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)

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. either through direct effects on the vessels or by resulting in altered biomechanical properties of the surrounding structures In these latter cases. an area of growth cartilage fails to undergo matrix calcification or vascular invasion. such as hemodynamic disorders may be implicated in the pathogenesis of osteochondrosis only so long as they affect cartilage canal function. it may be justified to regard the resulting lesions of osteochondrosis as being secondary to the generalized condition. prior to the point of the disease at which a focal failure of enchondral ossification occurs and is grossly visible. and the subjacent bone marrow is edematous and hyperemic. The principal lesion of osteochondrosis is a focal failure of enchondral ossification. with no single factor accounting for all aspects of the disease. and therefore does not become converted to bone. that is. 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).III. . However. The persisting cartilage is soft and reddish. 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. NARRATIVE EXPLANATION OF THE SCHEMA Osteochondrosis is regarded as having a multifactorial etiology. Generalized factors. the appropriate designation for the lesion is osteochondrosis dissecans (OCD).

There is little evidence that the body weight affects the prevalence of early lesions of osteochondrosis. V. Acute pain related to fracture. constricting devices. is mandatory . or impaired venous return. 2. swelling. Self-care deficit: feeding.NURSING DIAGNOSIS 1. • In bilateral or familial cases. dressing/grooming or toileting due to restricted range of motion. Altered health maintenance related to loss of independence. Anxiety related to changes in body integrity. 6. IV. 7. Bone scan or MRI should be done to confirm the diagnosis. 8. 5. DIAGNOSTICS • Diagnosis is suspected based on symptoms. Ineffective coping related to fear of the unknown. particularly multiple epiphyseal dysplasia. swelling and possible presence of immobilization device. perception of disease process. 10. that increased body weight promotes the progression from osteochondrosis to osteoarthritis. joint degeneration. Impaired physical mobility related to pain. 3. Risk for ineffective therapeutic regimen management related to insufficient knowledge or lack of available support and resources. bathing/hygiene. and inadequate support system. Risk for situational low self-esteem related to impact of musculoskeletal disorder. because they can be normal or show minimal flattening. or inflammation. a skeletal survey to exclude hereditary skeletal disorders. • X-ray studies initially may not be useful. 4. 9. Decrease tissue perfusion related to swelling. It is known. Risk for infection related to surgical procedure/ break in the skin.

and trauma must also be excluded. Jr. page 1251. Chaplain’s Operative Orthopedic. 11th edition. Stamford: Appleton & Lange. Pitcher’s Elbow in Adolescents. Robert E.15:105. Judith A. REFERENCES: 1.because prognosis and optimal management differ.Mosby Elsevier." In Current Pediatric Diagnosis and Treatment. Am J Sports Med 1980. King AG. Janice L. Kerry H Cheever 3. Anderson AF. Rashkin A. et al. Grana WA. W. edited by W. 6. Hinkle. Inc. Brenda G. Injury 1983. Dr. Tears of the Anterior Cruciate Ligament in Adolescents. J Bone Joint Surg 1986.68A:19.. sickle cell anemia. Hypothyroidism.2007 4. "Orthopedics. COPYRIGHT© 2004—Western Schools.8:333. 1997.. Halstead. and Gaia Geogopoulos. 2. Eilert. Lipscomb AB.. Meniscal Lesions in Children and Adolescents: A Review of the Pathology and Clinical Presentation. 7. Brunner and Suddarth's textbook of medical-surgical nursing By Suzanne C Smeltzer. . Orthopedic Nursing Caring for Patients with Musculoskeletal Disorders. Hay. Bare. 5.