Avascular necrosis: Difference between revisions
ClaireLewis (talk | contribs) (Created page with "==Background== *Also called osteonecrosis, ischemic necrosis, bone infarction *Interruption in vascular supply leads to death of osteocytes and marrow, necrosis, and (eventual...") |
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*Interruption in vascular supply leads to death of osteocytes and marrow, necrosis, and (eventually) collapse of dead segment | *Interruption in vascular supply leads to death of osteocytes and marrow, necrosis, and (eventually) collapse of dead segment | ||
==Causes/Risk factors== | ===Causes/Risk factors=== | ||
===Nontraumatic=== | ====Nontraumatic==== | ||
*[[Sickle cell disease]] | *[[Sickle cell disease]] | ||
*Exogenous [[corticosteroids]], Cushing's disease | *Exogenous [[corticosteroids]], Cushing's disease | ||
| Line 17: | Line 17: | ||
*Idiopathic | *Idiopathic | ||
===Traumatic=== | ====Traumatic==== | ||
*[[Hip dislocation]] | *[[Hip dislocation]] | ||
**High risk if not reduced within 6h | **High risk if not reduced within 6h | ||
| Line 25: | Line 25: | ||
*[[Proximal humerus fracture]] | *[[Proximal humerus fracture]] | ||
**Risk factors: 4 part fractures, head split, short calcar segments, disrupted medial hinge | **Risk factors: 4 part fractures, head split, short calcar segments, disrupted medial hinge | ||
*[[Elbow diagnoses|Elbow fractures]] ( | *[[Elbow diagnoses|Elbow fractures]] | ||
**Trochlear fracture | |||
**[[Lateral epicondyle fracture (peds)|Lateral]] or [[Medial epicondyle fracture (peds)|medial epicondyle fracture]] | |||
*[[Lunate fracture]], [[Capitate fracture]] | *[[Lunate fracture]], [[Capitate fracture]] | ||
| Line 32: | Line 34: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Sickle cell DDX}} | |||
==Evaluation== | ==Evaluation== | ||
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==Management== | ==Management== | ||
*Ortho consult | *Ortho consult | ||
*Usually splint, non-weightbearing | *Usually [[Splinting|splint]], non-weightbearing | ||
==Disposition== | ==Disposition== | ||
Latest revision as of 18:56, 8 July 2021
Background
- Also called osteonecrosis, ischemic necrosis, bone infarction
- Interruption in vascular supply leads to death of osteocytes and marrow, necrosis, and (eventually) collapse of dead segment
Causes/Risk factors
Nontraumatic
- Sickle cell disease
- Exogenous corticosteroids, Cushing's disease
- Collagen vascular disease (e.g. SLE)
- Chronic kidney disease (renal osteodystrophy), post-renal transplant
- Pancreatitis
- Radiation therapy
- HIV
- Caisson Disease (aka dysbarism)
- Legg-Calve-Perthes disease
- Slipped capital femoral epiphysis (may be atraumatic or minor trauma)
- Idiopathic
Traumatic
- Hip dislocation
- High risk if not reduced within 6h
- Femoral neck fracture
- Major talus fracture (talar head/neck)
- Navicular fracture (central part of bone is avascular)
- Proximal humerus fracture
- Risk factors: 4 part fractures, head split, short calcar segments, disrupted medial hinge
- Elbow fractures
- Trochlear fracture
- Lateral or medial epicondyle fracture
- Lunate fracture, Capitate fracture
Clinical Features
- Depends on cause and location
Differential Diagnosis
Sickle cell crisis
- Vaso-occlusive pain crisis
- Bony infarction
- Dactylitis
- Avascular necrosis of femoral head
- Acute chest syndrome
- Asthma
- Pulmonary hypertension
- Gallbladder disease
- Acute hepatic sequestration
- Infection
- Parvovirus B19
- Splenic sequestration
- CVA
- Cerebral aneurysm and ICH
- Priapism
- Papillary necrosis
Evaluation
- Plain films generally first step
- Further evaluation depends on cause/location
Management
- Ortho consult
- Usually splint, non-weightbearing