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    Go to the top of the page   ID: 20040206232311 Original case in english  More links about this topic on Pubmed (PubMed Reader)
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    Kohler's Disease II, Bilateral Freiberg-Kohler Disease
    Ina Sorge. Kohler's Disease II, Bilateral Freiberg-Kohler Disease. PedRad [serial online] vol 4, no. 2.
    URL: www.PedRad.info/?search=20040206232311


     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Ina Sorge (Kinderradiologie/Uni Leipzig)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    13 Years  

     
     Pediatric Radiology CasesGender:

    Female  

     
     Pediatric Radiology CasesRegion-Organ:

    Leg-Bones  

     
     Pediatric Radiology CasesMost likely etiology:

    circulatory  

     
     Pediatric Radiology CasesHistory:

    Pain initially in the left foot; a few months later also in the right foot, particularly on exertion. Slight swelling, pain on pressure.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    Aseptic bone necrosis are seen in children along with cartilage ossification defects throughout growth or throughout increased exertion. A cause may be passing intraossic vascularization disturbances through a mycotic-embolic vessel obstruction, bland infections, trauma, vessel spasms, vegetative dysregulations or vessel trauma. Constitutional and alimentary factors seem to play a role as well. The infestation can be unilateral or bilateral.  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Left foot, October 2000: subchondral density and fragmentation of the 2nd metatarsal bone with undamaged joint.






    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Left foot, November 2000: Flattening of the joint.






    X-Ray 3 <- view X-Ray 3

    X-Ray 3: Right foot, September 2001: Barely noticeable flattening and subchondral density of the head of the 2nd metatarsal.






    X-Ray 4 <- view X-Ray 4

    X-Ray 4: Right foot, December 2001: 3 Months after the first image shows an obvious flattening of the joints, beginning fragmentation.






    X-Ray 5 <- view X-Ray 5

    X-Ray 5: Right foot, October 2002: 1 year after disease began. Fragmentation, Break of the joint.






    X-Ray 6 <- view X-Ray 6

    X-Ray 6: January 2003: Late stage disease on both sides with deformation of the joint and beginning osteophytic structures as seen in a beginning secondary arthrosis.


     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    Total constellation (Consens)  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    none  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    Freiberg-Kohler's disease is the only bone necrosis that is more often seen in girls than in boys.

    II: partially detached osteochondral lesion

    III: completely detached, non-displaced fragment

    IV: detached and displaced fragment

    There are 4 stages:
    1. Initial stage with cartilaginous edema and joint effusion. The X-ray is still unnoticeable, in MRI bone marrow edema.

    2. Condensation-density of bone structures in hypermineralization of necrotic bony trabecula. In the X-ray it is already seen, in MRI double-line sign.

    3. Fragmentation with deformity of joint structures. Up until this stage, 2 or 3 years since begin of disease may have passed.

    4. Repair with replacement of necrotic tissue with the new bone substance. Requirement: Revascularisation

    An early diagnosis is possible , next to MRI, with the 3-phase skeletal szintigraphy. Avascular bone areas are known as so-called "cold-spots".

    Treatment:
    Conservative: decompression and increased circulation. bed rest, no sports, decompressing wraps, support insoles. Antiphlogistical, hyperemic and physical therapy. Prostaglandin analogs such as Ilomedin (Schering).

    Surgical: Drilling to result in pressure decompression and increased revascularization. Nailing/Pinning, correction in Freiberg-Kohler as, for example, open-flap osteotomies in the later stages with pain and deformation.

    The course of the disease is dependent on how fast vessels revascularize the area. An early diagnosis is therefore of great importance.  

     
     Pediatric Radiology CasesComments of the author about the case:

    The images show a phasic course of an osteonecrosis. On the right side Stage I (barely noticeable changes in X-Ray) up to a defect healing about 3 years later.  

     
     Pediatric Radiology CasesFirst description / History:

    N/A  

     
     Pediatric Radiology CasesLiterature:

    1. Medline: Medline
    G.Petje, C.Radler, N.Aigner, G.Kriegs-Au, R.Ganger, F.Grill
    Aseptische Knochennekrosen im Kindesalter
    Der Orthopäde 2002-31:1027-1038
     

     
     Pediatric Radiology CasesKeywords:

    aseptic bone necrosis, osteonecrosis, avascular necrosis, Kohler's Disease II, Freiberg-Kohler, avascular bone necrosis, child, childhood, pediatric radiology  

     
     Pediatric Radiology Cases Cite this article:

    Ina Sorge. Kohler's Disease II, Bilateral Freiberg-Kohler Disease. PedRad [serial online] vol 4, no. 2.
    URL: www.PedRad.info/?search=20040206232311  

     
     Pediatric Radiology Cases Read similar articles: with corresponding keywords
    in the same field: Leg-Bones
    or in the region: Leg
    or in the tissue/organ: Bones
    or with the etiology: circulatory
     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] View all modalities [ All ]   
     
    Kohler's Disease II, Bilateral Freiberg-Kohler Disease
    Ina Sorge. Kohler's Disease II, Bilateral Freiberg-Kohler Disease. PedRad [serial online] vol 4, no. 2.
    URL: www.PedRad.info/?search=20040206232311


     

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    Kohler's Disease II, Bilateral Freiberg-Kohler Disease
    Other cases by these authors:

    Search Ina Sorge in Medline Ina Sorge (8)   

    Kohler's Disease II, Bilateral Freiberg-Kohler Disease  
     
    Kohler's Disease II, Bilateral Freiberg-Kohler Disease
    Ina Sorge. Kohler's Disease II, Bilateral Freiberg-Kohler Disease. PedRad [serial online] vol 4, no. 2.
    URL: www.PedRad.info/?search=20040206232311


     

    Which diagnosis have other collegues guessed?


    • Osteosarcoma (both sides)
      Votes: 0 (0 %)


    • Köhler's Disease I
      Votes: 7 (46 %)


    • Köhler's Disease II
      Votes: 7 (46 %)


    • Thiemann's Disease
      Votes: 0 (0 %)


    • Iselin's Disease
      Votes: 1 (6 %)



        Total answers: 15

     
    Kohler's Disease II, Bilateral Freiberg-Kohler Disease
    Ina Sorge. Kohler's Disease II, Bilateral Freiberg-Kohler Disease. PedRad [serial online] vol 4, no. 2.
    URL: www.PedRad.info/?search=20040206232311


     

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    Kohler's Disease II, Bilateral Freiberg-Kohler Disease
    Ina Sorge. Kohler's Disease II, Bilateral Freiberg-Kohler Disease. PedRad [serial online] vol 4, no. 2.
    URL: www.PedRad.info/?search=20040206232311


     




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