Definition
- Disorders of endochondral ossification in growing children
- Affect the epiphysis, apophysis or physis
- Repetitive stress, vascular insult and genetic predisposition
- Osteonecrosis and fragmentation, then repair
Pathology
- Disordered ossification, with avascular necrosis in some forms
- Revascularisation, resorption and new bone formation follow
- Radiographs show sclerosis, flattening and fragmentation, then reconstitution
- Outcome depends on age, site and articular remodelling before skeletal maturity
Classification
Siffert classification
| Type | Description | Examples |
|---|---|---|
| Articular | Joint surface and epiphysis, with risk of secondary osteoarthritis | Perthes, Freiberg, Kohler, Panner |
| Non-articular | Traction apophysitis at a tendon or ligament insertion, self-limiting | Osgood-Schlatter, Sever, Sinding-Larsen-Johansson |
| Physeal | Growth plate involvement with resulting deformity | Blount, Scheuermann |
Original publication Siffert RS. Classification of the osteochondroses. Clin Orthop Relat Res. 1981;(158):10-8.
Articular
- Legg-Calve-Perthes disease, femoral head, boys aged 4 to 8 years
- Kohler disease, navicular, young children, self-limiting
- Freiberg disease, metatarsal head (usually second), adolescent girls
- Panner disease, capitellum, boys under 10, distinct from capitellar OCD in older adolescents
- Kienbock disease, lunate, young adults, with negative ulnar variance
Non-articular
- Osgood-Schlatter disease, tibial tubercle apophysis, active adolescents
- Sinding-Larsen-Johansson syndrome, inferior pole of patella
- Sever disease, calcaneal apophysis at the Achilles insertion
Physeal
- Scheuermann disease, vertebral ring apophysis, thoracic kyphosis with wedging of three or more vertebrae
- Blount disease, posteromedial proximal tibial physis, progressive tibia vara
Clinical Features
- Activity related pain, limp, local tenderness and swelling
- Deformity in physeal forms
- Apophyseal forms often bilateral and linked to growth spurts and sport
Investigations
- Plain radiographs usually confirm the diagnosis, with comparison views where helpful
- MRI for early disease, staging of necrosis and articular involvement
Management
- Non-articular forms resolve at skeletal maturity with activity modification, stretching, ice and analgesia
- Articular forms aim to preserve congruity and range of motion
- Surgery for progressive collapse, loose bodies or deformity
- Physeal forms may need bracing or corrective osteotomy, as in Scheuermann and Blount disease
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.