Juvenile osteoarthritis as consequence of enchondral injuries. Frostbite, Kashin-Beck disease, rat bites and other causes

Purpose. To review the similarities of the radiographic changes in frostbit e, the Asian disease of Kashin-Beck, and long term growth damage from injur y such as rate bite. Materials and Methods. Radiographs and literature from subjects with these diagnoses were analyzed for the common features and differences. Included w as an infant with hand changes 8 months after unwitnessed rat bites. Results. Each condition revealed findings consistent with the hypothesis of localized damage to sites of enchondral ossification, including at acrophy ses - the growth plates that are not between epiphysis and metaphysis, but instead lie at the margins of growth centers, including carpal and tarsal b ones, and the non-epiphyseal ends of sma II tubular bones. Discussion. The patterns observed support a final common pathway of damage in frostbite due to cold injury, Kashin-Beck disease (endemic in China) of unknown etiology, and damage from toxines associated,for example, with rat bite. In frostbite,the distribution is acral because of the site of exposur e, while the distribution in Kashin-Beck is more diffuse and often less con tiguous. In each condition, arthrotic sequelae may be expected in the natur al course of follow-up. MRI may play a role in acute diagnosis that might m odify the course of each disease.