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Paper 3
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
A 19 year old male who is usually fit and active has plain films of the right knee for ongoing knee pain. The radiograph demonstrates subtle flattening of the lateral surface of the medial femoral condyle with a loose osteochondral fragment. He has an MRI for investigation of suspected osteochondritis dissecans.
The locomotor system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Avascular necrosis is seen in several disorders of childhood. Perthes’ disease affects the hips in children, particularly males, who present with pain and a limp. About 10% of cases are bilateral. Pathologically there is necrosis of the femoral epiphysis, which may heal without significant deformity or collapse. This may result in osteoarthritis in later life. In other conditions bone necrosis follows an episode of trauma. In osteochondritis dissecans, a wedge-shaped area of bone and its attached articular cartilage separate from the articular surface leaving a well-demarcated defect. The bone undergoes necrosis. This commonly involves the lateral aspect of the medial femoral condyle. The loose body formed may cause locking and damage to the articular cartilage. Similar conditions may affect the tarsal navicular (Köhler's disease), lunate (Kienböck's disease), and second metatarsal (Freiberg's disease).
The Child With A Limp
Published in Michael B O’Neill, Michelle Mary Mcevoy, Alf J Nicholson, Terence Stephenson, Stephanie Ryan, Diagnosing and Treating Common Problems in Paediatrics, 2017
Michael B O’Neill, Michelle Mary Mcevoy, Alf J Nicholson, Terence Stephenson, Stephanie Ryan
Osteochondritis dissecans is complete or incomplete separation of a portion of joint cartilage and underlying bone, causing a loose body in the joint space. It usually affects the knee joint in athletic teenagers. Adolescents present with knee pain or discomfort and swelling. Pain is usually worse after exercise. There may be a history of a clicking or popping sensation of the knee joint. Boys are more commonly affected than girls. The aetiology is unknown but may be related to repetitive micro-trauma or stress. AP, lateral and tunnel-view (knee in flexion) X-ray views should be taken. If a lesion is noted, an MRI should be requested to determine the stage of the lesion.
Incapacitating pain from Tenofovir Induced Hypophosphatemic Osteomalacia in a Hemophilia Patient – A Case Report
Published in Canadian Journal of Pain, 2020
Emma Woo, Dinesh Kumbhare, Paul Winston
His treatment and workup began with a prescription of oxycodone 2 mg tabs 1 to 2 q4h, and the early diagnostics focused on the hip with an early tentative diagnosis of right hip osteoarthritis. Investigations performed included an x-ray of the lumbar spine and hips followed by computed tomography of the lower lumbar spine and pelvis, which showed no evidence of hemarthrosis, hematoma, or other acute pathology that could explain the pain. Avascular necrosis and osteochondritis dissecans had been ruled out on magnetic resonance imaging (MRI; see Figure 1b). A bone scan revealed moderate uptake in both hips and mid-femurs, previous multiple rib fractures, and a possible old left femur fracture and mild uptake in the spine, shoulders, hips, and elbows consistent with arthropathy (see Figure 1c).
Particulated juvenile articular cartilage allograft transplantation for osteochondral lesions of the knee and ankle
Published in Expert Review of Medical Devices, 2020
Colleen M. Wixted, Travis J. Dekker, Samuel B. Adams
An osteochondral lesion describes a wide range of pathology that results in disruption of the articular cartilage and corresponding subchondral bone. This definition encompasses the numerous etiologies associated with development of these lesions and the various joints where they may be found, although the knee and ankle are most typical. For this reason, osteochondral lesions of these two joints will be the focus of this article. Other terms to refer to these lesions include osteochondral defects, transchondral fractures, and osteochondritis dissecans; however, the use of osteochondritis dissecans suggests an etiology focused on spontaneous necrosis of the bone[1].