Osteochondroses

Definition

The term osteochondroses refers to a group of diseases of children and adolescents in which localized tissue death (necrosis) occurs, usually followed by full regeneration of healthy bone tissue. The singular term is osteochondrosis.

Description

During the years of rapid bone growth, blood supply to the growing ends of bones (epiphyses) may become insufficient resulting in necrotic bone, usually near joints. Since bone is normally undergoing a continuous rebuilding process, the necrotic areas are most often self-repaired over a period of weeks or months.

Osteochondrosis can affect different areas of the body and is often categorized by one of three locations: articular, non-articular, and physeal.

Physeal osteochondrosis is known as Scheuermann disease or juvenile kyphosis. It is a deformity of the thoracic spine (in the chest area, the vertebra to which ribs are attached) caused by abnormal centers of bone development at the intervertebral joints (physes). It is most common among children ages 13 to 16.

Articular disease occurs at the joints (articulations). One of the more common forms is Legg-Calvé-Perthes disease, which occurs at the hip joint. Other forms include Köhler disease (foot), Freiberg disease (second toe), and Panner disease (elbow). These diseases are most common during adolescence , although they have been found in individuals ranging in age from eight to 77.

Non-articular osteochondrosis occurs at any other skeletal location. For instance, Osgood-Schlatter disease of the tibia (the large inner bone of the leg between the knee and ankle) is relatively common. It is often the cause of knee and leg pain in active teens.

Osteochondritis dissecans (OCD) is a form of osteochondrosis in which loose bone fragments form in a joint. The knee is a common site for osteochondritis dissecans. The condition is found most often in people aged ten to 20, although it may occur at other ages. OCD is sometimes associated with some sort of past trauma to the joint. In about 30 to 40 percent of cases the same joint on both sides of the body is involved (e.g. both knees, both elbows).

Demographics

Osteochondroses are disorders of teens and young adults. Some are rare disorders, and in many cases, the number of individuals who have these disorders is not known, since cases many resolve on their own. Scheuermann disease is thought to occur in 0.4 to 8 percent of individuals. One Finnish study found that 13 percent of adolescents had Osgood-Schlatter disease. Freiberg disease is the one type of osteochondrosis that is more common in females than in males. OCD affects males about twice as often as females. All other osteochondrosis appear to affect the sexes equally.

Causes and symptoms

Many theories have been advanced to account for osteochondrosis, but none has proven fully satisfactory. Stress on the bone, ischemia (reduced blood supply), and trauma to the site are commonly mentioned factors. Athletic children are often affected when they overstress their developing limbs with a particular repetitive motion. Many cases are idiopathic, meaning that no specific cause is known.

The most common symptom for most types of osteochondrosis is pain, usually a dull, non-specific ache, at the affected joint. Pain is especially noticeable when pressure is applied. Locking of a joint or limited range of motion at a joint can also occur.

Scheuermann disease can (rarely) lead to serious kyphosis (hunchback condition) due to erosion of the vertebral bodies. Usually, however, the kyphosis is mild, causing no further symptoms and requiring no special treatment.

When to call the doctor

A doctor should be consulted whenever a child has a persistent joint pain that does not go away after resting the joint for a few days.

Diagnosis

Diagnosis is suspected based on history and symptoms. It can be confirmed by x-ray findings.

Treatment

Conservative treatment is usually attempted first. In many cases, resting the affected body part for a several days or weeks brings relief. A cast may be applied if needed to prevent movement of a joint.

Surgical intervention may be needed in some cases of osteochondritis dissecans to remove abnormal bone fragments in a joint. Rarely is spine curvature so pronounced in Scheuermann disease that the individual needs to wear a brace or have surgical intervention.

Prognosis

Accurate prediction of the outcome for individual adolescents is difficult with osteochondrosis. Some individuals heal spontaneously. Others heal with little treatment other than keeping weight or stress off the affected limb. The earlier the age of onset, the better the prospects for full recovery. Surgical intervention is often successful in osteochondritis dissecans.

Prevention

No preventive measures are known.

Parental concerns

Persistent pain in the joint may keep children temporarily from playing sports .

KEY TERMS

Osteoblast —A bone-building cell.

Osteoclast —A large, multinuclear cell involved in the physiological destruction and absorption of bone.

Resources

WEB SITES

Boyer, Matison, and James K. DeOrio. "Freiberg Infraction." eMedicine.com, April 21, 2004. Available online at <www.emedicine.com/orthoped/topic492.htm> (accessed January 16, 2005).

Ertl, James P., and Gyorgy Kovacs. "Knee Osteochondritis Dissecans." eMedicine.com 5 June 2002. Available online at <www.emedicine.com/sports/topic57.htm> (accessed January 16, 2005).

Joshi, Aparna. "Osgood-Schlatter Disease." eMedicine.com, July 2, 2004. Available online at <www.eMedicine.com/radio/topic491.htm> (accessed January 16, 2005).

Nowak, Jozef. "Scheuermann Disease." eMedicine.com, September 1, 2004. Available online at <www.emedicine.com/pmr/topic129.htm> (accessed January 16, 2005).

Tish Davidson, A.M.

Victor Leipzig, PhD

Osteochondroses

Definition

Osteochondroses is a group of diseases of children and adolescents in which localized tissue death (necrosis) occurs, usually followed by full regeneration of healthy bone tissue. The singular term is osteochondrosis.

Description

During the years of rapid bone growth, blood supply to the growing ends of bones (epiphyses) may become insufficient resulting in necrotic bone, usually near joints. The term avascular necrosis is used to describe osteochondrosis. Since bone is normally undergoing a continuous rebuilding process, the necrotic areas are most often self-repaired over a period of weeks or months.

Osteochondrosis can affect different areas of the body and is often categorized by one of three locations: articular, non-articular, and physeal.

Physeal osteochondrosis is known as Scheuermann's disease. It occurs in the spine at the intervertebral joints (physes), especially in the chest (thoracic) region.

Articular disease occurs at the joints (articulations). One of the more common forms is Legg-Calvé-Perthes disease, occurring at the hip. Other forms include Köhler's disease (foot), Freiberg's disease (second toe), and Panner's disease (elbow). Freiberg's disease is the one type of osteochondrosis that is more common in females than in males. All others affect the sexes equally.

Non-articular osteochondrosis occurs at any other skeletal location. For instance, Osgood-Schlatter disease of the tibia (the large inner bone of the leg between the knee and ankle) is relatively common.

Osteochondritis dissecans is a form of osteochondrosis in which loose bone fragments may form in a joint.

Causes and symptoms

Many theories have been advanced to account for osteochondrosis, but none has proven fully satisfactory. Stress and ischemia (reduced blood supply) are two of the most commonly mentioned factors. Athletic young children are often affected when they overstress their developing limbs with a particular repetitive motion. Many cases are idiopathic, meaning that no specific cause is known.

The most common symptom for most types of osteochondrosis is simply pain at the affected joint, especially when pressure is applied. Locking of a joint or limited range of motion at a joint can also occur.

Scheuermann's disease can lead to serious kyphosis (hunchback condition) due to erosion of the vertebral bodies. Usually, however, the kyphosis is mild, causing no further symptoms and requiring no special treatment.

Diagnosis

Diagnosis can be confirmed by x-ray findings.

Treatment

Conservative treatment is usually attempted first. In many cases, simply resting the affected body part for a period of days or weeks will bring relief. A cast may be applied if needed to prevent movement of a joint.

Surgical intervention may be needed in some cases of osteochondritis dissecans to remove abnormal bone fragments in a joint.

Prognosis

Accurate prediction of the outcome for individual patients is difficult with osteochondrosis. Some patients will heal spontaneously. Others will heal with little treatment other than keeping weight or stress off the affected limb. The earlier the age of onset, the better the prospects for full recovery. Surgical intervention is often successful in osteochondritis dissecans.

Prevention

No preventive measures are known.

Resources

BOOKS

Eilert, Robert E., and Gaia Geogopoulos. "Orthopedics." In Current Pediatric Diagnosis and Treatment, edited by W. W. Hay, Jr., et al. Stamford: Appleton & Lange, 1997.