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Rheumatic Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Osteonecrosis is a term given to cell death within bone and may be caused by a number of conditions, most of which lead to an impaired blood supply. The femoral head is commonly involved, although other bones may be affected (e.g. carpal scaphoid).
Radionuclide Bone Scintigraphy
Published in Michael Ljungberg, Handbook of Nuclear Medicine and Molecular Imaging for Physicists, 2022
Kanhaiyalal Agrawal, Gopinath Gnanasegaran
The causes of osteonecrosis include trauma, long-term steroid intake, sickle cell disease, other vascular diseases, and so forth. During the initial phase, there is a photopenic area in the involved region due to the cut-off of blood supply.Later, there is increased uptake due to reactive osteoblastic activity. MRI is usually the gold standard imaging modality in AVN. However, the bone scan shows changes quite early during the disease process.
Effects of treatment on bone and bone marrow
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Lia A Moulopoulos, Vassilis Koutoulidis
Radiation therapy and corticosteroids are known causes of osteonecrosis. Osteonecrosis develops several years after radiation treatment and has been reported to occur in 19% of bone marrow transplant recipients (29). Cumulative prednisolone-equivalent doses over 3 g have been associated with a 13% risk of osteonecrosis (30). In such cases, necrosis occurs as a result of decreased local blood flow caused by fatty marrow hypertrophy or lipid emboli (30). Before the introduction of MRI, radionuclide examination was the procedure of choice for the diagnosis of osteonecrosis. With this modality, however, false-negative rates of up to 18% have been reported (31). In another study, radionuclide studies failed to detect 10% of cases of osteonecrosis which were positive on MRI studies (32).
A meta-analysis of union rate after proximal scaphoid fractures: terminology matters
Published in Journal of Plastic Surgery and Hand Surgery, 2022
Han Hong Chong, Kunal Kulkarni, Rohi Shah, Melinda Y. T. Hau, Lambros Athanatos, Harvinder Pal Singh
For waist fractures, there is evidence to suggest that displacement is associated with instability and non-union, with operative management (fixation) advocated to minimise non-union [1,51,52]. However, a combination of diagnostic difficulty due to poor visualisation of the fracture on plain radiographs, inter-observer variation in classification (varying definition of the boundaries between waist and proximal) and finally, the differences in fracture configuration (transverse vs oblique) leads to differences in treatment, contributing to the heterogeneity in reported outcomes. The task becomes more complex when proximal fractures are considered, with less evidence to guide management. The goals of treatment are to prevent the sequelae of non-union and osteonecrosis. As non-union of proximal scaphoid fractures is more likely to progress to degenerative changes (SNAC) than their distal counterparts, operative management is usually recommended [53,54].
Complications and adverse effects related to surgical and medical treatment in patients with inflammatory bowel disease in a prospectively recruited population-based cohort
Published in Scandinavian Journal of Gastroenterology, 2021
Anders Rönnblom, Östen Ljunggren, Urban Karlbom
In this material, there are only occasionally bone mineral density (BMD) measurements so osteoporosis development, measured as a decrease in BMD, cannot be assessed. Data on fractures were, however, collected and in this material only one fracture, a femoral fracture, which might be related to GC treatment was identified. This fracture occurred in a young patient after a prolonged steroid treatment. The patient also suffered from severe comorbidity in the form of cerebral palsy and tetraplegia. The BMD measurement from this patient revealed low bone mass for the age but to what extent this was due to GC treatment is not possible to decide. Overall there are no indications of an overrepresentation of typical osteoporosis-related fractures in this material. As for osteonecrosis three patients were identified with this diagnose in the charts. One suffered severely and had joint replacement in both hips and in a shoulder. Regarding the other two there are no information of joint replacements. One of the cases was unclear since the MRI was not conclusive, and the patient did not attend further appointments. The third patient was lost to follow up. In total giving the fact that in this material 358 patients were treated with systemic GC this gives an incidence of 0.8% which is in the lower range of previous reports [35–37].
Antiphospholipid antibodies and osteonecrosis in systemic lupus erythematosus: a meta-analysis
Published in Expert Review of Clinical Immunology, 2021
Wei Qijiao, Zhou Meng, Liu Jianwen, Zhang Shengli, Gao Fei, Lin He, Chen Zhihan
Osteonecrosis (ON) is the destruction of the normal blood supply to bone tissue, which is attributable to various reasons, leading to collapse of the bone structure, thereby causing joint pain and loss of function. The femoral head and knee joint bone are most commonly affected [1]. ON is the primary cause of disability in systemic lupus erythematosus (SLE), which seriously hampers the quality of life of patients [2]. Several risk factors for ON in SLE have been identified [3,4]. Antiphospholipid antibodies (aPLs) include lupus anticoagulant (LA), anticardiolipin (ACL), and antiβ2GP1 antibodies. They closely modulate thrombus formation [5]. However, aPLs have also been considered a classification criterion for SLE post-1997 (SLICC, ACR-EULAR, etc.). The association between aPLs and ON in SLE remains a matter of contention, and no concrete conclusion has been arrived at yet. In the present study, a meta-analysis of the literature related to SLE, aseptic ON, and aPLs was conducted, and their association was explored.