Osteonecrosis and Transient Osteoporosis of the Femoral Head

Berg, Bruno C. Vande; Lecouvet, Frédéric; Maldague, Baudouin

doi:10.1007/3-540-30000-7_13

Cited by 3 publications

(1 citation statement)

References 74 publications

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“…The imbalance leads to a progressive loss of trabecular bone first (most metabolically active) and then progressively cortical bone. [12][13][14][15] Senile osteoporosis affects both genders and is age related, occurring in individuals ! 75 years.…”

Section: Pathophysiologymentioning

confidence: 99%

Nonspinal Fragility Fractures

Gómez

2016

Semin Musculoskelet Radiol

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This article focuses on nonspinal fragility or insufficiency fractures. Fragility fractures occur when normal levels of energy are applied to weakened bone, and they normally represent spontaneous fractures or traumatic fractures from minimal energy trauma that would not normally result in fracture in healthy people. This is the case in osteoporosis, where there is reduction of bone mass as well as loss of normal trabecular architecture leading to changes in structural characteristics that compromise biomechanics.The prevalence and most common locations, as well as clinical and diagnostic aspects, of nonspinal fragility fractures are presented. Osteoporosis is highly prevalent and can have different causes. The most common ones are primary, such as postmenopausal and senile osteoporosis, and secondary to several causes.Clinically, patients with insufficiency fractures present with pain, in many cases severe, and usually no history of trauma or eventually a history of minor trauma, such as a fall from standing height. If some cases, when these fractures are not displaced, detection is a challenge. In other cases, due to their location and equivocal features, differential diagnosis with malignancy has to be made. Radiographs, magnetic resonance imaging, multidetector computed tomography, positron emission tomography-computed tomography, and radionuclide scans have diverse roles in the diagnosis of insufficiency fractures.

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Section: Pathophysiologymentioning

confidence: 99%

Nonspinal Fragility Fractures

Gómez

2016

Semin Musculoskelet Radiol

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Circulatory Diseases of Bone and Adjacent Soft Tissues

Peh

Yang

2009

Diagnostic Imaging of Musculoskeletal Diseases

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The blood circulation of bone may be affected by a variety of insults, involving the arterial, capillary, sinusoidal or venous networks. Blood flow impedance may be due to mechanisms such as intraluminal obstruction, vascular compression or physical disruption of the vessel. In circulatory diseases of bone, imaging aims to demonstrate the reparative host response. Avascular necrosis (AVN) is a lesion in which an early diagnosis is vital in order that the appropriate management can be undertaken, with the femoral head being the most important affected site. There are numerous predisposing factors for AVN. The radiographic hallmark of femoral AVN is increased femoral head density in an otherwise normal joint. Established AVN is seen as collapse of the articular surface and fragmentation. MR imaging is the most accurate technique for diagnosing early AVN, demonstrating characteristic marrow changes. Trauma-induced AVN may affect specific sites, following injuries such as the scaphoid and lunate fractures, and slipped capital femoral epiphysis. Spontaneous osteonecrosis of the knee (SONK) affects the weight-bearing surface of the medial femoral condyle. AVN precursor syndromes include regional osteoporosis, reflex sympathetic dystrophy, transient osteoporosis and regional migratory osteoporosis. Osteochondroses related to osteonecrosis include Legg-Calve-Perthes disease, Kienbock disease, Freiberg infraction, Kohler disease and osteochondritis dissecans. Miscellaneous vascular disease that affects the musculoskeletal system encompass, frostbite, thermal and electrical injuries, compartment syndrome/myonecrosis, venous insufficiency of soft tissue, and ischemic fasciitis.

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Osteochondral Lesions of the Knee: Differentiating the Most Common Entities at MRI

et al. 2018

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Several pathologic conditions may manifest as an osteochondral lesion of the knee that consists of a localized abnormality involving subchondral marrow, subchondral bone, and articular cartilage. Although understanding of these conditions has evolved substantially with the use of high-spatial-resolution MRI and histologic correlation, it is impeded by inconsistent terminology and ambiguous abbreviations. Common entities include acute traumatic osteochondral injuries, subchondral insufficiency fracture, so-called spontaneous osteonecrosis of the knee, avascular necrosis, osteochondritis dissecans, and localized osteochondral abnormalities in osteoarthritis. Patient demographics, the clinical presentation, and the role of trauma are critical for differential diagnosis. A localized osteochondral defect can be created acutely or can develop as an end result of several chronic conditions. MRI features that aid in diagnosis include the location and extent of bone marrow edema, the presence of a fracture line, a hypointense area immediately subjacent to the subchondral bone plate, and deformity of the subchondral bone plate. These findings are essential in diagnosis of acute traumatic injuries, subchondral insufficiency fracture, and its potentially irreversible form, spontaneous osteonecrosis of the knee. If the lesion consists of a subchondral region demarcated from the surrounding bone, the demarcation should be examined for completeness and the presence of a "double-line sign" that is seen in avascular necrosis or findings of instability, which are important for proper evaluation of osteochondritis dissecans. Subchondral bone plate collapse, demonstrated by the presence of a depression or a fluid-filled cleft, can be seen in advanced stages of both avascular necrosis and subchondral insufficiency fracture, indicating irreversibility. Once the diagnosis is established, it is important to report pertinent MRI findings that may guide treatment of each condition. RSNA, 2018 An earlier incorrect version of this article appeared online. This article was corrected on August 23, 2018.

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Osteonecrosis and Transient Osteoporosis of the Femoral Head

Cited by 3 publications

References 74 publications

Nonspinal Fragility Fractures

Nonspinal Fragility Fractures

Circulatory Diseases of Bone and Adjacent Soft Tissues

Osteochondral Lesions of the Knee: Differentiating the Most Common Entities at MRI

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