Osteochondropathy of the ischium in children. Chondropathy: symptoms, treatment and prevention of the disease

Osteochondropathies in children are diseases characterized by degeneration of spongy bones and pathological changes articular cartilage, which are manifested by dysfunction of the joint and bone deformation.

Etiology. The reasons are unknown. Osteochondropathies in children do not have a genetic basis. They differ in the anatomical localization of the lesion, course and prognosis.

Pathogenesis. The pathomorphological basis of osteochondropathy in children is aseptic necrosis spongy bone. The cause of aseptic necrosis is a violation of the blood supply to the bone.

Classification of osteochondropathy in children

Osteochondropathies of the epiphyses tubular bones:

heads 2-3 metatarsal bones(Köhler's disease 2).
osteochondropathy of the head femur(or Legg-Calvé-Perthes disease);

Osteochondropathies of short cancellous bones:

patella (Larsen's disease):
scaphoid (or Köhler disease 1);
osteochondropathy of the lunate bone of the hand (or Kienböck's disease).
osteochondropathy of the vertebral body (or Calve's disease);

Osteochondropathies of the apophyses:

tubercular osteochondropathy calcaneus(or Gaglund-Schinz disease).
vertebral apophyses (or Scheuermann-Mau disease);
tuberosity osteochondropathy tibia(or Osgood-Schlatter disease);

Partial wedge-shaped osteochondropathy of articular surfaces:

osteochondropathy of the capitate eminence humerus(or Panner's disease).
osteochondropathy of the femoral condyles (Konig's disease);

Legg-Calvé-Perthes disease

This is idiopathic aseptic necrosis of the epiphysis of the femoral head, which occurs mainly in boys 6-10 years old, leading to deformation of the head and neck of the femur, then to the development of coxarthrosis.

Clinical manifestations .

In the hip joint, lameness, gait disturbances.

The onset of the disease is gradual with slow progression.

Movement in the joint is limited, muscle atrophy appears.

The pain in the joint becomes less or disappears with rest.

Diagnostics is based on the results of an x-ray of the hip joint, which shows the following sequentially developing stages.

Initial - characterized by osteoporosis of the head and neck of the femur, widening of the joint gap, the cartilaginous layer of the femoral head is not involved in the process.

The impression fracture stage is characterized by flattening of the head of the femur, compaction and deprivation of the structural pattern.

The stage of fragmentation of the femoral head is characterized by lysis of necrotic masses with the formation of islands of new connective tissue. The head of the femur becomes flattened and the joint space becomes wider. The femoral neck is thickened due to periosteal layers.

Stage of repair and reconstruction of bone substance. The shape of the head is not restored.

The stage of consequences is characterized by secondary deformation of the head and cavity of the joint. Deforming arthrosis is formed.

Treatment.

Conservative - includes rest, stimulation of bone repair processes with medications and physiotherapy.

Surgical treatment is carried out to stimulate regenerative processes in the bone.

Forecast. Without treatment, the disease has long course(2-3 years), When the process stops progressing, residual displacement of the head relative to the acetabulum leads to deforming arthrosis.

Köhler's disease 1 is an aseptic necrosis of the epiphysis of the navicular bone of the foot. Clinical manifestations: the foot becomes swollen and painful with its maximum localization in the area of the medial longitudinal arch. Lameness. Diagnosis is based on the results of an X-ray examination, which shows compaction and sclerosis of the bone, and then, before reossification, fragmentation of the scaphoid bone. Treatment includes rest, reducing the load on the foot, and physical therapy.

Köhler's disease 2 - osteochondropathy in children, aseptic necrosis of the head of the metatarsal bone. Clinical manifestations: Pain in anterior section feet with swelling and gait disturbance. X-ray - the heads of the metatarsal bones are thickened, areas of fragmentation with dense islands connective tissue. Treatment includes rest, reducing the load on the foot, and physical therapy.

Larsen's disease is a disorder of the ossification process of the patella, which is manifested by swelling, pain, and recurrent hydrarthrosis of the knee. Occurs in adolescence. The treatment is similar.

Calvet disease is aseptic necrosis of the vertebral body. Clinical manifestations. Pain in a limited area of the back with swelling. Limitation in physical activity. X-ray shows flattening of the body of one vertebra with expansion of the intervertebral discs. Treatment includes rest and physical therapy.

Kienböck's disease is an osteochondropathy in children, aseptic necrosis of the lunate bone, which manifests itself as pain in the wrist joint, swelling on the back of the hand.

Osgood-Schlatter disease– osteochondropathy in children, aseptic necrosis of the tibial tuberosity. Clinical manifestations: swelling in the area of the tuberosity. Increased pain with physical activity. X-ray shows fragmentation of the tibial tubercle. Treatment includes rest and physical therapy.

Scheuermann-May disease– osteochondropathy in children, aseptic necrosis of the apophyses of the vertebral bodies. Clinical manifestations: pain in the lower thoracic region spine with the development of an arcuate curvature posteriorly. X-ray - loosening, fragmentation of the apophysis with subsequent deformation of the vertebral bodies, depression of the apophyses and its fusion with the vertebral body. Treatment includes therapeutic exercises, unloading of the spine.

Koenig's disease is aseptic necrosis of the internal condyle of the femur. Clinically manifested by pain in the knee joint, swelling and limitation of movements.

Panner's disease is aseptic necrosis of the head of the 3rd metatarsal bone.

Freiberg's disease- aseptic necrosis of the head of the 2nd metatarsal bone, manifested by the dorsum of the foot, pain in the metatarsus of the phalangeal joints.

The article was prepared and edited by: surgeon

As for the reasons for the appearance of this disease, then a number of possible causes for pathology have not yet been fully studied, but at the same time there is a certain set of preceding factors.

A hereditary factor, the disease can occur in the womb of the fetus.
Problems with activities endocrine glands or the endocrine system as a whole.
Metabolic disease.
The body's inability to absorb calcium and other vitamins.
Various injuries.
After exhausting physical activity. First, the vessels are compressed, and then they narrow in the spongy bones.

Symptoms

The disease osteochondropathy may affect certain parts body:

calcaneus (Haglund-Schinz syndrome) - observed in teenage girls up to about 16 years of age. The manifestations are known for sharp pain in the heel area that appears after exercise. In addition to pain, there is slight swelling. Those suffering from this type of disease cannot step on the entire foot, they begin to walk on their toes, running and jumping become excruciating and painful;
spine (Scheuermann-Mau disease) - affects young people under 18 years of age. Several stages are known. In the first case, the spine is bent in upper section, the second is severe pain. The patient gets tired quickly, the back muscles are weak and ache at the slightest exertion. Last stage characterized by the final fusion of the vertebrae with the apophyses, with progressive pain syndrome;
femur (Legg-Calvé-Perthes syndrome) occurs in boys with preschool age and up to 12 years. At first it is asymptomatic. Later, the patient feels pain in the hip, which radiates to the knee. As a rule, children do not always complain of such pain, since the discomfort periodically passes and then appears again. Over time, atrophy of the muscle of the sore hip occurs, and it loses a lot of weight;
tibial tuberosity (Schlatter's disease) - boys also suffer from this pathology. The disease can occur from 12 to 16 years of age and is associated with certain activities, so those who are interested in sports dancing, ballet get sick. The patient experiences pain when bending his knees or climbing stairs. The knee area suffers.

Diagnosis of osteochondropathy in a child

Identification technique pathological process is closely related to the localization of the pathological process.

Although there is one thing that unites all clinical cases.

The specialist first conducts an x-ray examination of the part of the body that interests him. He looks at all the changes that the X-ray machine can show in detail, and based on the picture he sees, he makes treatment recommendations.

In case of a disease of the heel region, the study shows compaction of the apophysis. In the pictures of a disease of the spine, it is noticeable how much the structure of the vertebrae is changed. As for the femoral part, here we consider the possible five stages of deformation of the femoral head. If we are talking about tibial tuberosity, the diagnosis is also made on the basis clinical picture course of the disease and x-ray images.

Complications

Severe consequences And Negative consequences really avoidable. At adequate therapy Experts give a favorable prognosis for this disease. In general, the prognosis is very favorable. The most important thing is not to delay treatment. To forget about this problem forever, you should treat the problem as soon as possible. An experienced, qualified doctor will help parents here.

Treatment

What can you do

Parents should more attention pay attention to the child’s problem and follow all the doctor’s recommendations.

The specialist will explain in detail what needs to be done for a certain form of the disease. Parents will only have to comply with all the instructions of the treating specialist.

What does a doctor do

Elimination of inflammation of the heel bone consists of prescribing the use of non-steroidal anti-inflammatory drugs for severe pain, physical procedures, and limiting physical activity. To relieve the load on the sore foot, the doctor recommends special insoles-instep supports.
Osteochondropathy of the vertebrae is eliminated with the help of special massage, swimming, exercise therapy, and underwater exercises. IN difficult situations surgical intervention is indicated.
Therapy for an abnormal process in the femur can be medicinal and surgical. Plastic surgery on bones are carried out depending on the severity of the pathology. Conservative therapy pathology consists in the prescription bed rest(the child needs to lie down), foot massage, physiotherapy. Skeletal hip traction is also shown.
To eliminate problems with tibial tuberosity, physiotherapy and the application of warm compresses are recommended. When the pain is unbearable, a plaster cast is applied. It happens that doctors perform an operation to eliminate the area of the tuberosity. Loads are eliminated.

Prevention

Preventive actions associated with the part of the body that has been affected by the pathological process.

So, to prevent pathology it is necessary:

Always wear comfortable and spacious shoes - if you experience pain in the heel.
Engage in physical therapy and strengthen the back muscles if you have problems with the spine, and at the same time do not bother yourself with excessive loads.
If knees hurt during training, athletes are recommended to sew foam pads into their uniforms.
Massage and swimming are indicated for the prevention of hip disease.

In the article you will learn what osteochondropathy is, why this disease appears in children, what the first symptoms are and how to treat this disease.

One of the joint diseases that can be found most often in adolescents is osteochondropathy. The disease is associated with metabolic disorders with joint tissues as a result of impaired blood supply to a certain area. Dead areas of bone form, e.g. physical activity. With osteochondropathy, the bones become brittle and the child is susceptible to spontaneous fractures, so it is very important to consult a doctor at the first signs of the disease. The main symptom of the pathology is pain in the affected area; the child also becomes lethargic and may complain of weakness.

Osteochondropathy main causes

The etiology of the disease is not fully understood, but doctors say that the following factors underlie osteochondropathy:

Hereditary predisposition. If one of the family members suffered from bone pathology, the child’s risk of getting the disease is increased.
Hormonal disorders. Often osteochondropathy is associated with pathology endocrine system.
Injuries. More susceptible to illness are children who are often injured, who also play sports and undergo large physical exercise.
Metabolic disease. Pathology can be caused by a lack of calcium and vitamin D in the body, which is why it is so important to monitor the child’s nutrition.
Circulatory disorders. In this case, lack of nutrition provokes necrosis bone tissue.

The disease most often affects the legs, since they bear the main load. The onset of the disease practically does not manifest itself, but when the first symptoms appear, it is important to consult a doctor. By taking a picture, a specialist can determine the extent of the lesion and the complexity of the disease. Typically, treatment can be complex (bed rest, therapy, medications) or surgical.

Symptoms of the disease

The first signs of bone tissue damage can be determined by the following factors:

Swelling appears at the site of the lesion, but signs inflammatory process may be missing.
Pain occurs. It can be either constant or occur under a certain load.
In the presence of such a disease, fractures can often occur.
Appear visual signs posture changes. There may be lameness.

Despite the danger of the disease, it can be brought under control and even completely eliminated. Proper treatment in a timely manner will avoid bone deformation and additional difficulties will not arise in the future.

Classification of osteochondropathy

Distinguish the following types osteochondropathy:

Pathology of short tubular bones. This type of disease includes Köhler I, Kienbeck, Calve, and Praiser diseases.
Pathology of tubular bones. The second type includes Legg-Calvé-Perthes and Köhler II disease.
In the apophyses. This type includes Haglund-Schinz, Osgood-Schlatter, and Scheuermann-Mau disease.
Osteochondropathy of the joint surface. The latter type is called Koening's disease.

Vertebral osteochondropathy

Diseases that affect the spine are called Sherman-Mau disease and Calvet disease. Sherman-Mau disease is characterized by destruction of the apophyses of the vertebrae; this disease occurs most often in boys in adolescence.

In this case, there are often no symptoms, patients do not complain of pain, but there is a pronounced deformation of the spine, the back becomes round. This condition often forces parents to consult a specialist.

With Calvet disease, damage to the vertebral body occurs, and this condition usually occurs before the age of 7 years. The disease is accompanied by pain in the spine, and the child becomes lethargic, weak, and capricious. For osteochondropathy of the spine, treatment should be carried out in a hospital setting, since the patient needs complete rest.

Osteochondropathy of the hip joint

This pathology is called Perthes disease, the disease occurs most often in boys under the age of 9 years, and the head of the femur is affected. Often the disease occurs after a pelvic injury, the child suddenly begins to limp and complains of pain in the pelvis, which radiates to the leg.

The disease gradually progresses, the function hip joint is disrupted and motor activity is impaired, muscles atrophy. If hip subluxation occurs, the affected leg may become shorter.

This pathology requires compulsory treatment, otherwise the head of the hip joint is formed incorrectly, which leads to the occurrence of deforming arthrosis. In most cases, the disease is treated conservatively, but in advanced stages of the pathology it may be necessary surgical intervention.

Osteochondropathy of the tibia

Schlatter's osteochondropathy most often occurs in boys during adolescence, and is characterized by pain in the area of the tibia.

Unpleasant sensations worsen when the patient gets up from a chair, or climbs stairs, as well as in a kneeling position. Sometimes there may be dysfunction knee joint.

In most cases, this pathology does not leave complications; the disease is treated on an outpatient basis, surgical methods do not apply.

Osteochondropathy of the foot

In Köhler's disease II, the 2nd and 3rd metatarsal bones are destroyed. The disease occurs more often in girls during adolescence, develops gradually, the first symptoms of the disease are mild pain in the foot area. Over time, the pain intensifies, the child limps, and the skin around the affected area swells slightly.

The disease can be cured at home by prescribing limb immobilization and then physical therapy. If you consult a doctor in a timely manner, the prognosis is favorable.

In Köhler's disease I, the scaphoid bone is affected and occurs mainly in boys under 7 years of age. The symptoms of the pathology are similar to the previous one, the child limps and complains of pain, there is swelling of the foot with outside.

Schinz's disease is characterized by damage to the tubercle of the calcaneus; children aged 6 to 14 years are susceptible to pathology. The child complains of pain in the heel, swelling of the affected area is observed, the patient limps and tries to take care of the affected heel.

Koenig's disease

This pathology is called osteochondropathy dissecans and is more common in boys during adolescence. When the disease occurs, the knee and hip joints are affected, a section of cartilage undergoes necrosis and peels off, sometimes fragments penetrate into the joint.

Patients who are faced with this diagnosis are interested in how arthrosis differs from osteochondropathy. With arthrosis, deformation of the joint occurs, and with osteochondropathy, destruction cartilage tissue.

The disease is accompanied characteristic symptoms: joint pain, impaired motor activity. The advanced stage of the disease is characterized by atrophy muscle tissue, and the complication is deforming arthrosis.

Most often, diseases are provoked by increased physical activity, while the blood circulation of any part is disrupted, and its destruction occurs due to lack of nutrition. Treat the disease surgically, since the dead section of cartilage must be removed.

Stages and symptoms of the disease

The following stages of osteochondropathy are distinguished:

The disease begins with gradual necrosis of bone tissue, while symptoms may not be observed at all, or the patient may be bothered aching pain in the affected area. Painful sensations worsen with movement and when pressing on the affected area, may also be disrupted physical activity affected limb.
On next stage disease, a fracture of the affected bone occurs, with corresponding symptoms.
At the next stage, the affected tissue is resorbed and replaced by granulation tissue.
On last stage bone tissue is restored. Without treatment full recovery does not occur, complications arise in the form cosmetic defects and deforming arthrosis.

The average duration of the disease is 3 to 4 years.

Echo signs of osteochondropathy

Only a doctor can correctly diagnose the disease, so at the first signs of the disease it is necessary to show the child to an orthopedist as soon as possible. During the examination, the doctor interviews the patient and examines him, based on the data received. experienced specialist can immediately make a preliminary diagnosis.

To confirm the diagnosis, the patient is referred for radiography and ultrasound, or computed tomography. On initial stages The disease is difficult to identify pathology using radiography, and with the help of ultrasound, the doctor detects echo signs of the disease even in the initial stages.

Treatment of osteochondropathy

There are 2 stages of treatment for osteochondropathy. First, the patient is prescribed complete rest and non-steroidal anti-inflammatory drugs to stop the destruction of bone tissue and relieve pain. The next step is for the patient to massotherapy, physiotherapy, physiotherapy.

In case of severe pain, a plaster cast may be applied, and if the foot is affected, wearing special orthopedic insoles. The operation is performed for severe deformation of the spine or limb, and if the hip joint is affected, skeletal traction may be indicated.

Osteochondropathies combine a group of diseases occurring in childhood and adolescence that affect the subchondral parts of the epiphyses of some bones. From a morphological and pathophysiological point of view, osteochondropathy represents aseptic necrosis, which has a unique clinical picture.
Aseptic necrosis often develops in the femoral head (Legg-Calvé-Perthes disease), in the heads of the II and III metatarsal bones (Köhler-II disease), in the tibial tuberosity (Osgood-Schlatter disease), in the lunate bone of the hand (Kienbeck disease), in the internal condyles of the femur (König's disease) and much less often - in the navicular bone of the foot (Köhler's disease-I), in the tubercle of the calcaneus (Schinz's disease), very rarely - in the epiphyses of the vertebrae (Showerman-May disease) and in the vertebral bodies (Calvé's disease) .
Main goal of treatment- restore impaired blood circulation of the periosteum, prevent deformations and the development of deforming arthrosis.
The main methods of rehabilitation such patients are massage, Exercise therapy, physio- and hydrotherapy procedures, cryomassage, vibrating massage, hydrokinesitherapy and etc.

Legg-Calvé-Perthes disease

Osteochondropathy of the femoral head often occurs in children aged 5 to 12 years. Boys suffer 4-5 times more often than girls. The disease begins unnoticed with the appearance of minor pain in the hip joint and lameness. Atrophy of the muscles of the diseased limb is determined, and in advanced cases - functional shortening of the leg by 1-2 cm, as well as limited mobility in the hip joint.
Conservative treatment consists in early unloading of the affected limb (unloading devices, traction or crutches). Massage, LH are indicated (in the supine position, include general developmental and breathing exercises, mainly for the muscles of the trunk and healthy limb, isometric tension of the quadriceps muscle), physiotherapy ( mud applications on the joint, phonophoresis with mumiyo ointment or mobilate). If the patient is on inpatient treatment, then glue or cuff traction is prescribed to completely unload the limb and LH, massage, and physiotherapy are used. After discharge, hydrokinesitherapy is indicated, vibration massage back and lower extremities.

Köhler's disease-II

Osteochondropathy of the metatarsal head It is more common in girls aged 13 to 19 years. In 90% of cases, the head of the second metatarsal bone is affected. Swelling and tenderness in the area of the metatarsophalangeal joint are characteristic. On palpation, thickenings and bone growths are noted on the head of the metatarsal bone. Movement in the metatarsophalangeal joint is limited.
massage of the thigh and calf muscles, physiotherapy (paraffin-ozokerite, mud applications, phonophoresis), LH (lying and sitting), wearing inserts in shoes. Hydrokinesitherapy is indicated. Doing exercises in a standing position (squats, jumps, jumps, etc.) is excluded.

Osgood-Schlatter disease

Osteochondropathy of the tibial tuberosity often observed in adolescents 12-16 years old. It develops due to overload of the quadriceps femoris muscle, acute injury, chronic microtraumatization, etc. In the area of the tibial tuberosity, swelling and slight swelling of the soft tissues appear.
Conservative treatment includes massage, LH in water, physiotherapy (ultrasound with mobilate, 10% mumiyo ointment). Loads on the lower limb are avoided for 2-3 weeks. The site of the disease is fixed with an adhesive plaster, and cryomassage is also used in the first 3-5 days.
Massage technique
From the first day of the disease, a suction massage is carried out, that is, first the muscles of the thigh, knee joint, calf muscles using stroking, kneading, rubbing. After this, massage the site of the disease, using stroking, and in subsequent days, rubbing with the base of the palm and fingertips. After the pain subsides, you can carefully use kneading with fingertips, forceps-like rubbing, alternating with stroking. It is advisable to use massage in combination with physiotherapeutic procedures. Duration of massage is 10-15 minutes.

Kienböck's disease

Osteochondropathy of the lunate observed in persons exposed to frequent injuries. Characterized by pain in the area of the lunate bone, which intensifies with pressure. Movement in the wrist joint causes severe pain. Swelling appears in this area.
Conservative treatment includes immobilization, massage of healthy tissues, physical therapy (general developmental exercises, breathing, isometrics, etc.), physiotherapy (UHF No. 3, phonophoresis, electrophoresis with a 10% mummy solution), training on a bicycle ergometer, after removal plaster cast massage, swimming, vibration massage of the back and lower extremities are used.
At surgical treatment (removal of the lunate bone) LH is performed, massage of the collar area, shoulder girdle muscles and healthy limb. Workout on a bicycle ergometer or treadmill. After removing the plaster cast, a vibration massage of the back, arms and legs is started.

Koenig's disease

Aseptic necrosis of the femur is an aseptic subchondral necrosis of a small semicircular area of the epiphysis, which often leads to the formation of a free intra-articular body. The localization of the process is most often noted in the area of the internal condyle, that is, in those areas of the epiphysis that are subject to the greatest functional load.
The disease is characterized joint pain, feeling unwell, or instability in the affected joint. IN late stage diseases, characteristic phenomena arise - “blockade” of the joint, synovitis.
Surgical treatment- removal of the affected area of the bone.
IN postoperative period carry out massage of healthy tissues, LH (general developmental, breathing exercises in a lying position). After removing the sutures and splints - electrical stimulation of the quadriceps femoris muscle, hydrokinesitherapy and cryomassage. Then the motor mode gradually expands and exercises on exercise machines and walks are included. After discharge from the hospital, the patient does exercise therapy at home.

Osteochondropathies are pathological changes in the skeleton, caused by degeneration of bone tissue. They are usually diagnosed in children and adolescents and are characterized by a long-term benign course.

Causes of the disease

Osteochondropathies develop when blood circulation is impaired in some segments of bone tissue, resulting in areas of aseptic necrosis (death) of spongy bone during exposure to physical activity.

The causes of these processes are considered to be:

genetic factors
metabolic disease
injuries
infections
abnormalities in hormonal levels
malnutrition

The inflammatory process develops in the epiphyses and apophyses of tubular bones and vertebral bodies. More often affected lower limbs because of increased loads on them.

Main types and symptoms of osteochondropathy, their diagnosis and treatment

Each type of disease is characterized by its own symptoms, but some signs are common:

Pain – constant or occurring with certain movements.
Swelling over the affected area without signs of inflammation.
Changes in posture and gait, the appearance of lameness.
Violation of cellular nutrition of muscles, decrease in their tone.
Due to weakening bone structure Fractures easily occur not only after physical exertion, but also from the patient’s own weight.

Osteochondropathy of the femoral head (Perthes disease)

The disease is more often found in boys aged 4–13 years, and occurs after injury.

There are the following stages of the disease:

Necrosis (death) of bone tissue. X-ray shows the presence of osteoporosis.
Changes in the shape of the head of the femur, its flattening, resulting from its fracture after loading.
Fragmentation is the gradual resorption of compressed and dead spongy bone tissue.
Osteosclerosis is the regeneration of a flattened head with proper treatment.
Deforming arthrosis – occurs in the absence of timely treatment; the head of the femur is deformed, its functions are impaired.

The onset of the disease is hidden, without any symptoms. Later, patients complain of pain in the hip joint, radiating to the knee joint. The pain goes away overnight, so patients do not immediately seek help. Restrictions in hip movement gradually appear, and the muscles of the limb slightly atrophy. At laboratory examination no deviations are found.

An important role in diagnosing the disease is played by an x-ray of the hip joint, performed in two projections. Depending on the stage of development of the pathological process, osteoporosis, deformation, and a decrease in the size of the femoral head are detected on the x-ray.

Treatment for Perthes disease is long-term, sometimes about five years. The choice of treatment method depends on the stage of development of the disease. Two types of treatment are used:

Conservative – consists of maintaining bed rest, unloading the hip joint using the cuff traction method. They also carry out massage and physiotherapeutic procedures (electrophoresis, UHF, paraffin baths).
Surgical - its methods depend on the stage of the disease and the degree of deformation of the femoral head. After the operation, rehabilitation of patients in rehabilitation centers and balneological resorts is mandatory.

Osteochondropathies of the spine

Osteochondropathy of the vertebral bodies (Calvé's disease) - affects the lower thoracic or upper lumbar vertebra for boys 7–14 years old. Signs of the disease are increasing pain in the area of the affected vertebra; at x-ray examination Flattening of the vertebral body with its simultaneous expansion is detected.

Treatment is non-operative, patients are prescribed bed rest, the spine is fixed using a plaster corset (plaster bed). Later, corrective gymnastics and wearing a reclining corset are prescribed. Treatment lasts from two to five years. If the vertebral deformity progresses, surgery is performed.

Osteochondropathy of the apophyses of the vertebral bodies (Scheuermann-Mau disease) is more common in adolescents 11–17 years old. Symptoms of the disease include back pain, increased fatigue and decreased tone of the back muscles, changes in posture. The x-ray shows scoliotic deformation of the spine, changes in the shape of the vertebrae, and a decrease in the height of the intervertebral discs.

Assign conservative treatment: reclining gymnastics, swimming, underwater massage and underwater traction.

Kümmel's disease (traumatic spondylitis) - occurs in men after injuries thoracic vertebra. Symptoms do not appear immediately: when the pain passes after the injury, an asymptomatic period begins, lasting from several months to several years. Then patients begin to feel pain in the thoracic spine. X-ray reveals wedge-shaped deformation of the injured vertebra, osteoporosis.

Treatment consists of following bed rest for 4 weeks, wearing a corset, and performing therapeutic exercises.

Osteochondropathies of the foot

Köhler's disease Ι is osteochondropathy of the navicular bone of the foot. The disease is diagnosed in children 3–12 years old. Symptoms: the dorsum of the foot swells, severe pain appears when walking. An x-ray shows deformation of the scaphoid bone and compaction of the bone structure.

Treatment is carried out without surgery; the limb is unloaded by applying a plaster cast for one and a half months. Later – electrophoresis, wearing orthopedic shoes, massotherapy.

Köhler's disease ΙΙ is osteochondropathy of the metatarsal head. Patients complain of swelling in the metatarsal bones and severe pain when walking barefoot. If the disease is not diagnosed on time, deforming arthrosis of the metatarsophalangeal joint develops.

Treatment consists of applying a plaster boot. Massage is also recommended hydrogen sulfide baths, ultrasound, mud applications, exercise therapy, wearing orthopedic shoes. Duration of therapy is up to three years. For deforming arthrosis, surgery is prescribed.

Haglund-Sever disease is an osteochondropathy of the calcaneal tubercle. It occurs mainly in girls 13–16 years old. Symptoms: pain when walking, redness and swelling in the area where the Achilles tendon attaches. The treatment is conservative, the foot is provided with complete immobility, and orthopedic shoes are subsequently prescribed.

Osteochondropathies of the knee

Osgood-Schlatter disease is an aseptic necrosis of the tibial tuberosity. The disease is hereditary and occurs in boys 13–18 years old and girls 10–11 years old; is the most common cause knee pain in teenagers. The course of the disease is chronic, acute period lasts up to 3 weeks, eventually sclerosis of sparse areas of the bone occurs. Rest, cold on the area of inflammation, and orthopedic devices to immobilize the limb are prescribed.
Koenig's disease is a lesion of the knee joint. It most often occurs in young people aged 18 years. Patients feel swelling of the knee joint and limited mobility. Most accurate diagnosis– using MRI (magnetic resonance imaging). Treatment is surgical, arthroscopy of the knee joint is performed.

Drug treatment of osteochondropathy

During treatment various types osteochondropathy is prescribed:

Anti-inflammatory drugs: ibuprofen, naproxen, diclofenac.
Compresses with dimexide (it is diluted with boiled chilled water in a ratio of 1:4–5).
For electrophoresis, solutions of novocaine 2% and calcium gluconate 5–10% are used.
Vitamin and mineral complexes.
Chondroprotectors: Teraflex, Chondroxide (if age-appropriate).

Disease prognosis

Some osteochondropathy lead to bone deformation and articular surfaces, but at timely diagnosis and purpose proper treatment it is possible to avoid significant dysfunction of the joints, and sometimes achieve restoration of the bone structure after the child’s growth is complete.

Prevention

Preventive measures include regular exercise therapeutic exercises and swimming to strengthen the muscle corset.

Excessive physical activity is contraindicated for children during their growth period. To prevent osteochondropathy of the heel bone, shoes should be comfortable, not tight.

Correct and timely treatment osteochondropathy allows you to restore blood circulation to bone tissue and prevent disability in patients.