Aseptic (avascular) necrosis of the ossification center. There are many types of clinics:
Perthes-Calve Legg Disease
It is aseptic necrosis of the femoral head (epiphysis), which is more common in males aged 4-8 years, It is thought that trauma plays a role in the etiology most frequently.
Symptoms that start clinically with pain and limping in the hip and knee are accompanied by limitation of hip abduction and internal rotation. Pain and shortening of the thigh muscles may develop.
Radiological Findings
• Synovitis stage: Swelling in joint capsule, increase in medial joint distance (tear or U sign), subchondral lytic line (crescent sign) are seen, which lasts for four weeks.
• Avascular necrosis period: It lasts for six months. There is an increase in density in the femoral head, flattening in the epiphysis, and a cystic appearance in the metaphysis.
• Fragmentation (regeneration) period: It lasts for 1-2 years. Sclerotic and lytic appearance in the epiphysis, the neck becomes shorter and flattened, the epiphysis flattens more and the acetabulum comes out.
• Residual stage: The femoral head is flat and broad (coxa plana). It is enlarged enough to protrude from the acetabulum (coxa magna), in some cases the depth of the acetabulum decreases.
Prognosis
1- The younger it starts, the better (the most important factor).
2- The less the head of the femur is involved, the better.
3- Obesity has negative effects.
4- Stiffness and flexion contracture formation in joint movements
Treatment
Conservative
• It is performed if the patient is young and has partial involvement of the femoral head.
• The aim is to direct the femoral head to the acetabulum and to give load on the hip.
• Bed rest, NSAID, traction and device are given.
Surgical
• It is performed if there is risky head and neck total involvement in patients older than 5 years of age.
• The aim is to increase blood supply and decrease interosseous pressure.
• varus osteotomy, Salter osteotomy, Chiari osteotomy and Cheilectomy are among the surgical methods.
Kohler's Disease
It is aseptic necrosis of the tarsal navicular bone.
Osgood-Schlatter Disease
is aseptic necrosis of the tuberositas tibiae .
Freiberg's Disease
It is aseptic necrosis of the second metatarsal head
Sever's Disease
Apophysitis of the posterior calcaneus
Kienbock's Disease
It is aseptic necrosis of the lunate bone.
Scheuermann's Disease (Adolescent Kyphosis)
Structural kyphosis of thoracic and thoracolumbar vertebrae.
It is more common in males.
The starting age is between 10-12.
Anterior wedging occurs in the lower thoracic and upper lumbar vertebrae.
Panner's Disease
It is avascular necrosis of the capitelum humeri.
Johansson-Larsen Disease
It is aseptic necrosis of the lower end of the patella.
Preiser's Disease
It is aseptic necrosis of the scaphoid bone.