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)
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
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.
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
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