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2.1
Bone Necrosis
Osteonecrosis
Osteonecrosis (avascular necrosis, bone infarction, aseptic necrosis, ischemic bone necrosis) is necrosis of bone due to bone infarction.

Images

WIKIDATA, CC BY-SA 3.0
WIKIDATA, Public Domain
WIKIDATA, CC BY-SA 3.0
WIKIDATA, CC BY-SA 3.0
WIKIDATA, CC BY-SA 3.0

Presentation

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]

Entire Body System

  • 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]

    Gaucher disease, and systemic lupus erythematosus. [medicinenet.com]

    Gaucher disease alcohol Behçet's disease 9 The above list applies to both bone infarct and subchondral avascular necrosis. [radiopaedia.org]

    Causes: fracture, dislocation, corticosteroids, nitrogen bubbles in dysbarism, vasculitis, radiation, vascular compression, venous hypertension, thrombosis (sickle cell disease), Gaucher’s disease, alcoholism Pathophysiology: initially necrosis of epiphysis [pathologyoutlines.com]

    alcohol use corticosteroids think of disorders that use corticosteroids such as systemic lupus erythematosus acute lymphoblastic leukemia transplantation Gaucher disease sickle cell disease caisson disease ("the bends") Pathogenesis impaired blood supply [medbullets.com]

  • Soft Tissue Mass

    An associated soft tissue mass is unusual with osteonecrosis; the presence of a soft tissue component suggests tumor recurrence. Radiation necrosis of the skull usually occurs after a minimum radiation dose of 3500 cGy. [emedicine.medscape.com]

Musculoskeletal

  • Joint Effusion

    The joint space and head contour have been maintained; the lytic lesion has regressed minimally. (c) Three years. There is no collapse and AVN has stabilized. (d) MRI showing marrow oedema and joint effusion on the right side. [doi.org]

    This pain is most often on the medial side of the femoral condyle or tibial plateau and manifests with tenderness, noninflammatory joint effusion, painful motion, and a limp. [merck.com]

    Perthes) 2% Intermittent pain, swelling and joint effusion If bone ® detached may ® locking or giving way X-Rays Taken in appropriate position to show defect (tangential to defect) Early ® line of demarcation Later ® separation (LB) & crater evident Pathology [flinders.edu.au]

  • Bone Disorder

    Unlike other bone disorders, this happens most often in men between age 40 and 50. Untreated injuries and diseases can cause AVN. Other causes include: Injury, such as a major impact from an accident or during sports. [upmc.com]

    Would you like to order publications on bone disorders to be mailed to you? Visit our online order form. [web.archive.org]

  • 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]

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]

MI), admission is indicated to a unit with telemetry monitoring and transcutaneous pacing capabilities Symptomatic patients should be treated with atropine and transcutaneous pacing immediately, followed by transvenous temporary pacing until further workup [emedicine.medscape.com]

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]

This should be managed like a type II with transcutaneous or transvenous pacing until further workup can be completed. [ncbi.nlm.nih.gov]

X-Ray

  • Schmorl's Nodes

    Polymyalgia rheumatica - Eosinophilic fasciitis - Hypermobility Dorsopathies Kyphosis - Lordosis - Scoliosis - Scheuermann's disease - Spondylolysis - Torticollis - Spondylolisthesis - Spondylopathies ( Ankylosing spondylitis, Spondylosis, Spinal stenosis ) - Schmorl's [wikidoc.org]

Treatment

Early diagnosis and treatment of this entity are crucial because it affects relatively young individuals, and treatment options for advanced disease are limited. [doi.org]

Therefore, early treatment to slow or prevent progression and save the joint is desirable. No completely effective treatment is yet available. [merck.com]

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]

Prognosis

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]

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]

Etiology

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]

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]

Better results can be expected with shorter preoperative delay, when preoperative pain is moderate and range of motion preserved and when the etiology is not postradiation avascular necrosis, which in our series yielded the worst results. [ncbi.nlm.nih.gov]

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.medscape.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]

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]

[…] and secondary degenerative joint disease Causes: fracture, dislocation, corticosteroids, nitrogen bubbles in dysbarism, vasculitis, radiation, vascular compression, venous hypertension, thrombosis (sickle cell disease), Gaucher’s disease, alcoholism Pathophysiology [pathologyoutlines.com]

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

Prevention Some tips to prevent avascular necrosis include: Avoiding alcohol intake Reducing blood cholesterol levels Avoiding too high doses of steroids, and especially repeated or high-dose courses Diagnosis and Treatment The diagnosis is based on the [news-medical.net]

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]

The best way to prevent AVN is to maintain strength and flexibility. Be sure to warm up before any physical activity and include strength training in your workouts. [upmc.com]

Therefore, early treatment to slow or prevent progression and save the joint is desirable. No completely effective treatment is yet available. [merck.com]

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