Bone osteochondropathy

Osteochondropathy is a group of diseases of the osteo-articular system. They are characterized by aseptic subchondral infarction of the marginal portion of the spongy substance of bone tissue in places with increased stress.

The main types of degenerative-dystrophic processes in bones:

• The epiphyseal ends of the tubular bones are the head of the femur, the head of the II and III metatarsal bones, the sternal end of the clavicle.
• Spongy bones - the patella, navicular bone of the foot and hand, the lunate bone of the hand, the body of the vertebrae, the sesamoid bone of the I metatarsophalangeal joint.
• Bone apophyses - tibial tuberosity, calcaneus tubercle, vertebral apophyses, pubic bone.
• Partial damage to the articular surfaces - the head of the femur, the distal end of the femur, the elbow and ankle joints, the head of the humerus, radial, and ulna bones.

Aseptic bone necrosis is primary and secondary:

1. Primary - develops in childhood, is associated with the action of vascular, age and endocrine factors. The rapid growth rate of the skeleton in children, the constitutional features of the skeletal system, have a significant significance for the development of the disease.
2. Secondary (symptomatic) - acts as a complication of the underlying disease. It develops on the background of bone ischemia, vasculitis, degenerative and metabolic disorders, neurotrophic and endocrine disorders and other pathological processes.

In most cases, the disease has a monoarticular lesion. Most often localized in the head of the femur, navicular bone, metatarsal bones. Occasionally, there is a multiple lesion of the epiphyses of the phalanges of the upper extremities, a bilateral lesion of the tibial tuberosity, and a calcaneal tuber.

Osteochondropathies of the bones are characterized by pronounced painful sensations at the site of the lesion, which are aggravated during exercise and decrease at rest. There is a local painful swelling due to reactive synovitis, which occurs when the injured part of the bone is traumatized. A slight deterioration in overall well-being is also possible.

The pathological process is characterized by a long course with a gradual disappearance of clinical and diagnostic signs. For diagnosis use a complex of laboratory and instrumental studies. Treatment consists of a course of drug therapy, physiotherapy, limited physical exertion. In severe cases, surgery is performed.

Osteochondropathy of the foot

The degenerative-dystrophic process in the bones of the foot is associated with necrosis of the cancellous bone, which is subjected to the greatest mechanical stress. Also, the disease is characterized by damage to the apophysis tubular bones. More often it is diagnosed in patients of childhood and adolescence, adults suffer very rarely.

In most cases, the pathology has a benign course, without affecting the functioning of the joints. The disease is characterized by self-healing. In this case, the presence of aseptic necrosis can be judged only by X-ray and the presence of deforming arthrosis.

The mechanism of the disease is not fully understood. Most often it is associated with local vascular disorders arising due to the action of various factors: trauma, infection, congenital and metabolic disorders.

Osteochondropathy of the foot has several forms:

1. The defeat of the navicular bone (Koehler's disease I) - most often develops in boys 3-10 years. Both one-sided and two-sided process is possible. Necrosis of the navicular bone in adults is Muller-Weiss syndrome.
2. Aseptic necrosis of the heads of the metatarsal bones (Koehler’s disease II) - this form of the disease occurs in less than 1% of cases of foot lesions. Most commonly diagnosed in female patients 10-20 years. In case of multiple necrosis, a static deformity of the foot is observed: plane-valgus and valgus deformity, transverse and longitudinal platypodia, dysplastic development.
3. The destruction of the sesamoid bone of the first metatarsophalangeal joint (Renander-Muller disease) occurs in women 15-30 years of age, manifested by sharp pains under the head of the first metatarsal bone, which are aggravated by the extension of the finger and during walking. Radiological signs determine the change in the structure of the affected bone, its fragmentation.
4. The defeat of the tuberosity of the V metatarsal bone - develops due to a violation of ossification, from the additional points of ossification. On the x-ray, there is an incompatible fracture of the tuberosity, persistent apophysis or the added bone of Vesalius. The disease is diagnosed in children with increased load on the foot. Patients have a limping gait with increased load on the internal foot.
5. Cutting osteochondrosis of the talus - most often occurs due to trauma of the ankle joint. The pathological process takes place in the region of the block of the talus and is manifested by aseptic inflammation. On X-ray, there is a focus of destruction with scalloped contours, separated from healthy tissue by the zone of sclerosis.
6. Aseptic necrosis of the calcaneal tuber (Gaglund-Shinz disease) - pain with pressure and palpation of the calcaneus occurs in patients 7-14 years. The disorder is manifested by periostitis or bursitis, it is possible to atrophy the muscles of the leg X-ray shows apophysis of the calcaneus, loosening of the cortex under the apophysis.

All of the above osteochondropathies go through several stages of development. Treatment depends on the stage of the disease, the presence of complications and the characteristics of the patient. Conservative therapy is most often carried out, but in especially severe cases surgical intervention is possible.

Osteochondropathy of the calcaneus

This form of degenerative-necrotic disease is more often diagnosed in children than in adults. The risk group includes girls 7-9 years old and boys 9-11 years old. Osteochondropathy of the calcaneus is characteristic of professional athletes and people who regularly experience increased physical exertion.

Schinz disease, that is, aseptic necrosis of the calcaneus develops due to a malfunction of the bone tissue. The main causes of the disorder include:

• Endocrine and metabolic disorders.
• Poor calcium absorption.
• Injuries and increased physical activity.

Symptoms of the disease depends on its stage and the presence of complications. In some, it proceeds sluggishly for an extended period of time, while in others it causes acute pain. Disruption of nutrition of the bone tissue is manifested by swelling in the affected area, there are problems with flexion and extension of the foot, pain when attempting to palpation. It is also possible to increase the local body temperature, limp when walking, pain in the place of attachment of the Achilles tendon to the bone of the heel.

Diagnosis consists of radiography, CT, MRI. X-ray shows violations of the structural patterns of apophysis and fragmentation, distorted the distance between the heel bone and the apophysis. In the sore leg, the roughness of the contours is more pronounced than in the healthy. It is mandatory to conduct differential diagnostics. Pathology is compared with analogous symptoms in the bones.

The treatment consists of a course of drug therapy. Patients prescribed chondroprotectors and calcium supplements, analgesics. Physiotherapy is shown to relieve pain and stimulate regenerative processes. It is also necessary to minimize the load on the affected limb and to choose the right shoes.

Osteochondropathy of the calcaneal tuber

The destruction and slow restoration of the cancellous spongy bone of the calcaneal tuber is predominantly found in female patients 12–15 years old. The disease can have one or two-sided nature of the lesion.

Causes of the degenerative process in the bones:

• Microtrauma.
• Increased exercise.
• Endocrine, vascular and neutrophic factors.

The main symptoms include: severe pain when walking, swelling of the affected tissues, altered structure and muscular atrophy. Diagnosis consists of a set of laboratory and instrumental methods. Differentiation is also carried out with bone tuberculosis, malignant tumors, bursitis, periostitis, osteomyelitis, inflammatory lesions.

Treatment begins with conservative methods. Immobilization of the affected limb, anesthesia, physiotherapy, taking multivitamin complexes. If the above methods did not bring the desired therapeutic result, then surgical intervention is indicated. Special attention is paid to preventive measures aimed at preventing the recurrence of the disease.

Osteochondropathy of the metatarsal bones

The metatarsi are five tubular short bones that are part of the foot. They are subject to degenerative-dystrophic processes. Alban Koehr's disease II or aseptic necrosis of the metatarsal bones is more common in young women. The main reason for the development of pathology is the frequent and prolonged wearing of high-heeled shoes.

The painful condition gradually progresses, causing acute pain while walking. Changing shoes and reducing the load on the legs eases discomfort, but necrosis of the bones continues, turning into deforming arthrosis. On X-rays, a compacted head of the metatarsal bone and its fragmentation are detected.

Treatment in most cases conservative. Patients are shown to reduce the load on the leg, physiotherapeutic procedures, wearing instep supports. In severe cases, resection of the metatarsal bone is performed to remove extensive bone growths.

Osteochondropathy of the metatarsal head

Aseptic lesion of the head of the metatarsal bone is most often diagnosed in female patients 12-18 years old. In 10% of cases, necrosis affects several metatarsal bones, and bilateral lesions are less common.

The main cause of the disease is the malnutrition of the bone. This occurs when injuries, wearing close or not in size shoes, due to overload of the lower extremities, flatfoot (static transverse, longitudinal). Tissue destruction occurs gradually, so the symptoms appear incrementally. Signs of disorder include:

• Painful sensations when loading the foot.
• Hromot.
• Impossibility to walk barefoot, in soft shoes and on uneven ground.
• On the dorsum of the foot, at the level of the lesion, there is a slight swelling that extends proximally along the metatarsal bone.
• Palpation of the head is painful.
• Shortening the finger adjacent to the head.
• Deformity of the metatarsophalangeal joint and restriction of movements in it.

For the diagnosis used radiography, computed tomography, magnetic resonance imaging. Also shown are laboratory tests and differential techniques.

X-ray signs of the disease:

1. The first stage is manifested by a slight compaction of the structure of the bone tissue of the lesion.
2. At the second stage, there is a thickening of the articular surface of the metatarsal head and an increase in the density of its bone tissue.
3. The third stage is characterized by fragmentation, that is, the resorption of necrotic bone tissue.
4. The fourth stage is the restoration of the structure of the deformed bone and the disappearance of signs of fragmentation.

In differentiation, the disease is associated with complications of a metatarsal head fracture, inflammatory processes, Deutschlander's disease (march fracture).

In the first and second stages, the immobilization of the affected limb is shown. At later stages, it is necessary to wear an orthopedic insole with a calculation of the transverse and longitudinal arches of the foot. You should also completely eliminate any overload of the foot. To reduce pain and stimulate regenerative processes, physiotherapy is performed.

If conservative therapy did not produce the expected results, then surgery is performed. Surgical intervention is aimed at removing bone growths that increase pain and interfere with the normal wearing of shoes. It is also possible to restore the mobility of the joint. The prognosis is in most cases favorable. Launched forms of the disease turn into deforming arthrosis in violation of the functions of the forefoot.

Osteochondropathy of the navicular bone

Koehler's disease I is rarely diagnosed and usually after injuries. This pathology is more common for boys 3-10 years old and older. Both unilateral and bilateral aseptic necrosis of the navicular bone is possible. If the disorder is detected in adults, then it refers to an independent nosological form of osteochondropathy and is called Muller-Weiss syndrome.

In children, the disease occurs in violation of the process of ossification of the navicular bone. On the radiograph, this is manifested by the following symptoms:

• Increased density of the affected bone.
• Flattening of the nucleus of ossification.
• Fragmentation of the navicular bone in the sagittal direction.
• Increased interosseous space.

On the back of the foot, swelling and pain appear at its inner edge. Because of this, the patient limps, advancing a sore limb. The disease can occur on the background of flatfoot, deformities of the foot and fingers. When differentiation takes into account the possibility of a fracture, inflammation, isolated tuberculous lesions.

The treatment is conservative. It is necessary to ensure the immobilization of the affected limb with the help of gypsum. It is mandatory to conduct physiotherapy procedures that improve the blood supply to the affected tissues, anesthetize and promote healing. Surgical intervention is not carried out. The duration of the complete restoration of the bone structure takes 1.5-2 years.

Osteochondropathy of the talus

The suprateal or ramus bone is one bone forming the lower part of the ankle. It is 60% covered with articular cartilage and is responsible for the transfer of body weight to the surface of the foot. The bone consists of several parts: the block, the head, the posterior process.

Aseptic necrosis of this localization is rare, threatens with limitation of mobility, disability. This problem is more often faced by men than women. The main age group of patients 20-45 years.

Causes of degenerative-dystrophic processes:

• Complications of fracture.
• Circulatory disorders.
• Ankle injuries.
• Increased exercise.

The disease is characterized by a slow course. Necrosis goes through several stages. The main symptoms include local swelling and pain when walking.

In the process of diagnosis used x-rays, CT, MRI, a complex of laboratory tests. On X-rays, a cell of destruction with a cellular structure, delimited by sclerosis from healthy bone, is clearly defined. There is also a protrusion and thinning of the locking plate over the lesion. In this case, both one and two-way process is possible.

Treatment in most cases conservative. Patients are prescribed medication and physiotherapy to improve blood circulation, restore bone cell density and stimulate regenerating processes. With timely treatment for medical care - the prognosis is favorable.

Osteochondropathy of the hip joint

Legg-Calvet-Perthes disease accounts for about 2% of all orthopedic pathologies. Most often, it is diagnosed at the age of 4-14 years. At the same time, male patients suffer more often than female patients. Pathological process can be bilateral, but unilateral localization of necrosis is more common.

Causes of hip joint injury:

• Myelodysplasia of the lumbar spinal cord.
• Inflammation of the hip joint.
• Injuries with clamping vessels and circulatory disorders.
• Infectious diseases.

The early stages of the degenerative process are asymptomatic. As they progress, pain in the hip and knee joints, and lameness. In the future, the deformation of the femoral head and the restriction of movement in the sore joint. Deformation depends on the size of the lesion and determines the outcome of the pathology.

For the diagnosis using MRI, ultrasound of the hip joints and radiography. The treatment is aimed at restoring the anatomical structure of the bone to prevent gait disturbances and eliminate pain. Patients are prescribed medications, physiotherapy, physiotherapy. Surgical treatment is indicated for severe forms of the disease. The operation is aimed at improving the blood supply to the thigh and the elimination of disorders in the joint. The duration of treatment takes from 3 to 4 years.

Osteochondropathy of the femur

Perthes disease is a pathological condition in which the blood supply to the femoral head is disturbed with its further aseptic necrosis. It occurs in childhood and adolescence from 3 to 14 years, is one of the most common osteochondropathies. Boys are sick more often than girls, but in the latter the disease is with severe complications.

Causes and factors of bone malnutrition:

• Exchange violations.
• The impact of external factors.
• Injuries and damage.
• Myelodysplasia.
• Inflammatory and infectious diseases.
• Hormonal changes in adolescence.
• Metabolic disorders involved in the formation of bone tissue.
• Genetic predisposition.
• Anomalies of the structure of the hip joint.

Aseptic necrosis of the femur goes through five main stages of development:

1. Disturbance of blood supply and the formation of the center of necrosis.
2. Impression fracture in the destroyed area.
3. Resorption of necrotic tissue, shortening of the femoral neck.
4. The proliferation of connective tissue in the lesion.
5. Replacement of the connective tissue of the new bone, fracture fusion.

In the first stages, mild pains occur during walking, which are located in the region of the hip joint. Discomfort can be given to the knee joint or to capture the entire leg. The patient begins to limp, podvolakivaya affected limb. Further destruction of the head and its impression fracture provokes sharp pains and severe lameness. Against this background, mobility is limited, the patient cannot turn out the leg, flexion and extension movements in the hip joint are limited. There are also vegetative disturbances in the distal parts - pale and cold foot, increased sweating.

For the diagnosis of conduct radiography, MRI, CT. Treatment depends on the stage of the disease, its complications and symptoms. In most cases, therapy is conservative. The complete unloading of the limb, taking drugs to improve blood circulation and stimulate the growth of bone tissue is shown. Physiotherapy is equally effective in maintaining muscle tone and accelerating the regeneration process.

Osteochondropathy of the femoral head

This is one of the most common forms of degenerative-dystrophic bone disease. Occurs in patients 5-12 years old. Unilateral lesions are most common, but bilateral pathological process is also possible. The main causes of the disorder include circulatory disorders, injuries, past diseases and genetic predisposition.

In the early stages of the disease, symptoms are blurred. As it progresses, pronounced pain occurs when walking, muscle atrophy, lameness, shortening of the affected limb by 1-2 cm. Diagnostic signs of necrosis appear after 6 months. On X-rays, this is determined by a uniform darkening of the femoral head due to necrosis and impression fracture.

The treatment is aimed at restoring the functional capabilities of the affected limb. The limitation of mobility of the hip joint, the use of crutches and orthopedic devices is shown. Surgical intervention is rarely performed and is aimed at improving the blood circulation of the femoral head.

Osteochondropathy apophysis

Scheuermann-Mau disease is an aseptic necrosis of the apophyses, that is, processes of the vertebral bodies. This form of the disease is more often diagnosed in patients during the period of intensive growth, that is, 11-18 years. The main cause of pathology is congenital defects in the development of intervertebral discs, a violation of the strength of the endopaque vertebral plates. Risk factors include endocrine diseases, functional overload, and injuries. That is, a violation of the ossification process in the growth zone of the vertebral bodies leads to their necrosis and deformation.

Degenerative-dystrophic processes are typical for VII, VIII, IX and X thoracic vertebrae. It is also possible damage to the lumbar-thoracic and lumbar. Symptoms of a disease depend on its stage.

The main signs of necrosis:

1. In the first stage, the pain is minimal. Possible asymmetry of the shoulder girdle, slightly increased thoracic kyphosis, paravertebral asymmetry. At the level of pathological changes are the spinous processes, palpation which causes pain. It is also possible to limit the slope of the case.
2. For the second stage is characterized by the appearance of ossification of the apophyses. There are pains in the back during long walking or sitting, increased fatigue and muscle weakness of the legs, back. Increased thoracic kyphosis, deformity. Develops radicular syndrome with limited mobility of the vertebrae.
3. The third stage is the fusion of the apophyses with the vertebral bodies. It is characterized by kyphosis and sphenoid deformity of the vertebral bodies, signs of arthrosis of the spine with acute pain syndrome. Fixed kyphosis and lumbar lordosis are not amenable to correction.

Diagnosis consists of a set of instrumental and differential techniques. Treatment in most cases conservative. Patients are prescribed fortifying procedures, taking vitamins, gentle work and rest. To develop a correct posture, you must choose a hard mattress, it is also possible to wear a special corset - posture corrector.

The therapeutic effect is swimming, back massage, physiotherapy. In severe kyphosis with neurological complications, surgical intervention is performed. With timely treatment, the disease has a favorable prognosis.

Osteochondropathy of the knee joint

This type of aseptic necrosis is most often diagnosed in patients of childhood and adolescence. The main cause of damage to the knee joint is increased mechanical loads and injuries.

The degenerative-dystrophic process includes several pathologies in the knee area, each of which has its own symptoms and localization:

• Koenig disease - damage to the surface of the knee and patello-femoral joint.
• Osgood-Schlatter disease - necrosis of tibial tuberosity.
• Sinding-Larsen-Ioganson disease - lesion of the superior / inferior patella.

In the initial stages of the disease does not appear bright symptoms. Suspected pathology can be pain syndrome, which increases during exercise on the knee. At the same time in a state of rest the discomfort goes away. In the later stages of necrosis, the pain becomes permanent.

Diagnose the disease using ultrasound, MRI, scintigraphy, arthroscopy and differential methods. For the treatment can be used both conservative and surgical methods. In the first case, a decrease in the load on the knee is shown by fixing it. During the operation, the cartilaginous body is removed with further chondroplasty.

The outcome of the disease depends on its stage and the presence of complications. With timely treatment for medical care, the prognosis is favorable. At later stages there is a risk of gonarthrosis, lameness, and limitation of movement of the knee joint. Full recovery of the affected limb takes about 1 year.

Patella osteochondropathy

Sinding-Larsen-Ioganson's disease is an aseptic necrosis in the patella area. Most often, this pathology is detected in patients 10-15 years old. The disease refers to polyetiological. The degenerative process may be associated with the rupture and separation of a portion of bone tissue from the patella due to the increased function of the quadriceps muscle.

Symptoms of pathology:

• Increasing pain in the knee joint.
• Soft tissue swelling of the affected area.
• Atrophy / strain of the quadriceps femoris.

In some cases, osteochondropathy of the patella occurs against the background of necrosis of the tibial tuberosity, that is, Osgood-Schlatter syndrome.

For the diagnosis used various instrumental techniques. On the radiograph is determined by the defeat of the cortical layer of the anterior-lower part of the patella, the fragmentation of its lower pole, periostitis.

Treatment consists of a complex of conservative methods. Patients are shown joint unloading, physiotherapy, massage. If the disease is not amenable to conservative treatment, then surgery is performed with the removal of the affected bone.

Clavicle osteochondropathy

The destruction and slow recovery of spongy bone tissue of the clavicle is extremely rare. This pathology is called Friedrich syndrome. Most often it is diagnosed in adolescent patients. Etiology in most cases associated with microtrauma.

Symptoms of the disease:

• Painful swelling in the sternoclavicular joint.
• Pain aggravated by exertion.
• On the radiograph is determined by the thickening of the sternal end of the clavicle and focal enlightenment, bone tissue is fragmented.

For the diagnosis using CT, MRI, radiography. In differentiation, the disease is associated with periostitis, clavicle osteomyelitis and other pathologies. The treatment is conservative. The orthopedist fixes the upper limb on the affected side for 7-10 days. Also shown are physiotherapy and the intake of mineral complexes. The prognosis is favorable.

[1], [2], [3], [4], [5], [6], [7], [8]

Osteochondropathy of the humerus

The humerus is the part of the skeleton of the upper limb, between the shoulder blade above, the ulnar bone and the radius bone below. It belongs to the long tubular bones, takes part in the formation of the shoulder and elbow joints, ensuring the freedom of their movements. The degenerative-dystrophic process is the destruction of bone matter with areas of necrosis and their replacement with adipose tissue.

Damage to the humeral head is one of the causes of aseptic necrosis. Also, the development of the disease may be associated with such factors:

• Violation of the blood supply to the bone.
• Squeeze syndrome
• Rough medical manipulations.
• Long-term hormone therapy with corticosteroids.
• Thrombosis and inflammatory diseases.
• Immunodeficiency states.
• Radiation or chemotherapy.
• Decompression states.

Aseptic necrosis of the humerus is manifested by painful sensations during palpation of the bone and with increased physical exertion. As the necrosis progresses, the mobility of the affected limb is disturbed, the muscles of the shoulder girdle atrophy, the bone becomes fragile.

Diagnosis consists of a visual inspection of the affected area, radiography, MRI, and laboratory tests. Medical treatment, with a course of physiotherapy. The operation is carried out only in severe cases. With timely treatment, the disease has a positive prognosis.

Osteochondropathy of the tibia

This pathology is a severe degenerative-dystrophic process in the bone tissue due to disruption of its blood supply, structure and fatty degeneration of the bone marrow. The disease belongs to the polyetiological, but there are a number of major factors that increase the risk of necrosis:

• Injuries and dysplasia.
• Toxic effects of drugs.
• Osteopenia
• Osteoporosis.
• Rheumatoid arthritis.
• Coronary heart disease.

Pathological condition is manifested by pains in the area of the hip joint and groin, which can be given to the knee, lower back, sacrum. As the disease progresses, discomfort becomes permanent. The patient begins to limp, the affected limb loses its mobility due to muscle atrophy.

Diagnosis of aseptic necrosis of the tibia consists of a review X-ray, MRI, CT, soft tissue scintigraphy. Conservative treatment: physiotherapy, medication, exercise therapy. Surgery is possible with serious degenerative changes.

Osteochondropathy of the fibula

The fibular bone is a tubular thin and long part of the calf. It connects with the tibia bone, consists of a body and two ends. It performs the function of an external stabilizer of the ankle joint.

Degenerative-dystrophic lesion of the fibula often occurs on the background of necrosis of the pelvic bones and is manifested by such signs: dilation of the joint space, reduction in the height of the epiphyses, bone death.

The disease causes pain during movement and palpation of the lesion. Pathology is characterized by cyclical course. Its total duration takes from 2 to 4 years. Complex treatment: drugs, physiotherapy, exercise therapy, mineral complexes.

Osteochondropathy of tibial tuberosity

Osgood-Schlatter disease  is one of the common forms of aseptic necrosis in children. The lesion of the tibial tuberosity is diagnosed in patients 10-18 years old, actively involved in sports. The disease can be both unilateral and with symmetric lesions of both limbs.

The main cause of the disorder is frequent injuries and increased exercise. The degenerative-dystrophic process is manifested by the following symptoms:

• Swelling of the lesion.
• Local tenderness for palpation and flexion of the limb.
• On palpation, a solid bone growth is determined.

In the early stages, discomfort is periodic. As the progression of pain becomes persistent, worse when walking, squatting. Due to edema, there is a moderate deformation of the anterior proximal part of the tibia. This is clearly seen from the side when the knee is bent. Tuberosity can be elastic or dense bone structure.

At statement of the diagnosis radiological signs of pathology are considered. A change in the structure and contours of the tibial tuberosity is observed — light areas alternate with dark and structureless, an edge cavity is formed. Differentiation is carried out with recurrent subluxation of the patella, cartilage tissue tumors, detachable fracture of the tibial tuberosity, osteomyelitis, and infra-epithelial bursitis.

The treatment consists of limiting flexion movements in the knee joints of the diseased limb. Patients are prescribed painkillers, bone tissue and the body that strengthen the medicines. Physical therapy is aimed at stimulating the regenerative processes. Surgical intervention is extremely rare, since there is a risk of damage to the germ zone and the development of synostosis. The disease lasts 1-1.5 years and ends with the restoration of bone structure. In advanced cases, deformation of the lesion is possible.

Osteochondropathy of the ischium

One of the three parts forming the pelvic bone is the ischial bone. Aseptic necrosis of this localization is Van Nek syndrome. The disease manifests itself at the age of 6-10 years, in boys more often than in girls. Pathology is manifested by pains in the hip and groin, reflex limp, fever. In some cases, there is limited pain in the area of the symphysis.

Used for the diagnosis of instrumental methods: radiography, MRI. On the x-ray is determined spherical expansion in the region of the ischial bone, single or bilateral necrosis. The degenerative process is differentiated with tumor lesions of the pelvis, bone tuberculosis, osteomyelitis. Treatment and prognosis depend on the severity of the disease.

Osteochondropathy of the sphenoid bone

Aseptic necrosis of the tarsus bones of the foot (resembling wedges) is Kücher syndrome. Damage to the sphenoid bone occurs due to shock, excessive pressure, twisting or bending of the foot. One of the most common causes of illness is wearing the wrong shoe, which does not fit the size and width of the foot.

The degenerative process is manifested by pains in the foot, which are aggravated during walking. The patient begins to limp, trying not to step on the diseased limb. To confirm the diagnosis, radiography is performed. Osteochondropathy of the sphenoid bone is differentiated with its fracture.

Treatment in most cases conservative. The patient's limb is immobilized with a plaster boot, and medication is prescribed to improve blood circulation. Also recommended physiotherapy, stimulating the regeneration of bone tissue.