Osteochondritis Dissecans of the Head of the Femur

Abstract

SUMMARY The history and occurrence of osteochondritis dissecans (O.D.) are briefly reviewed. Various factors which have been regarded as essential or contributory causes of the disease are discussed on the basis of the literature. It is concluded that the most plausible causal theory is that O.D. occurs on the basis of a fatigue fracture of a joint with mechanical inferiority. In the elbow and knee joints it may be due to the epiphyseal changes described by Ribbing, and in the hip joint to deviations from the normal form. In addition, the theory advanced by Bentzon is considered; according to this theory, aseptic necrosis occurs due to contusional injury to the vessels resulting in periarterial sympathectomy, which in turn gives rise to an abnormal callus reaction. Ten cases, of which two were bilateral, are reported. In one case, developments were followed from normal hip joints on both sides to O.D. in its complete form. Symptoms, differential diagnosis and treatment are briefly considered.