Osteochondropathy on radiographs

Five stages of disease progression

The radiological picture of osteochondropathy directly depends on the stage of the disease. The process is prolonged, without acute attacks. Laboratory data and pain syndrome are usually non-specific.

1. Pre-radiographic stage (subchondral aseptic necrosis). Only the spongy bone is affected, the cartilage remains intact (osteoporosis stage). Bone pathology is not detected on radiographs. The duration of this stage is up to 6 months. To confirm the diagnosis, CT, MRI, densitometry, or scintigraphy are required.
2. Stage of sclerosis (pathological fracture). Distinct signs appear on images: for example, flattening of the femoral head or wedge-shaped deformation of the vertebral bodies (more often in the thoracic spine). Lasts from 3 to 6–8 months.
3. Stage of fragmentation (resorption). Revascularization of the affected area occurs — ingrowth of blood vessels and connective tissue. There is a simultaneous process of resorption of old bone and formation of new bone. This phase takes 1–1.5 years.
4. Stage of repair. Sequestered shadows disappear from radiographs. The necrotic bone is completely replaced by newly formed tissue, in which areas of radiolucency are visible.
5. Final stage (secondary changes). The shape and structure of the affected area are restored to the state characteristic of mature bone. With a favorable outcome, the anatomy approaches normal, but ideal restoration (e.g., of vertebral bodies) occurs extremely rarely.

Classification of osteochondropathies by localization

In diagnostic radiology, it is customary to distinguish forms of aseptic necrosis depending on the anatomical location of the pathology.

Osteochondropathies of short spongy bones:

• Navicular bone of the foot — Köhler disease I.
• Lunate bone of the hand — Kienböck disease.
• Vertebral body — Calvé disease (flat vertebra forms).
• Patella — Sinding-Larsen disease.
• Tarsal bones — Iselin disease.
• Talus — Haglund-Sever disease.
• Sesamoid bone of the first toe — Renander-Müller disease.

Osteochondropathies of apophyses:

• Tibial tuberosity — Osgood-Schlatter disease.
• Calcaneal tuberosity — Haglund-Schinz disease.
• Vertebral apophyseal rings — Scheuermann's disease (juvenile kyphosis).
• Humeral head — Hass disease.
• Pubic bone — Burmann disease.

Other localizations:

• Heads of the II–III metatarsal bones — Köhler disease II.
• Phalanges of the hand fingers — Thiemann disease.
• Sternal end of the clavicle (rare form).
• Articular surfaces (partial osteochondropathies) — König disease.

Spinal osteochondropathy (Scheuermann's disease)

Juvenile kyphosis manifests at 11–17 years of age (rarely at 5–6 years), more often affects boys, and can be inherited in a dominant manner. 3–4 vertebrae are subject to aseptic necrosis, more often at the Th7–Th10 level. The disease is usually diagnosed already in the sclerosis stage, which leads to early fixation of the deformation.

Phases of the clinical and radiological course:

1. Initial phase. Proceeds latently and painlessly. Back muscle fatigue appears, the condition is often mistaken for "slouching". Postural abnormality develops with the shoulder girdle deviated forward. Signs of uniform kyphosis begin to emerge (unlike an acute tuberculous gibbus). The radiograph shows indistinct wedge-shaped deformation of the vertebral bodies, but the kyphosis is not yet fixed.
2. Progression phase (12–17 years). Kyphosis becomes clearly pronounced and partially fixed. The upper torso is displaced posteriorly, and the middle and lower torso anteriorly. Compensatory non-fixed lordosis occurs with tension of the lumbar muscles. There are no gross functional impairments. Radiologically, pronounced wedge-shaped deformation of 2–3 vertebrae and structural disturbance of the epiphyseal plates are detected.
3. Final phase (over 18 years). Spinal deformation is persistent and significant, the chest is sunken anteriorly. Persistent pain syndrome develops (as a consequence of osteochondrosis). Radiographs show sharply pronounced wedge-shaped deformation of 2, 3, or 4 vertebrae.

Class and exam questions

What else to study on this topic

• Methods for early diagnosis of osteochondropathies: CT, MRI, densitometry, and scintigraphy.
• König disease: features of the radiological picture of partial lesions of articular surfaces.
• Osteochondropathies of short spongy bones (Köhler I, Kienböck, Calvé diseases).
• Genetic studies to identify risk groups for the development of osteochondropathies.

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.