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Osteonecrosis, osteochondrosis, and osteochondritis dissecans 

Osteonecrosis, osteochondrosis, and osteochondritis dissecans

Chapter:
Osteonecrosis, osteochondrosis, and osteochondritis dissecans
Author(s):

Gavin Clunie

, Donncha O’Gradaigh

, and Adrian Crisp

DOI:
10.1093/med/9780199204854.003.2005_update_001

August 28, 2014: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

Update:

Chapter reviewed and heavily updated throughout.

Updated on 29 May 2014. The previous version of this content can be found here.
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date: 25 March 2017

Osteonecrosis (‘bone death’) can be caused by a range of conditions including trauma, drugs (e.g. glucocorticoids), metabolic or endocrine conditions (e.g. Cushing’s syndrome, Gaucher disease), and haematological disease (e.g. sickle cell disease, antiphospholipid syndrome [APLS]). There are no specific features on history or examination but the condition may present with pain or localised skeletal failure. Diagnosis is made by Magnetic Resonance (MR) imaging. Treatment involves approaches designed to improve blood supply (vasodilators, low-molecular-weight heparin), promote bone repair (bisphosphonates), revascularize bone (e.g. surgical core decompression), or remove or replace tissue (e.g. osteotomy, arthroplasty).

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. The usual presentation of both is with activity-related pain. Treatment includes modification of activities, analgesia and judicious use of physical therapy (e.g. stretching); surgery is required for refractory cases.

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