Ovarian bone necrosis (osteonecrosis) 4.67/5 (3)

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Avascular osteonecrosis
MRI examination: Avascular bone necrosis / osteonecrosis of the shoulder. Dr. Roberto Schubert, Radiopaedia.org. From the case rID: 16018


Avascular bone necrosis (osteonecrosis) is due to too low oxygen supply and causes bone tissue to die, most often in the end parts of the bones (epiphyses) such as in the femur towards the hip joints or down towards the knees. The humerus is often attacked by the shoulders. Smaller bones in the feet, hands and vertebrae can also be attacked. The condition is also called aseptic or ischemic bone necrosis.

Disease Causes

Avascular bone necrosis is caused by low blood supply to the skeleton in various conditions:

In children, avascular bone necrosis occurs at various locations (see table below), most commonly at the hip at Legg-Calve-Perthes disease and epiphysiolysis (epiphysiolysis capitis femoris).

Symptoms of avascular bone necrosis

Pain occurs early and is a typical symptom. Most people get symptoms from weight-bearing areas in the skeleton. If the bone cruciate ligament is close to the hip joint (most common location), the pain is often felt in the groin and pelvis, especially with strain and movement. A few are asymptomatic.

Avascular necrosis
Avascular necrosis of the vertebrae (Kümmell's disease). Illustration: A.Prof Frank Gaillard, Radiopaedia.org, rID: 5354


In the early stages, the diagnosis can be difficult to make. The medical history, age at onset and location can provide clues. The clinical examination is often without special findings. Laboratory tests are usually inconspicuous and are most useful in ruling out infection.

MRI however, often shows clear changes in the skeleton. If the bone structure collapses, X-rays will also be useful, and clinical examination often shows reduced mobility.


Avascular bone necrosis is detected on the basis of medical history with symptoms and early MRI examination. Later in the process, X-rays also show typical changes.

Various types of avascular bone necrosis

Osteonecrosis in children and adolescents (From Gran & Palm, Revma Compendium, 2022)

Calve-Legg PertheThe femoral head2-20 years, most often 4-8 yearsgutter
Köhler IBig toe6-9 years
Köhler II (Freibergs disease)Metatarsal head of toe 2 or 36-14 yearsBoth
Osgood Schlatter Aseptic necrosis of the tibial tuberosity10-15 yearsBoth
Severe diseaseHeel6-10 yearsBoth
Scheuermann's diseaseThoracic column (Type 1), thoracolumbar (Type 2)TeenagersBoth
Osteochondritis dissectionOften knees10-20 yearsgutter

List of location and own name:

Shoulder: Hass disease: Shoulder (humerus head)

collarbone: Friedrich disease: Collar (medial)

Elbow: Brailsford disease: Elbow (head radius). Panner disease: Elbow (humerus head)

Wrist: Wrist (distal ulna)

Hand: Caffey disease: hand or knee (whole hand or intercondylar on tibia). Dietrich disease: Hand (metacarpal heads). Kienbock disease: Hand (os lunatum). Mauclaire disease: Hand (metacarpal heads). Preise illness: Hand (scaphoid). Thiemann disease: Hands or feet (base of the phalanges).

Back Whirls: Kümmell disease: Vertebra

Hip: Epiphysiolysis in children (epiphysiolysis capitis femoris)

Add-Calvé-Perthes disease: in children, hip (thigh bone head)

Pelvic: From Neck-Odelberg disease: Pelvic (ischiopubic synchondrosis)

Knee: Ahlback disease: knee (medial femoral condyle, ie SONK). Caffey disease: hand or knee (whole hand or intercondylar on tibia). Kohler disease: Knee or foot in children (patella or os navicularis.

Ankle: Dias disease: foot (trochlea on talus). Liffert-Arkin Disease: Ankle (distal tibia)

Foot: Freiberg disease: Foot (head of 2nd metatarsal). Iselin Disease: Foot (base of 5 metatars). Mueller-Weiss disease: Foot in adults (os navicularis). Sever disease: Foot, heel (calcaneus epiphysis). Thiemann disease: Hands or feet (base of phalanxes).

Similar conditions, differential diagnoses


An optimal treatment for osteonecrosis remains to be found. In the early stages, it is recommended to relieve the affected area, for example by using crutches and using painkillers or NSAIDs as required. For pain, zoledronic acid (Aclasta) is also used, possibly with repeated infusions, but then outside the approved indication (experimental treatment). Most will still need surgery eventually. In case of major joint damage in the hips, knees or shoulders, the insertion of a joint prosthesis is often chosen.


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