1. osteochondritis

2. 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. Koehler’s disease : osteochond. Of the navicular
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 : Schermann`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

18. 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 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 .

19. Osteochondritis dissecans