Chapter

Osteonecrosis, osteochondrosis, and osteochondritis dissecans

Donncha O’Gradaigh and Adrian Crisp

in Oxford Textbook of Medicine

Fifth edition

Published on behalf of Oxford University Press

ISBN: 9780199204854
Published online May 2012 | e-ISBN: 9780199570973 | DOI: http://dx.doi.org/10.1093/med/9780199204854.003.2005

Series: Oxford Textbooks

Osteonecrosis, osteochondrosis, and osteochondritis dissecans

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Osteonecrosis—this can be caused by a range of conditions including trauma, drugs (e.g. corticosteroids), metabolic/endocrine (e.g. Cushing’s disease, Gaucher’s disease), sickle cell disease. It occurs particularly in patients with inherited procoagulant disorders (e.g. resistance to activated protein C). The epiphyses of the femoral head or condyles, or the head of the humerus, are particular affected. There are no specific features on history or examination, but the condition may present with pain and disability. MRI is required for diagnosis. Treatment may involve approaches designed to ameliorate vascular occlusion (vasodilators, low-molecular-weight heparin), promote bone repair (bisphosphonates), revascularize (e.g. surgical core decompression), or other surgical techniques (e.g. osteotomy, joint replacement).

Osteochondrosis and osteochondritis dissecans—osteochondrosis can occur at any epiphysis; osteochondritis dissecans is a distinct form of osteochondral injury through the articular cartilage in a diarthrodial joint, particularly the knee or elbow. Usual presentation is with progressive activity-related pain. Initial treatment includes modification of activities, analgesia, and a stretching regime to release traction on apophyseal sites; surgery is required for refractory cases.

Chapter.  2095 words. 

Subjects: Rheumatology

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