osteochondrosis Саху Сарита Кумари pptx.pptx

Osteoarthritis
Osteoarthrosis
Osteochondrosis
Trauma
Orthopedic

1. OSTEOCHONDROSIS Саху Сарита Кумари Л-505В

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

3. 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

4. FEMORAL HEAD 1 Aseptic necrosis Legg-Calve-Perthe- TARSAL NAVICULAR 1 Aseptic necrosis Necrosis following # Kohler METATARSAL HEAD 1 Aseptic necrosis Necrosis following # Freibergs LUNATE 1 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

5. 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)

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

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

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

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

10. OSTEOCHONDRITIS OF TARSAL NAVICULAR

11. 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 .

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

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

14. 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.

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

16. 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

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

18. 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

19. 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

20. 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 )

21. 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.

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

23. Discogram showing discal herniation into defects

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

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

26. OSTEOCHONDRITIS AT OTHER SITES Hip and spine mostly involved Capitellum Patella---1 center Kohlers Patella---2 center Sinding-Larsen or Osgood-Schlatter

27. 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.

28. 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

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

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

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

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

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

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

35. Thank you