Osteochondropathy

A group of diseases with a long cyclical course, malnutrition of the bone tissue and its further aseptic necrosis are osteochondropathy.

This pathology has a dystrophic nature and is closely related to genetic factors. According to the International Classification of Diseases ICD 10, it is included in group XIII Diseases of the musculoskeletal system and connective tissue (M00-M99):

M80-M94 Osteopaths and Chondropati:

• M80-M85 Violations of bone density and structure.
• M86-M90 Other osteopathy.
• M91-M94 Chondropati.

According to radiological manifestations and secondary clinical signs, the disease is associated with resorption and replacement of the destroyed areas of the bone. Aseptic osteochondrocrosis is characterized by cyclical interchangeable such processes:

• Non-inflammatory (aseptic) bone necrosis.
• Pathological fracture in the affected area.
• Resorption and rejection of necrotic parts of the bone.
• Damage recovery.

If articular cartilage is involved in the pathological process, then there are high risks of dysfunction of its function. The disease is characterized by a long, chronic course. With timely and adequate treatment has a favorable outcome.

[1], [2]

Epidemiology

According to medical statistics, many diseases of the musculoskeletal system are associated with impaired bone structure and density and are most often found in elderly people. But with osteochondropathy all the way around, it manifests itself in the period of active growth of the organism. It is diagnosed mainly in patients 10-18 years of athletic physique. At the same time, the majority of cases are boys.

The main affected area is the bones of the joints, which are exposed to increased muscular loads and microtraumas: knees, hip joint, feet. Adult patients with degenerative joint lesions are diagnosed with osteoarthritis, which has a clinical picture similar to aseptic necrosis.

[3], [4]

Causes of the osteochondropathy

To date, the exact cause of the development of degenerative-necrotic lesions of certain parts of the bones has not been established. Studies indicate that osteochondropathy is associated with such factors:

• Hereditary predisposition
• Hormonal imbalance.
• Endocrine diseases.
• Exchange violations.
• Frequent herbs and microtraumas.
• Infectious diseases.
• Unbalanced nutrition.
• Impaired interaction between bone tissue and vessels.
• Violation of the nervous trophism and regulation of blood flow.
• The limbs and the spine are in an unnatural position for an extended period of time.
• Atrophy of the femoral muscles.
• Long reception of certain groups of medicines.

In the process of diagnosis, all of the above reasons are taken into account, and treatment is aimed at preventing them in the future.

[5],

Risk factors

There are a number of factors that significantly increase the risk of malnutrition of bone tissue:

• Children and adolescence.
• Developed muscle mass.
• Overweight.
• Male.
• Genetic factor.
• Endocrine pathology.
• Inadequate nutrition.
• Disorders of the metabolism of vitamins and calcium.
• Excessive physical exertion, injury.
• Systemic connective tissue disease.
• Use of corticosteroids.
• Neutrophic disorders.
• Age changes.
• Congenital malformations of organs and systems.
• Wrong shoes.

The more combinations of the above factors, the higher the risk of developing osteochondropathy.

[6],

Pathogenesis

The mechanism of development of damage to bones and joints is not fully understood. The pathogenesis of osteochondropathy is associated with excessive physical exertion and injury. There are also a number of other predisposing factors that may be associated with the development of the disease:

• Metabolic syndrome (metabolic irreplaceable substances).
• Hormonal imbalance due to endocrine pathologies.
• Diseases of the pituitary, thyroid, ovaries, adrenal glands.
• Various infectious diseases.
• Deficiency of magnesium, calcium and other beneficial substances in the body.
• Disorder of the blood supply to the bone tissue.
• Obesity of any stage.
• Professional sports and frequent microtraumas.

The degenerative-dystrophic process in bones is closely related to hereditary factors. If one of the parents suffers from damage to the bones and joints, then under the action of the above factors, the child may inherit this problem.

[7], [8], [9], [10]

Symptoms of the osteochondropathy

There are several types of osteochondropathy, each of which has its own symptoms.

Consider the symptoms of the most common pathologies:

1. Hip joint injury:

• Patients 4-9 years.
• Restriction of movements in the joint.
• Muscular atrophy in the lower leg and thigh.
• The defeat of the head of the hip bone.
• Severe pain in the damaged area.
• Soreness in the knee.
• Shortening of a sore limb by 1-2 cm.

2. Tuberous tibia:

• Patients 12-15 years old, male.
• Swelling in the affected area.
• Increased pain with intense movements.
• Impaired joint function.

3. Metatarsus:

• Children's age of patients.
• Systematic pain in the lesion.
• Swelling and redness of the skin from the back of the foot.
• Restriction of motor function.
• Shortening of the 2nd and 3rd fingers of the affected limb.

4. Damage to the vertebrae and spine:

• Kyphosis of the thoracic and lower thoracic spine.
• Discomfort in the back.
• Interpersonal Neuralgia.
• Fast back fatigue.
• Deformation of the affected segment.

The localization of pain syndrome depends entirely on the area of damage, and the severity of pain depends on the severity of the pathological process. In all cases, the discomfort increases with physical exertion, causing a number of additional symptoms.

There are a number of symptoms that indicate the development of aseptic necrosis. The first signs of the disease include:

• Physical activity causes exacerbation of pain in the affected area.
• Swelling of affected tissues.
• Crunch of joints during movements.
• Limited motor functions and lameness.
• Changes in structure and muscular atrophy.

Ignore the above signs is unacceptable. Without timely medical care, they begin to progress rapidly, causing acute pain and complications.

Stages

Degenerative-necrotic disease of certain parts of the bone has several stages, each of which has certain symptoms:

1. Necrosis of bone tissue - there are mild pain in the affected area with impaired functioning of the limb. Regional lymph nodes are normal, palpation reveals nothing. Radiological changes are absent. Lasts from several months to six months.
2. Compression fracture - the bone sags and damage areas wedge into each other. There is a homogeneous darkening of the lesion area and the absence of a structural pattern on the x-ray. This stage lasts from 2 to 6 months or more.
3. Fragmentation - resorption of dead bone areas. The affected areas are replaced by granulation tissue and osteoclasts. On X-rays, a decrease in the height of the bone, as well as fragmentation of the affected areas with alternating dark and light zones. Duration from six months to 2-4 years.
4. Recovery - the gradual restoration of the shape and structure of the bone. Lasts from several months to several years.

The duration of all stages is 2-4 years. If you leave the disease without medical care, the recovery process will proceed with residual deformation, which leads to the development of deforming arthrosis.

[11], [12]

Forms

Aseptic necrosis may occur in the cancellous regions of any bone. The pathological condition is divided into several types, each of which has its own characteristics of the course and treatment.

1. Tubular bones (epiphysis):

• The head of the femur is Legg-Calvet-Perthes disease.
• The head of the I-III metatarsal bone, the sternal end of the clavicle, the fingers of the hands - Keller's disease II.

2. Short tubular bones:

• Scaphoid foot - Koehr's disease I.
• The lunate bone in the hand - disease Kinbek.
• Scaphoid carpus - Pryzer disease.
• The body of the spine - Calvet disease.

3. Apophyses:

• Tibial tuberosity - Osgood-Schlatter disease.
• Hillock of calcaneus - Haglund-Shinz disease.
• Apophyseal vertebral rings - Scheuermann-Mau disease.

4. The surface of the joints - Koenig disease.

Also, aseptic osteochondronecrosis is divided into those that are treated with medication and require surgical intervention. The latter include:

• Koenig disease (femoral condyles).
• Diaz disease (ankle bone).
• Legg-Calve-Perthes disease (femoral head).
• Larsen's disease (lower pole of the patella).
• Leuven's disease (articular surface of the patella).

The method of its treatment and the prognosis for recovery depend on the type of the pathological condition.

The degenerative-dystrophic process in bones has several stages. Each stage has its own varieties and its characteristic features.

Consider in more detail the classification of osteochondropathy:

1. Dystrophic and necrotic disorders in tubular bones (epiphysis). This category includes:
   • Head of metatarsal bone.
   • Clavicle (part of the bone in the thoracic spine).
   • Phalanges of the fingers of the upper limbs.
2. Damage of short tubular bones:
   • Scaphoid foot bone.
   • The lunate bone of the hand.
   • Scaphoid carpus.
   • The body of the vertebrae.
3. Pathological process in apophyses:
   • Tibial tuberosity.
   • Heel heel
   • Apophysary rings of the spine.
4. Damage to the surface of the wedge-shaped and superficial joints:
   • Elbow joint
   • Ankles
   • Knee-joint.

In most cases, degenerative-necrotic disease occurs in patients of childhood and adolescence, affecting the bones and joints. For all forms of the disease is characterized by a benign chronic course with a favorable outcome.

Osteochondropathy Leuven

The defeat of the articular surface of the patella is a degenerative-necrotic disease of Leuven. It is based on aseptic necrosis of the patella and damage to cartilage. Pathology occurs in patients 12-14 years old and is one-sided. It develops due to chronic microtrauma in the area of the patella, with dislocations, violation of the quadriceps biomechanics.

Symptoms manifest as intermittent moderate pain in the area of the knee joint. Their occurrence is not always associated with physical exertion. At the same time, the movement in the joint is painless and fully preserved.

Diagnosis consists of the collection of anamnesis, a complex of laboratory and instrumental methods. The most informative include CT, MRI and radiography. Arthroscopy is performed to make a final diagnosis. The treatment is conservative. The doctor prescribes a course of medication, physiotherapy, exercise therapy. With timely treatment, the disease has a favorable prognosis.

Complications and consequences

Among the possible complications and consequences of osteochondropathy, patients most often face the following problems:

• Violation of the functionality of the joints.
• Modification of bone structure.
• Restriction in the joint of the injured limb.
• Dystrophic processes in the joints.
• Slow destruction of bone tissue.

To prevent complications, you should promptly seek medical help and fully perform medical appointments.

[13], [14], [15]

Diagnostics of the osteochondropathy

If a degenerative-necrotic disease is suspected in certain parts of the bones, a complex of laboratory and instrumental methods is carried out, as well as a differential approach.

Diagnosis of osteochondropathy begins with collecting history and studying the clinical picture. Further, blood tests and rheumatic tests are prescribed. Special attention is paid to radiography.

At the initial stage of the disease, the X-ray picture is not very informative, therefore, MRI and CT are performed to detect the smallest changes in the bone structure. Diagnostic examinations are also shown during the treatment process to determine its effectiveness.

[16], [17], [18]

Analyzes

Laboratory diagnosis of aseptic necrosis is necessary to determine the level of minerals in the blood, markers of bone formation and bone resorption in biological fluids. General analysis of blood and urine are not informative during degenerative processes in the bones, but are carried out to assess the general condition of the body and identify inflammatory processes.

1. Analysis of the determination of minerals in the blood.
   1. Calcium - the main component of the bone, is involved in the construction of the skeleton. Its norm in venous blood is 2.15-2.65 mmol / l. If the values are below normal, then the mineral deficiency is compensated by leaching from the bones. This leads to the gradual destruction of the bone and does not appear on the visible health of the body.
   2. Phosphorus and magnesium - interact with calcium, improve its penetration into bone tissue. With an increased value of phosphorus, calcium is washed out of the body. The normal ratio of calcium and phosphorus is 2: 1. The norm of phosphorus in the blood is from 0.81 to 1.45 mmol / l, the norm of magnesium is from 0.73 to 1.2 mmol / l. In case of violation in the growth zone of the spongy bones, their values may decrease or remain within the normal range.
2. Biochemical indicators of bone tissue destruction

Collagen protein, which provides strength and elasticity of bone tissue, is the main material of the interosseous substance, which is located between the bone plates. With the defeat of the bones, the protein, like collagen, is destroyed, breaking down into several markers. Substances get into the blood and in an unchanged form are excreted with urine.

The main markers of aseptic necrosis include: deoxypyridone (DPID), pyridinoline and Cross-Laps. The latter is the 8 amino acids that make up collagen involved in the construction of proteins.

Also during the diagnosis, indicators of bone formation enhancement are analyzed. The most informative is osteocalcin. This substance is produced by osteoblasts during the formation of bone tissue and partially penetrates into the systemic circulation. With the defeat of the bones, its level rises.

[19]

Instrumental diagnostics

Mandatory component of diagnosis in cases of suspected osteochondropathy is a complex of instrumental examinations. Hardware techniques have a number of indications for:

• Recently suffered injuries.
• Acute, chronic pain, radiating to other parts of the body.
• Monitoring the effectiveness of the treatment.
• Preparing for surgery.
• Assessment of bone and blood vessels.

1. X-ray - gives a general idea of the condition of the affected bone. Does not detect circulatory disorders. As a rule, images are performed in several projections for more accurate analysis.
2. Computed tomography - a layer-by-layer examination of bones and soft tissues. It determines the structure of the affected bone and the state of the vessels with the help of a contrast agent.
3. Magnetic resonance imaging - reveals pathological changes in the early stages. Electromagnetic waves are used to visualize the affected area.
4. Scintigraphy - identifies abnormal bone processes in the early stages, before they appear on the x-ray. Most often used as an additional method for MRI or CT. In pediatric practice is rarely used.
5. Arthroscopy - allows you to accurately assess the condition of the knee joint and make further tactics of treatment. Combines diagnostic and therapeutic functions. It is most commonly used to diagnose Koenig's disease, that is, lesions of the femoral condyles.

Osteochondropathy on roentgen

Radiography refers to the gold standard of research for suspected degenerative-necrotic bone disease. Consider the main signs of osteochondropathy of any location on the x-ray:

1. Necrosis of spongy bone and bone marrow. Articular cartilages are not exposed to death.
2. Pathological fracture - dead bone tissue is not functional, the trabeculae of the spongy substance do not withstand the load exerted on them. There are signs of bone deformation, shortening and compaction on X-rays. This stage lasts about six months.
3. Stage of resorption of necrotic masses using lysis. On the roentgenogram, there are necrotic masses surrounded by osteoclasts. The epiphysis has a heterogeneous structure, there may be signs of hemorrhage followed by calcification, cystic changes.
4. At the stage of repair, that is, the restoration of the bone structure, radiography shows areas of enlightenment in the newly created bone tissue caused by cystic changes.

To determine the stage of the disease, the results of radiography are compared with the clinical symptoms of the disease.

Differential diagnosis

When making a final diagnosis, osteochondropathy is differentiated from other symptomatic diseases. Symptom complex of the disease is compared with such pathologies:

• Deforming arthrosis.
• Tuberculosis of the bones.
• Arthritis.
• Atherosclerosis.
• Degenerative-proliferative bone changes.
• Neoplasm.
• Infectious and inflammatory diseases.
• Syndromes of compression and pinching of peripheral nerves.

When conducting a differential diagnosis, a complex of laboratory and instrumental examinations is analyzed, and the stage of aseptic necrosis is also determined.

[20], [21], [22], [23]

Treatment of the osteochondropathy

According to the results of the diagnosis, the orthopedist draws up a plan for the treatment of aseptic necrosis. First of all, patients are prescribed a course of medications, which includes the following drugs:

• Painkillers
• Nonsteroidal anti-inflammatory.
• To improve blood circulation.
• Vitamin complexes.

 

Prevention

Prevention of a violation in the spongy bone growth zone consists of a set of methods aimed at the general strengthening of the body, enhancing the protective properties of the immune system, and supplying useful micro and macro elements.

Prevention of osteochondropathy consists of the following recommendations:

• Balanced physical activity to create a muscular corset and strengthen it.
• Limit increased physical exertion.
• Avoidance of injury.
• Balanced diet.
• Reception of vitamin and mineral complexes.
• Timely treatment of viral, infectious and other diseases of the body.
• Wearing properly selected shoes with orthopedic insoles.
• Regular checkups at the doctor.

Also preventive measures include regular massage of the limbs and other parts of the body. When the first pain in the bones and joints should seek medical help to diagnose the causes of the disease state and eliminate them.

[24], [25], [26]

Forecast

With timely diagnosis and treatment, osteochondropathy has a favorable prognosis. Severe forms of aseptic necrosis are difficult to correct, and therefore may have an unfavorable outcome. The prognosis worsens significantly with the development of complications of the disease.

Osteochondropathy and the army

The degenerative-necrotic disease of certain parts of the bones is not an exemption from the army. In order to avoid military service, it is necessary to undergo a military-medical examination, which will confirm the presence of functional disorders that impede the service.

The list of pathologies that may prohibit the army are diseases of the skeletal system and their complications:

• Congenital curvature of the spine of a fixed type.
• Severe chest deformity with severe respiratory failure.
• Acquired spinal curvatures with vertebral rotation.
• The inability to maintain a vertical position due to skeletal deformations.
• Instability of spinal segments.
• Muscle weakness of the limbs, muscle paresis with decompensation.
• Motor impairment.

In the presence of the aforementioned diseases, the recruit is sent to undergo a series of examinations that confirm the pathological changes: CT scan, MRI, radiography, radioisotope scanning. According to the results of the research and on the conclusion of the medical consultation commission, the conscript gets an exemption from service due to osteochondropathy or its complications.

[27], [28]