young adult
with painful wrist , stiffness and local tenderness .
X-ray : dense fragmented lunate bone and in advanced case
osteoarthritic changes seen in the wrist .
Treatment : in early stage need splintage only , but later on
when the pain become sever arthrodesis of the
wrist is indicated .
Schermann`s disease :
Osteochond. Of the thoracic spine ; vertebral bodies become
wedge in shape due to fragmentation of the upper and
lower epiphysis of the vertebral body .

7. Kinnock's disease

8. The site of pain in
kienbock`s disease

9. Patient presented with smooth , rigid
kyphosis of the dorsal spine with back
pain ; the disease affecting the
adolescent .
X-ray : wedging and fragmentation of the
upper
and lower vertebral end plate .
Treatment :
Exercise and some time we use brace or
splint .

11. Pulling osteochondritis
( traction ) :
Excessive pull by large tendon may damage the unfused
apophysis to which it attached and this typically occur
in two place :
1-tibial tuberosity (osgood-schlatter`s
disease)
2- calcaneal apophysis (sever`s disease ).

12. Osgood schlutter`s disease :
It is osteochondritis of upper tibial tubercle ,affecting children
8-15 years old .
The tibial tuberosity become swallown , tender and extension
of the knee joint against resistant is painful .
X-ray : show irregular fragmentation of apophysis in which
infra patellar tendon is inserted .
Treatment : spontaneous recovery is usually occur and it is
necessary to modified child activity e.g., stop
plying foot ball and stop cycling . If pain persist then put in
plaster cylinder for about 1-2 months occasionally excision of
the fragmented piece by operation is done

13. Osgood – schlatter disease

15. Sever`s disease :
Osteochondritis of the calcanium which affect child
about 10 years old .
Patient usually presented with pain and tenderness
over the posterior aspect of the heel .
X- ray :show fragmentation of the apophysis in
which the tendoachillis is inserted into the
calcanium .
Treatment : restriction of the activity for few weeks
and heel
raising .

16. Saver's disease

17. Splitting osteochondritis (osteochondritis
dissecans )
Small fragment of articular cartilage and the
subjacent bone may separated (dissect) as an
avascular fragment .
It is occur in young adult more in male , the
commonest site is the knee joint . The cause is
repeated minor trauma lead to osteochondral
fracture , the fragment loosen its blood supply .
Clinically : the patient 15-20 years old complain from
intermittent pain , swelling , joint
effusion and in case of separation of the piece it
will act as a loose body in the joint and this will
cause locking of the joint and unexpected episode
of giving way .

18. Treatment
 The first step is to rest the joint.
Children must stop playing most
sports for at least two to four
months. During that time, they
also may use crutches, a brace or
a cast to reduce pressure and
protect the joint.
 Physical therapy for
osteochondritis dissecans is also
used as a non-surgical treatment.
