Depending on the cause, a distinction is made between septic and aseptic osteonecrosis.
Septic bone necrosis occurs in the context of osteomyelitis. This is a bacterial infection of the bone cortex and bone marrow.
Aseptic bone necrosis can have various causes. These include, among others
Bone necrosis can also have an unknown cause. This is referred to as spontaneous (idiopathic) osteonecrosis.
In the case of epiphyseal necrosis during growth, the growth plate and adjacent parts of the metaphysis may also be involved (osteochondronecrosis).
Primary necrosis of the articular cartilage does not occur due to the lack of its own blood supply. However, the cartilage can become secondarily diseased.
In bone necrosis, bone tissue dies off, making the bone unstable © Aksana | AdobeStock
Juvenile aseptic osteochondrosis can develop in
- Epiphyses,
- apophyses and
- short bones
bones. It is caused by local circulatory disorders of unknown origin. It heals spontaneously through repair, but may retain permanent form and function disorders.
Juvenile aseptic osteochondronecrosis has a staged course with
- Initial stage,
- condensation stage,
- fragmentation stage and
- reparation stage.
Most important forms of juvenile aseptic osteochondral necrosis
- Necrosis of the femoral head(Perthes' disease): Most common disease in this group, children between 3 and 7 years, mainly boys. Pain, limping, increasing deformity. Later arthrosis deformans. Therapy: Relief. Osteotomy to improve position if necessary.
- Necrosis of the tibial apophysis (Schlatter's disease): Mainly boys between 12 and 15 years of age. Pain on pulling the quadriceps tendon and on pressure (when kneeling!), joint uninvolved. Swelling. Therapy: Rest (sport!), application of heat. Plaster tutor with elimination of the quadriceps pull.
- Necrosis of the scaphoid bone on the foot (Köhler's disease I): Children between 3 and 8 years of age. Pain, occasional swelling. Therapy: orthotic treatment.
- Necrosis of the metatarsal heads (Köhler's disease II, Freiberg's disease): Mostly girls around puberty. Pain, possibly swelling of the forefoot. Therapy: Insole, forefoot support with metatarsal pad, orthopaedic shoe fitting. If unsuccessful: surgery.
- Aspophysitis calcanei (Haglund's disease): Ossification disorder in the dorsal calcaneal apophysis. Pain when walking and when tensing the Achilles tendon. Therapy: heel elevation, possibly walking cast in pointed foot position for 4 weeks.
- Osteochondrosis dissecans: Demarcation of a bone/cartilage disk from a joint surface, usually on the knee, during and after the pubertal period. Corpus librum (joint mouse). Pain, effusion, possibly incarceration. Therapy: Rest (sport), if necessary plaster tutor or orthosis for 6-12 weeks, arthroscopy. Attempt refixation or removal of the discectomy. In the case of extensive cartilage damage, Pridie drilling, possibly osteotomy of the hip joint.
- Necrosis of the femoral head in adults: Predominantly men between 25 and 30 years of age. Alcohol, cortisone, diabetes, hyperlipidemia, liver disease, divers, post-traumatic femoral head necrosis after femoral neck fracture. Pain, limping, increasing restriction of movement. Typical X-ray findings if the clinical picture is pronounced. Early diagnosis: scintigraphy, magnetic resonance imaging(MRI). Therapy: at the beginning possibly relieving orthosis, flexion osteotomy, head resection with arthroplasty.
- Osteonecrosis of the femoral condyle(Ahlbäck's disease): Mainly women over 60 years of age, after cortisone therapy, pain on the inside of the knee, effusion. X-ray: flattening and compression, later dissection. Therapy: conservative treatment as with gonarthrosis is not very promising, valgus osteotomy, arthroplasty.
- Necrosis of the humeral head (Hass disease): Analogous to necrosis of the femoral head. Therapy: arthrodesis or alloarthroplasty.
- Lunate malacia (Knieböck's disease): Necrosis of the lunate bone of the hand. Possible occupational disease, pain when using the hand. Therapy: Immobilization. Possibly surgical removal or arthrodesis.
- Necrosis of the sesamoid bones under the metatarsophalangeal joint of the big toe: pain on exertion and pressure, tugging pain on passive dorsal movement of the big toe. X-ray: clavicular disintegration. Therapy: relieving insole or extirpation.
- Post-traumatic aseptic necrosis of a vertebral body (Kümmel-Verneuil disease): Months after vertebral fracture, pain, increasing kyphosis. X-ray: compression, flattening, progressive wedge shape with preservation of the neighboring intervertebral spaces. Differential diagnosis: tumor! Therapy: physical measures, physiotherapy, possibly a corset. Ultima ratio spondylodesis.
