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Bone Necrosis

AVN

Osteonecrosis (avascular necrosis, bone infarction, aseptic necrosis, ischemic bone necrosis) is necrosis of bone due to bone infarction.


Presentation

  • Serum amylase was elevated in 33 patients; liver dysfunction was present in 50; hepatomegaly was found in 32; and biopsy-confirmed cirrhosis was present in 22 cases. Hyperuricemia was found in 22 patients, some of whom had received steroids.[ncbi.nlm.nih.gov]
  • This paper presents a case in which accidental injection of sodium hypochlorite into the lingual gingiva of a female patient caused gingival and bone necrosis. Surgical intervention was required.[ncbi.nlm.nih.gov]
  • To describe some toxic effects of arsenic trioxide in the mouth, to condemn its continued use, and present a case in which a tooth was preserved despite significant bony destruction.[ncbi.nlm.nih.gov]
  • We found the cases of three young patients who presented the appearance of hot spots on bone scintigrams which were finally diagnosed as bone necrosis.[ncbi.nlm.nih.gov]
  • The most important symptom was pain, present in all cases, and the mandible was the most common involved site.[ncbi.nlm.nih.gov]
Gaucher Disease
  • The osteonecrosis was idiopathic in 6 shoulders, was a result of corticotherapy in 10, occurred after radiation in 2, and occurred after Gaucher's disease in 1. A total shoulder arthroplasty was performed in 5 cases and a hemiarthroplasty in 14.[ncbi.nlm.nih.gov]
  • disease, and systemic lupus erythematosus.[medicinenet.com]
  • The following are possible causes: Using oral or intravenous steroids Excessive alcohol use Sickle cell disease Dislocation or fractures around a joint Clotting disorders HIV or taking HIV drugs Radiation therapy Gaucher disease (disease in which harmful[nlm.nih.gov]
  • Gaucher’s disease. Decompression sickness, also know as divers' disease, the bends, or caisson disease. Gout. Vasculitis. Osteoarthritis. Osteoporosis. Blood disorders, such as sickle cell disease.[niams.nih.gov]
Cushingoid
  • Patients with AVN, when compared with controls, had a significantly higher incidence of neurological disease (39% vs 14%; P 0.001) and Cushingoid body habitus after steroid treatment (79% vs 53%; P 0.004).[ncbi.nlm.nih.gov]
Soft Tissue Mass
  • The radiographic appearance is that of a soft tissue mass associated with bone destruction at a site of previous bone infarction.[emedicine.medscape.com]
Oral Ulcers
  • Oral ulcer, pleuritis, Raynaud's phenomenon, cutaneous vasculitis, lymphadenopathy, autoimmune thyroiditis, peripheral neuropathy and Sjögren's syndrome were higher incidence in SLE patients with AVN.[ncbi.nlm.nih.gov]
Hepatomegaly
  • Serum amylase was elevated in 33 patients; liver dysfunction was present in 50; hepatomegaly was found in 32; and biopsy-confirmed cirrhosis was present in 22 cases. Hyperuricemia was found in 22 patients, some of whom had received steroids.[ncbi.nlm.nih.gov]
Osteophyte
  • Necrotic area in cross section is yellow, opaque, chalky with hyperemic fibrous tissue at margin Adjacent bone may be thickened Late changes are breaks in smooth contour of femoral head, destruction of articular cartilage, loose bodies and marginal osteophytes[pathologyoutlines.com]
  • […] acquired deformities of limbs ( Valgus deformity, Varus deformity, Wrist drop, Foot drop, Flat feet, Club foot, Unequal leg length, Winged scapula ) patella ( Luxating patella, Chondromalacia patellae ) Protrusio acetabuli - Hemarthrosis - Arthralgia - Osteophyte[wikidoc.org]
  • In stage IV there is progressive loss of articular cartilage and the development of acetabular osteophytes. The radiographic picture is that of osteoarthritis superimposed on a deformed femoral head.[doi.org]
Distractibility
  • Cowell, Bisphosphonate rescue in distraction osteogenesis: a case series, Bone 38 (2006) 80-80; R. Marx, Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic, J. Oral Maxillofac.[ncbi.nlm.nih.gov]

Workup

  • The purpose of this article is to report a prototypical case with complete radiographic and histologic workup and to provide facts regarding Kummel disease that are salient to the primary care provider.[doi.org]
  • Besides confirming the diagnosis, another major role for the radiologist in the workup of osteonecrosis is staging the current state of the disease. The usual plain film and MR stages are listed below.[rad.washington.edu]
  • See Workup. Early diagnosis and appropriate intervention can delay the need for joint replacement. However, most patients present late in the disease course.[emedicine.medscape.com]

Treatment

  • Most people with osteonecrosis need treatment. The goals of treatments are to: Improve use of the joint. Stop further damage. Protect bones and joints. Your treatment options may include surgery or nonsurgical treatments, such as medicines.[niams.nih.gov]
  • Although a treatment for bisphosphonate-induced bone lesions has not yet been established, we suggest careful evaluation of the patients' oral health before prescribing bisphosphonate treatment.[ncbi.nlm.nih.gov]
  • Our data indicates that a policy of selected tooth removal, before radiation treatment, will minimize the risk of osteoradionecrosis.[ncbi.nlm.nih.gov]

Prognosis

  • Clinical data as well as treatment and prognosis information were obtained from all 14 patients. RESULTS: Twelve patients (86%) were submitted to biphosphonate therapy.[ncbi.nlm.nih.gov]
  • In addition, lesion size and location can be more easily assessed on magnetic resonance images, and this has been shown to relate to prognosis and need for treatment.[doi.org]
  • The prognosis for teeth number 27 and 28 was considered hopeless, and they were extracted. Due to extensive necrosis there was no interdental alveolar bone.[ncbi.nlm.nih.gov]
  • Early-stage avascular necrosis of the femoral head: MR imaging for prognosis in 31 cases with at least 2 years followup. Radiology 1993; 187: 199–204. Google Scholar 6. Mankin HJ. Nontraumatic necrosis of bone (osteonecrosis).[doi.org]
  • They have been used most often in treating osteonecrosis of the hip where the prognosis without treatment is worse than that for other regions.[merck.com]

Etiology

  • The etiology and management of herpes zoster infection associated with destructive oral sequelae are discussed.[ncbi.nlm.nih.gov]
  • Editions Published Year of Publication subjects Accessible book, Necrosis, Bones, Abnormalities, Bones--Necrosis, Etiology, Tibia, Adverse effects, Blood supply, Blood-vessels, Decompression sickness, Diphosphonates, Diseases, Drug Therapy, Jaw Diseases[openlibrary.org]
  • Because this disease can masquerade as many other pathologies, physicians should be aware of the etiology, presentation, and treatment options for osteonecrosis in the foot.[ncbi.nlm.nih.gov]
  • Although bone scintigraphy using single photon emission computed tomography (CT) may be nearly as accurate as MRI, MRI offers a more specific diagnosis in the patient who presents with hip pain of uncertain etiology.[doi.org]

Epidemiology

  • Introduction Clinical definition reduced vascular sup ply to the bone resulting in progressive and painful degeneration of the bone also termed osteonecrosis Epidemiology incidence typically occurs in the anterolateral femoral head demographics dependent[medbullets.com]
  • Epidemiology Frequency United States The frequency of AVN depends on the site involved. The most common site is the hip; other locations include the carpals, talus, femur, metatarsal, mandible, and humerus.[emedicine.com]
  • Epidemiology For oral bisphosphonates used to treat osteoporosis, the number of spontaneous reports of ONJ submitted to their manufacturers indicates a reporting rate of less than 1 per 100,000 patient treatment years.[iofbonehealth.org]
Sex distribution
Age distribution

Pathophysiology

  • We will review the pathophysiologic mechanisms of AVN and the current use of MRI in the diagnosis of this condition.[doi.org]
  • Pathogenesis The underlying pathophysiological mechanisms behind ONJ have yet to be elucidated.[iofbonehealth.org]
  • Pathophysiology Although the pathophysiology of AVN is not fully understood, the final common pathway is interruption of blood flow to the bone.[emedicine.medscape.com]

Prevention

  • Therefore, early treatment to slow or prevent progression and save the joint is desirable. No completely effective treatment is yet available.[merck.com]
  • Recognition of the quite characteristic imaging findings can prevent misdiagnosis and may have implications for the prediction of the natural course of the disease.[ncbi.nlm.nih.gov]
  • Further studies are needed to determine the effective length of use of biphosponates and the efficacy of drug holidays to prevent BRONJ. Copyright 2014 Elsevier Inc. All rights reserved.[ncbi.nlm.nih.gov]
  • BACKGROUND: Intravenous bisphosphonates are the current standard of care for the treatment of hypercalcemia of malignancy and for the prevention of skeletal complications associated with bone metastases.[ncbi.nlm.nih.gov]
  • Oral and Intravenous Bisphosphonate-Induced Osteonecrosis of the Jaws: History, Etiology, Prevention, and Treatment. Quintessence Publishing, Hanover Park, IL; 2006. Marx RE.[revistas.ces.edu.co]

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Last updated: 2019-07-11 22:13