I.

DEFINITION OF TERMS

• Osteochondroses is a group of diseases of children and adolescents in

which localized tissue death (necrosis) occurs, usually followed by full

regeneration of healthy bone tissue. The singular term is osteochondrosis.

• It is a non-inflammatory, noninfectious derangement of bony growth at

various ossification centers occurring during their greatest developmental

activity and affecting the epiphyses.

In humans, these conditions may be classified into three groups:

1. Spinal: Scheuermann's disease (of the interspinal joints) which is a curve in

the thoracic spine.

2. Articular: Legg-Calvé-Perthes disease (or, avascular necrosis of the femoral

head in the hip), Köhler's disease (of the tarsal navicular bone of the foot),

Panner's disease (of the capitulum of the elbow), and Freiberg's infraction (of the

second metatarsal of the foot; sometimes called Freiberg's Infarction or

Freiberg's disease)

3. Non-articular: This group includes Sever's disease (of the calcaneus, or

heel), and Kienbock's disease of the hand, and other conditions not completely

characteristic of the osteochondrosis, such as Osgood-Schlatter's disease (of the

tibial tubercle) and Osteochondritis dissecans.

LESS COMMON CONDITIONS:

• Diaz or Mouchet’s Disease (talus)

• Buschke’s Disease (cuneiforms)

• Treves’ or Ilfelds’Disease (sesamoids)

• Thiemann’s Disease (phalanges)

III. NARRATIVE EXPLANATION OF THE SCHEMA

Osteochondrosis is regarded as having a multifactorial etiology, with no

single factor accounting for all aspects of the disease. The principal lesion of

osteochondrosis is a focal failure of enchondral ossification; that is, an area of

growth cartilage fails to undergo matrix calcification or vascular invasion, and

therefore does not become converted to bone. The persisting cartilage is soft and

reddish, and the subjacent bone marrow is edematous and hyperemic. However,

prior to the point of the disease at which a focal failure of enchondral ossification

occurs and is grossly visible, the lesion in articular osteochondrosis is

characterized histologically by a focal area of necrosis that is confined to the

growth cartilage and involves neither the overlying articular cartilage nor the

underlying subchondral bone. It has been designated that there is the presence

of a focal area of cartilage necrosis that is confined to the epiphyseal cartilage as

osteochondrosis latens, whereas the presence of a focal failure of enchondral

ossification that was visible on macroscopic and radiographic examination was

designated as osteochondrosis manifesta After a fissure forms in the area of

necrotic cartilage and extends through the articular cartilage (cartilage flap or

loose body), the appropriate designation for the lesion is osteochondrosis

dissecans (OCD).

Generalized factors, such as hemodynamic disorders may be implicated in

the pathogenesis of osteochondrosis only so long as they affect cartilage canal

function, either through direct effects on the vessels or by resulting in altered

biomechanical properties of the surrounding structures In these latter cases, it

may be justified to regard the resulting lesions of osteochondrosis as being

secondary to the generalized condition.

 There is little evidence that the body weight affects the prevalence of early

lesions of osteochondrosis. It is known, that increased body weight promotes the

progression from osteochondrosis to osteoarthritis.

IV.NURSING DIAGNOSIS

1. Acute pain related to fracture, joint degeneration, swelling, or inflammation.

2. Risk for infection related to surgical procedure/ break in the skin.

3. Decrease tissue perfusion related to swelling, constricting devices, or impaired

venous return.

4. Altered health maintenance related to loss of independence.

5. Risk for ineffective therapeutic regimen management related to insufficient

knowledge or lack of available support and resources.

6. Impaired physical mobility related to pain, swelling and possible presence of

immobilization device.

7. Risk for situational low self-esteem related to impact of musculoskeletal

disorder.

8. Anxiety related to changes in body integrity.

9. Self-care deficit: feeding, bathing/hygiene, dressing/grooming or toileting due

to restricted range of motion.

10. Ineffective coping related to fear of the unknown, perception of disease

process, and inadequate support system.

V. DIAGNOSTICS

• Diagnosis is suspected based on symptoms. Bone scan or MRI should be

done to confirm the diagnosis.

• X-ray studies initially may not be useful, because they can be normal or

show minimal flattening.

• In bilateral or familial cases, a skeletal survey to exclude hereditary

skeletal disorders, particularly multiple epiphyseal dysplasia, is mandatory

 because prognosis and optimal management differ. Hypothyroidism, sickle

cell anemia, and trauma must also be excluded.

REFERENCES:

1. Eilert, Robert E., and Gaia Geogopoulos. "Orthopedics." In Current Pediatric

Diagnosis and Treatment, edited by W. W. Hay, Jr., et al. Stamford: Appleton &

Lange, 1997.

2. Brunner and Suddarth's textbook of medical-surgical nursing By Suzanne C

Smeltzer, Brenda G. Bare, Janice L. Hinkle, Kerry H Cheever

3. Chaplain’s Operative Orthopedic, 11th edition, page 1251,Mosby Elsevier,2007

4. Orthopedic Nursing Caring for Patients with Musculoskeletal Disorders, Dr.

Halstead, Judith A., COPYRIGHT© 2004—Western Schools, Inc.

5. Lipscomb AB, Anderson AF. Tears of the Anterior Cruciate Ligament in

Adolescents. J Bone Joint Surg 1986;68A:19.

6. Grana WA, Rashkin A. Pitcher’s Elbow in Adolescents. Am J Sports Med

1980;8:333.

7. King AG. Meniscal Lesions in Children and Adolescents: A Review of the

Pathology and Clinical Presentation. Injury 1983;15:105.