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This is Pediatrics week five case four and

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the diagnosis under consideration is osteochondrosis or

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osteochondral defect.

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This is a condition that affects the cartilage and

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the underlying bone of many locations throughout

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the immature. Skeleton.

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A number of these locations have eponyms whether

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they be in the calcaneus or the tailless the

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radius the navicular the femur.

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I think it's less important to be

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able to describe the eponym on your report and more important

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to identify the degree of injury in the bone and

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for subtle cases to identify the injury at all. So here

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we have a ankle three view

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ankle radiograph AP oblique and lateral views

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and the ankle itself is intact. There's

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no displaced fracture, but if we

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magnify

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this radiograph and look very carefully we

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can notice as our eyes

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go across the articular surface of the

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the tailor Dome that there's a

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slight little depression in lucency of

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the surface of that Talus and

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if we go over here

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and we look at the oblique. It's even more apparent.

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I'm just going to magnify that and then

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I'm gonna

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show you what I mean.

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But there's a slight injury to

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the surface of the bone. Here is the divot right

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there take that off. You can see there's just a thin

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rim of sclerosis and then some lucency. So

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there's been a fracturing of the articular cartilage

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and a small flake of bone is also got

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a little crack in it. This is not a displaced fracture.

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And this is a early progression of

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the disease. We do not see the late changes which

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can even result in breaking away of a chunk

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of the bone and a loose body in the joint space. This

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is a subtle mild osteochondrosis of

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the Taylor Dome. And in order to fully evaluate the

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extent of the disease we're going to want to go ahead and do MRI.

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So MRI is going to show us the full

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extent of that fracturing that fracking of

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the cartilage and the underlying very superficial bone.

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It's also going to help us to understand is

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there's fluid signal completely surrounding that

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fragment. Is there a loose fragment. So here

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we've got

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T2 weighted sagittal view of the ankle here. You can see the

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talus and the calcaneus and as I come across

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At the very apex of the Taylor Dome at

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the same location. We saw on the radiograph. There's a

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very subtle amount of edema in that Taylor Dome

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and if we pull over another fluid sensitive, but

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coronal image, you're going to see the same thing don't

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expect this to always scream and be super dramatic

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because sometimes it can be quite subtle.

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And here we've got just a little bit of edema in the tailless and

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you can see the edema extends down

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into the body of the talus a little bit more than was a

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parent earlier. And then this dark hypo

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intense region where the actual osteochondral

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defect occurs note that

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what we don't see is fluid from the joint space

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outlining the entire lesion. So this is

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not a completely separated fragment or a

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loose body. It is an osteochondral defect

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but it hasn't Advanced to that severe State we

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can go ahead and look at this on the T1 which will

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show us a little bit of hypo intense signal

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at that same location. And here's the proton density same

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type of thing a very subtle little divot and a

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cracking that extends a little bit into the

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tailor Dome. So this is an early mild case of osteocondrosis something

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to be aware of especially knee and

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ankle and any of the joints in

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the immature SK.

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And can be affected. That's the end of the case.