acute respiratory distress syndrome

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SMOLENSK STATE MEDICAL ACADEMY:

SMOLENSK STATE MEDICAL ACADEMY OSTEOCHONDRITIS DR.JYOTISHNA SHUKLA GRP-10 YR-6

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Osteochondritis dissecans often abbreviated to OCD or OD, is a joint disorder in which cracks form in the articular cartilage and the underlying subchondral bone . OCD is caused by blood deprivation in the subchondral bone.

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This loss of blood flow causes the subchondral bone to die in a process called avascular necrosis. The bone is then reabsorbed by the body, leaving the articular cartilage it supported prone to damage. The result is fragmentation (dissection) of both cartilage and bone, and the free movement of these osteochondral fragments within the joint space, causing pain and further damage.

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OCD is classified by the progression of the disease in stages. There are two main staging classifications used; one is determined by MRI diagnostic imaging while the other is determined arthroscopically . However, both stagings represent the pathological conditions associated with OCD's natural progression .

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While the arthroscopic classification of osteochondral lesions is considered standard, the Anderson MRI staging is the main form of staging used in this article.[Stages I and II are stable lesions. Stages III and IV describe unstable lesions in which a lesion of the cartilage has allowed synovial fluid between the fragment and bone.

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Anderson MRI staging of osteochondritis dissecans Stage Evaluation Findings I Early Subchondral bone flattening in the epiphyseal plate before growth plate closure IIA Stable Subchondral cyst present IIB Unstable Incomplete separation of the osteochondral fragment due to repetitive trauma

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III Unstable Effusions (fluid around an undetached, undisplaced osteochondral fragment. IV Terminal Complete separation (detachment) of osteochondral fragment(s); mechanical irregularities and formation of loose bodies

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Cheng arthroscopic staging of osteochondritis dissecans . Grade Findings A Articular cartilage is smooth and intact but may be soft or ballottable B Articular cartilage has a rough surface C Articular cartilage has fibrillations or fissures D Articular cartilage with a flap or exposed bone E Loose, nondisplaced osteochondral fragment F Displaced osteochondral fragment

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Individual complaints usually consist of mechanical symptoms including pain, swelling, catching, locking, popping noises and giving way; the primary presenting symptom may be a restriction in the range of movement .

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Physical examination typically reveals an effusion, tenderness, and crepitus . The tenderness may initially spread, but often reverts to a well-defined focal point as the lesion progresses . Just as OCD shares symptoms with common maladies, acute osteochondral fracture has a similar presentation with tenderness in the affected joint, but is usually associated with a fatty hemarthrosis .

CAUSES:

CAUSES Trauma, rather than avascular necrosis, is thought to cause osteochondritis dissecans in juveniles.In adults, trauma is thought to be the main or perhaps the sole cause, and may be endogenous, exogenous or both . The incidence of repetitive strain injury in young athletes is on the rise and accounts for a significant number of visits to primary care.

Diagnostic imaging:

Diagnostic imaging X-rays show lucency of the ossification front in juveniles. In older people, the lesion typically appears as an area of osteosclerotic bone with a radiolucent line between the osteochondral defect and the epiphysis.

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Magnetic resonance imaging (MRI ) is useful for staging OCD lesions, evaluating the integrity of the joint surface, and distinguishing normal variants of bone formation from OCD by showing bone and cartilage edema in the area of the irregularity. MRI provides information regarding features of the articular cartilage and underlying subchondral bone, including edema, fractures, fluid interfaces, articular surface integrity, and fragment displacement.

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Computed tomography (CT) scans and Technetium-99m bone scans are also sometimes used to monitor the progress of treatment. Unlike plain radiographs (X-rays), CT scans and MRI scans can show the exact location and extent of the lesion . Technetium bone scans can detect regional blood flow and the amount of osseous uptake. Both of these seem to be closely correlated to the potential for healing in the fragment .

Treatment :

Treatment Treatment options include modified activity with or without weight bearing; immobilization; cryotherapy ; anti-inflammatory medication; drilling of subchondral bone; microfracture ; removal or reattachment of loose bodies; mosaicplasty and osteoarticular transfer system (OATS) procedures.

The primary goals of treatment are::

The primary goals of treatment are : Enhance the healing potential of subchondral bone; Fix unstable fragments while maintaining joint congruity; and Replace damaged bone and cartilage with implanted tissues or cells that can grow cartilage. The articular cartilage's capacity for repair is limited .

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partial-thickness defects in the articular cartilage do not heal spontaneously, and injuries of the articular cartilage which fail to penetrate subchondral bone tend to lead to deterioration of the articular surface . As a result, surgery is often required in even moderate cases where the osteochondral fragment has not detached from the bone.

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