Tuesday, May 24, 2011

Osteochondritis dissecans

Osteochondritis dissecans is the fragmentation of cartilage and subchondral bone separated from the articular surface. Bone that has a loose osteochondral fragments normal vascularization. This feature differentiates osteochondritis dissecans of osteonecrosis, the bone is avascular.
Etiology was dissected osteocondritei true source for decades of enthusiastic debate. The etiology has been described as traumatic, ischemic, idiopathic and hereditary. Discussions continue, but most doctors believe that the outcome of osteochondritis dissecans of multifactorial elements.
Osteochondritis dissecans affects two distinct populations Fizeau differentiated by their status. Patients with ages between 5 and 15 years with open Fizeau juvenile form of the disease shows. Mature teens and adults who have closed Fizeau shows adult form of the disease. Symptoms depend on the state osteocondritei dissected lesion. If left untreated it can lead to early degenerative changes with chronic pain and functional impotence.
The disease usually cause pain and joint swelling with pain in outpatient radiation. Physical examination showed effusion, tenderness and crackles. The disease can be difficult to diagnose because the symptoms are found in other diseases. Yet osteochondritis dissecans can be confirmed by radiography, tomography, magnetic resonance. It is classified by this imaging or arthroscopy.
For a long time treatment of choice for osteochondritis dissecans remains with the removal artrotomia osteochondral fragments or conservative treatment. The latter remains the standard treatment option for patients with early disease and Fizeau open. In contrast, surgical options have traditionally included the drilling of the defect, removing bodies, fragmented, their attachment to the place of separation and placement of osteochondral grafts. Current interventional methods include determining the lesion, drilling into the lesion and autologous osteochondral mosaicplasty autologous chondrocyte transplantation.
Osteochondritis dissecans of the knee therapy is largely guided by the patient's age. Symptomatic lesions in skeletally immature children or patients who do not require X-ray shows the body loses the initial conservative treatment for 3 months. Conservative treatment in these patients includes limiting activity and joint protection to prevent future dislocations. Affected joints are fixed to limit the stress in the lesion.
Pathogenesis and causesTrauma:Trauma has been described as a potential etiology for osteochondritis dissecans. The knee can create a direct trauma fracture transcondrala, however predilection for Posterolateral portion of the medial femoral condyle suggests indirect trauma.The ankle injuries are accepted as the etiology. Tibiotalara result in incarceration talus subluxation tibia or fibula. Talara anterolateral talus injuries cause impaction in the fibula. The exact cause of osteocondritei dissected elbow is not clear. Most doctors believe that the important role of repetitive microtraumei potential etiology.Sports elbow that moves the head and basketball cause the formation of compressive forces between the radial head and capitelium, leading to changes osteocondritice.
Ischemia:Ischemia was investigated as a potential etiology for osteochondritis dissecans. Natural propensity for ischemia leads to the formation of bone attachment and vulnerability to injury.
Genetics:A few researchers have investigated a genetic link for this disease. It has been reported for the disease hereditary influence.
Pathophysiology:Once this an injury that typically progresses through four stages if not treated properly.Stage I consists out of a small area of ​​compression of subchondral bone.Stage II consists dintrun partially detached fragment. A bone scan showed a well-circumscribed area of ​​sclerotic subchondral bone separated from the epiphysis of a line radiolucenta.Stage III shows the lesions completely detached fragments which remain in the crater of the lesion.Stage IV consists of complete detachment of fragments of lesion-known crater and the body loses.
Signs and symptoms of osteochondritis dissecansMean age of presentation of osteocondritei dissected juvenile is 11-13 years. For the adult form of the disease is between 17-36 years. For the average age of onset of ankle disease is 15-35 years and 12-21 years for the elbow.Osteochondritis dissecans of the knee occurs in 75% of cases and the ankle in 4% of cases. Knee medial femoral condyle appears in 75% of cases, the surface that supports the weight of the medial condyle in 10% of cases and the one side in 10% of cases, hole in patella intercondiliana or 5% of cases. The ankle appears to posteromediala the talus in 56% of cases and anterolateral talus in 44% of cases.
Dissected osteocondritei symptoms vary with lesion stage. Knee injuries early in their evolution are associated with vague, poorly defined symptoms, including varying degrees of pain and swelling.As the lesion progresses, symptoms such as transmissibility, location and radiation are frequently observed. These symptoms are intermittent and associated with exercise. Patients should ask about frequency of symptoms. Are constant and severe symptoms that are typically associated with lost corpus knee. Symptoms that increase in intensity and frequency may indicate progression of the lesion. In addition, patients can feel the body loses these fragments into the joint. Differentiation of osteonecrosis of osteochondritis dissecans is difficult and the most important clue is the patient's age. Younger patients tend to develop osteochondritis dissecans and osteonecrosis of the elderly.
Physical Exam:Physical examination of any patient who reported problems with the knee should begin with examining ambulatiei. In a patient with osteochondritis of the knee, the foot may be affected in extreme rotation during gait in an attempt to avoid incarceration front tibia lateral condyle. Patients with damage to the knee shows the weakness of the quadriceps and gluteus maximus not.Check for signs of atrophy or weakness of the quadriceps muscle.It can be seen an effusion. The patient may be unable to perform a full knee extension. Is sensitive to palpation of the lesion. Tesutl Wilson is useful. In this test, the examiner flexes the knee to 90 degrees and the tibia internally rotates slowly extending the knee.As the knee is extended to 30 degrees flexion, leg pushes the medial femoral condyle lesion causing the pain. Eliminates pain by removing external rotation tibia lesion.
Patients with impaired ankle swelling reported symptoms of pain and its outpatient or active movements of the ankle. Approximately 90% of patients have a clear history of trauma in history. Patients may not experience pain, depending on lesion stage.Physical examination showed a patient with damage to the ankle joint effusion, crackles and diffuse or localized tenderness. As the lesion progresses, symptoms become more severe and localized.Tibiotalare compression and joint pain with dorsiflexie crepitantele or plantar flexion are common. Lateral lesions can cause pain and tenderness over the medial high.
Patients with elbow osteochondritis reported insidious onset of intermittent joint pain and limiting movement. Patient's symptoms are intermittent and associated with exercise. Patients have a history of injuries or trauma overutilization. Most patients have practiced throwing tennis or sports.

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