bennett2

Question 1

Legg-calve-perthes disease

Answer 1

• Ischemic necrosis of the femoral capital ossification center
• males (4-8)
• Avascularity (occlusion of the blood supply to the femoral head)
• Self-limited
• SIGNS/SYMPTOMS
  
  • pain in region of the hip (synovial effusion)
  • antalgic gait (protect the hip)
  • limited range of motion (Abduction and internal rotation

Question 2

Four stages of LCPD

Answer 2

• Incipient or synovitis phase
  
  • soft changes around the hip (inflammation)
  • 1-3 weeks
• Aseptic necrotic/avascular stage
  
  • entire head or anterior half of the ossific nucleus is dead
  • no evidence of bone regeneration
  • last several months –> years
• regenerative/fragmentation stage
  
  • ingrowing fibrous vascular tissue and immature bone growth
• residual stage
  
  • rarefied area gradually disappear- normal trabecular patterns
  • residual coxa magna (if no treatment)

Question 3

TX of LCPD

Answer 3

• aimed at preventing deformity of the femoral head and degenerative chagnes in the hip
• preserve congruity of the joint
• abduction cast or some type of abduction brace
• femoral osteotomy and innominate osteotomy (prevent or overcome subluxation

Question 4

Osgood’s sclhatter’s disease

Answer 4

• osteochondrosis of the tibial tuberosity
• males (10-15 years/old)
• SYMPTOMS
  
  • pain and soft tissue edema
  • enlargement of the tibial tuberosity, with a maximum area of tenderness at the insertion of the patellar tendon
• Presumed etiology = trauma

Question 5

radiographic findings during the phases

Answer 5

• ACUTE PHASE = soft tissue swelling anterior to tibial tuberosity
• CHRONIC PHASE
  
  • type 1 = tibial tuberosity prominent and irregular
  • type 2 = same as above with small free particle of bone located at the anterior tuberosity
  • type 3 = normal tuberostiy with bone particle

Question 6

Treatment of Osgoods sclhatters disease

Answer 6

• withdrawal froma ctive sports that cause pain
• ICE, Nsaid, pad to protect tuberosity, rest
• cast for immobilization for 6 weeks
• COMPLICATION = doesn’t heal –> remains as a local source of pain

Question 7

Kohler’s disease**

Answer 7

• Osteochondrosis of the navicular
• 4x more common in males between 3-7
• ossification (18-24 months for males and 24-30 months in males)
• SYMPTOMS:
  
  • antalgic gain (weight bearing on lateral side)
  • local pain and tenderness over the navicular
  • posterior tibial tendon inflamed at its insertion site

Question 8

Kohlers disease radiographic findings

Answer 8

• flattening of the navicular
• irregular rarefactions and sclerosis
• Two radiographic patterns
  
  1. flattened navicular with pathcy areas of increased bone density and loss of normal trabecular
  2. normal shape navicular with increased density

(right is sclerotic)

Question 9

treatment of kohlers disease

Answer 9

• below knee walking cast (foot in 10-15 degrees of varus and 20 degrees of equinus) for 6-8 weeks
  
  • decrease strenuous activity
  • rigid orthoses or thomas heel
  • follow through with soft longitudinal arch support
  • prognosis very good

Question 10

Freibergs infarction

Answer 10

• Avascular necrosis of metatarsal head
• between ages 13-18 (more common in females)
• second metatarsal (most common location) and third metatarsal
• CLINICAL PRESENTATION
  
  • local pain, tenderness, swelling
  • limitation of mpj motion

Question 11

Classifications of freibergs infarction (stages 1-5)

Answer 11

• stage I = epiphyseal fissure fracture
• stage II = central portion of bone reabsorption
• stage III = metatarsal head begins to flatten
• stage IV = articular loose body
• Stage V = complete flattening of the metatarsal

Question 12

radiographic findings of kohlers disease

Answer 12

• widening of joint space with effusion
• initial lesion (subchondral bone fracture)
• central and dorsal head detaches
• loose fragment becomes encompassed in a cavity
• collapse of lateral margin

Question 13

treatment of kohlers disease

Answer 13

• acute stage = below the knee walking cast (3-4 weeks) or until symptoms subside
• use of metatarsal pad after cast removal
• orthoses
• adult = surgical intervention (metatarsal head resection or implant)

Question 14

Sever’s disease

Answer 14

• Osteochondrosis of the calcaneus
  
  • normal ossification appearance varies between 8-13 years old
• apophysis usually has a greater density than the calcaneus
• CLINICAL PRESENTATION
  
  • pain, tenderness to palpation
  • antalgic gain
  • exacerbated by activity
  • little pain in morning or after rest

Question 15

contributing factors for sever’s disorder

Answer 15

• gastroc-soleus equinus
• any foot deformity resulitn gin excessive pronation and decreased shock absorption
• cavus foot
• obesity
• inflammatory conditions
• LEVEL OF ACTIVITY!

Question 16

treatment of Severs disease

Answer 16

• decrease in activity
• short leg cast 2-4 weeks
• NSAID
• control pronatory force
• treat gastroc-soleus equinus

Question 17

Thiemann’s disorder

Answer 17

osteochondrosis of the palanges (proximal epiphyses)

Question 18

islen’s disease

Answer 18

osteochondrosis of the styloid process or base of 5th metatarsal

Question 19

Buschke’s disease

Answer 19

• Osteochondrosis of the cuneiform bones
• radiographs show IRREGULARITY OF CONTOUR AND FRAGMENTATION
• children between ages 5-13

Question 20

Diaz disease

Answer 20

osteochondrosis of the talus

Question 21

Treve disease

Answer 21

osteochondrosis of the sesamoids

Question 22

Osteochondritis dessicans

Answer 22

• juvenile and adult type
• basic distrubance due to epihpyseal development
• knee joint is most commonly affected
  
  • also medial femoral condyle, femoral head, talus
• SYMPTOMS
  
  • intermittent pain in the joint
  • stiffness
  • swelling
  • clicking and locking
  • giving way

Question 23

treatment of osteochondritis dessicans

Answer 23

• RADIOGRAPHIC = fragment of subchondral bone
• TREATMENT
  
  • conservative
  • long leg plaster cast
  • for a lesion of the talus a short leg cast
  • arthrotomy and insertion of graft