Oral examinations
Deepak Subedi, Marialena Gregoriades, En Hsun Choi, John T Murchison, Graham McKillop in A Complete Guide to the Final FRCR 2B, 2011
There are a number of causes of avascular necrosis. Sometimes no apparent cause can be identified. In a significant number of patients, avascular necrosis of the hip is bilateral, and therefore both femurs should be imaged. This ensures early detection so that treatment can be instituted prior to any damage occurring to the articular surface. On MRI there is diffuse bone marrow oedema in the early stages, which progresses to a serpiginous T1 low-signal line surrounding an area of fatty marrow. This is the most characteristic sign of avascular necrosis. On T2-weighted images, a heterogeneous high signal can be visualised. In advanced stages, there is a focal low signal on both T1 and T2, consistent with bone collapse and sclerosis.
Corticosteroids
Sarah H. Wakelin, Howard I. Maibach, Clive B. Archer in Handbook of Systemic Drug Treatment in Dermatology, 2015
Gonadal hormone replacement therapy with oestrogen supplements for post-menopausal females reduces the risk of fractures. The oestrogen receptor modulator raloxifene, which has potent agonist effects on bone and antioestrogen effects on the uterus and breast, may be a good alternative. Testosterone replacement should be considered in males with low testosterone levels. Avascular necrosis (osteonecrosis) of bone may occur with high dose or prolonged corticosteroid therapy. The femoral head is most commonly affected and disease may occur bilaterally. Other sites include the femoral condyles and head of humerus. Symptoms of pain or reduced movement at one or more joints should prompt further investigation. Magnetic resonance imaging (MRI) is more sensitive for diagnosing early avascular necrosis than radiography. Specialist referral is warranted in suspected cases.
Medical Problems in Alcoholics
Frank Lynn Iber in Alcohol and Drug Abuse as Encountered in Office Practice, 2020
Aseptic necrosis of the hip occurs in alcoholics at a rate similar to that in patients on prednisone. It is manifest by pain and is recognized by vascular scanning of the femoral head or somewhat later at a much more advanced stage by hip X-rays. Replacement of the femoral head is effective in restoring ambulation. Osteoporosis has been described in a group of alcoholics, but the absence of liver disease was not sufficiently characterized.23 Others are less clear on the frequency of this lesion.24 Osteopenia, on the other hand, is common in all sorts of chronic liver disease, and is related to the duration and severity of the liver disease.
Multifocal avascular necrosis in a patient with refractory immune thrombocytopenia and antiphospholipid antibodies; case report and review of literature
Published in Platelets, 2019
Hala El-Gendy, Rasmia M. El-Gohary, Safaa Mahfouz, Hamdy M.A. Ahmed, Doaa M. El Demerdash, Gaafar Ragab
Dear editor(s), as you know, avascular necrosis (AVN), also known as ischemic necrosis, osteonecrosis and aseptic necrosis, was first described in 1738 by Alexander Munro and is defined as necrosis of a localized area of bone [1]. Immune thrombocytopenia (ITP) and antiphospholipid syndrome (APS) are two different autoimmune diseases that are rarely associated with AVN. ITP is characterized by low peripheral blood platelet count (< 100 × 109/L) and may present with petechiae and bleeding. It may occur in isolation (primary) or in association with other disorders (secondary) [2]. In ITP, anti-platelet antibodies directed against single or multiple platelet membrane glycoproteins (GP) lead to acceleration of platelet destruction and inhibition of their production [3]. Secondary causes include autoimmune disorders such as systemic lupus erythematosus (SLE) and APS; viral infections including hepatitis C virus (HCV) and human immunodeficiency virus (HIV); and certain drugs [4]. APS is caused by antiphospholipid antibodies (aPLs) and results in a hypercoagulable state which can clinically present with arterial, venous, or small vessel thrombosis and/or pregnancy morbidities [5].
Hip preserving surgery for avascular hip necrosis: does terminating exposure to known risk factors improve survival?
Published in The Physician and Sportsmedicine, 2020
Roger Erivan, Hicham Riouach, Guillaume Villatte, Bruno Pereira, Stéphane Descamps, Stéphane Boisgard
The present study was single-center, retrospective, and small scale, but this kind of pathology is rare, with 4.7 cases per 10,000 person-years in the Swedish population [27]. Moreover, there was no loss to follow-up, and all patients were included, reducing selection and attrition bias. Double reading was not implemented for X-rays [28], which may have biased the assessment of stages. Patient’s non-surgical treatments, if any were not taken into account, which again may have affected our findings [10]. Immunohistochemical factors affecting the progression of avascular necrosis were not analyzed [29]. Risk factors were categorized as avoidable or not, although in some cases there is room for discussion: e.g., does a diabetic patient who is under treatment still present a risk factor? – we decided that ‘yes’, but this may introduce bias. No differences were found preoperatively, but that may just have been due to small sample size.
Hallux sesamoid fractures in young athletes
Published in The Physician and Sportsmedicine, 2019
Cynthia J. Stein, Dai Sugimoto, Nathalie R. Slick, Corey J. Lanois, Bridget W. Dahlberg, Rebecca L. Zwicker, Lyle J. Micheli
In order to distinguish sesamoid fractures from other types of injury, a variety and often combinations of imaging including x-rays, MRIs, bone scans and CTs were used to make the diagnosis of a sesamoid fracture in our study population. MRI is generally the preferred study to distinguish between different causes of sesamoid pain [7,17]. At the present time, our protocol for pain at the first metatarsophalangeal (MTP) joint begins with anterior-posterior (AP), lateral and sesamoid view x-rays. If sesamoid fracture or injury remains in the differential, we obtain an MRI of the foot to help differentiate between sesamoiditis and sesamoid fracture. If symptoms persist despite treatment, our preferred imaging is then a CT scan to evaluate for the persistence of an unhealed fracture or the presence of avascular necrosis.
Related Knowledge Centers
- Alcoholism
- Femur
- Joint Dislocation
- Necrosis
- Bone Fracture
- Arthralgia
- Joint
- Circulatory System
- Steroid-Induced Osteoporosis
- Medical Imaging