Osgood-Schlatters disease Kohlers disease Friebergs infarction Vertebra plana Scheurmanns disease Sinding-Larsen disease Blount's disease

2. OSTEOCHONDROSIS/OSTEOCHONDRITIS
No inflammation/ No cartilage involvement
Disease of epiphyses
Begins as necrosis followed by full regeneration of
healthy bone tissue

4. Epiphyseal necrotic areas heal and convert into
normal bone
Prominent metaphyseal changes may also be present
(e.g. femoral head)
>40 sites---mechanism of pathological changes is diff.
at all sites
e.g. vascular occlusion , bone avulsion, eosinophilic
granuloma , discal herniation etc

5. FEMORAL HEAD 10
Aseptic necrosis Legg-Calve-Perthe-
TARSAL NAVICULAR 10
Aseptic necrosis
Necrosis following #
Kohler
METATARSAL HEAD 10
Aseptic necrosis
Necrosis following #
Freibergs
LUNATE 10
Aseptic necrosis
Necrosis following #
Keinbocks
TIBIAL TUBERCLE Necrosis following partial
avulsion of patellar
tendon
Osgood-Schlatter
LOWER POLE OF
PATELLA
Necrosis following partial
avulsion of patellar
tendon
Sinding-Larsen
CALCANEAL
APOPHYSIS
Necrosis following partial
avulsion of tendoachillis
Severs
VERTBRAL BODY
EPIPHYSIS
Eosinophilic granuloma Calves
RING LIKE EPIPHYSIS
OF VERTEBRA
Disc herniation thru
defective end plate
Scheuermanns

6. OSTEOCHONDRITIS OF TIBIAL TUBERCLE
Osgood-Schlatters disease
Adolescent males
 typically lasts 12-24 months
Epiphysial aseptic necrosis of the tibial tubercle---due
to avulsion injury
Soft tissue lateral film(May be normal )
Local soft tissue swelling over a
fragmented and dense tuberosity
Compare with other knee(for soft tissues)

7. Osgood-Schlatter disease.
Fragmentation of the tibial tuberosity with
thickening of the ligamentum patellae.

8. Note the prominence, irregularity and
fragmentation of the tibial tuberosity
(arrowed).

9. OSTEOCHONDRITIS OF TARSAL NAVICULAR
Kohlers disease l
M>F Age----3-10 years
Peak 5 and 6 years
Appears earlier in girls

10. Earlier---irregularity of navicular and fissure
formation
Later---bone may appear as dense disc
No cartilagenous loss

11. OSTEOCHONDRITIS OF TARSAL NAVICULAR

12. This comparison view was performed after
the right foot image was reviewed.
This 3 year old girl presented with a
spontaneous right sided limp. The
navicular appears small and abnormally
dense.

13. OSTEOCHONDRITIS OF METATARSAL HEAD
Friebergs infarction , Kohlers disease ll
F>M between 10 – 15 yrs
Chronic trauma e.g. girls wearing high heals
2nd
MT head is commonly involved

14. Epiphysis shows
condensation
increased density
irregularity
Joint space may increase with splaying of opposing
bone surfaces
Gradual thickening of MT neck and shaft

15. Osteochondritis of the second metatarsal head.
(A) Minimal change of increased density of the epiphysis. (B) Later
stage of flattening of the epiphysis, increased joint space and loose
body separation.

16. Note that central bone has undergone re-
absorption.
Typical osteonecrosis of the head of the
second metatarsal seen in Freiberg's
infraction

17. OSTEOCHONDRITIS OF THE VERTEBRAL BODY
Vertebra plana/ Calves disease
Manifestation
collapse and increase density of vertebral
body
adjacent disc spaces are normal or
increased in width

18. Mostly caused by histiocytosis
May be associated with paraplegia
Regeneration is also expected
DDs-----Leukemia
Ewing's Sa
Mets
Tuberculosis

19. ADOLESCENT KYPHOSIS
Vertebral epiphysitis , Osteochondritis of vertebral
epiphyseal plates ,Scheurmanns disease
M=F
Begins at puberty , peak incidence 15 to 16 yrs
Region ---mid and lower thoracic spine
usually several adjacent vertebra

20. RADIOGRAPHIC APPEARANCES
Irregularity of superior and inferior parts of the
vertebral bodies
Wedging of vertebral bodies and kyphosis
later
Some scoliosis may be present
Schmorls nodes present with narrowing of disc spaces
Paraspinal bulge at the level of lesion

21. Improvement is slow and consolidation may take
several years
Radiographic recovery is often incomplete
Old kyphosis is most frequent abnormality
Vertebral defects are bounded by sclerotic rims(Not
seen in Tb. Lesions )

22. Residual wedging in late cases may be
indistinguishable from that caused by a previous
compression fracture.
Discography shows a disc filled with contrast medium
which extends between the vertebral body and the
detached fragment of bone.

23. protrusions of disc material into the surface of the vertebral body,

24. Discogram showing discal herniation into defects

25. MRI
Affected disc is narrowed
Loss of signal indicative of dehydration
Disc herniation into end plate defect and beneath the
non fused ring apophysis

26. T1 sag. of lumbar spine.
Rounded central end plate defects with herniation of discal material

27. OSTEOCHONDRITIS AT OTHER SITES
Hip and spine mostly involved
Capitellum
Patella---10
center Kohlers
Patella---20
center Sinding-Larsen
or Osgood-Schlatter

28. Sinding-Larsen disease. A good plain film will demonstrate thickening of the
ligamentum patellae origin, together with irregularity of the bone from which it
originates. The lower pole seems irregular and lengthened.

29. Medial tibial condyle(Blounts disease)/ tibia sara
From 1 to 12 yrs
Irregular defect at medial aspect of proximal
metaphysis
Spur at Rt< to and just below the defect

30. Adjacent tibial epiphysis may also be defective with
femoral spur
Lateral aspect is normal
Overall it is a varus deformity

31. Blount's disease. There is a large medial spur at the upper tibial metaphysis
with irregularity of the bone adjacent to the growth plate

32. OSTEOCHONDRITIS IN ADULT BONES
Usually associated with trauma
Scaphoid
Carpal lunate(Keinbocks)
Tarsal navicular
Medial seasamoid bone of great toe
Os trigonum

33. PLAIN FILMS
Fragmentation
Collapse
Sclerosis
Cyst formation
CT----Also shows same features

34. MRI
Mixture of
Low signals indicating collapse , condensation and
sclerosis
High signals of fluid ,cyst or vascularity (Healing)

35. The patient's injury was followed up 2
weeks later. The lunate showed little
sclerosis
Further imaging after a month suggested a
possible increase in the previously noted
lunate sclerosis

36. Thank you