Definition

Avascular bone necrosis (osteonecrosis) causes bone tissue to die, most often in the end areas of bones (epiphyses), for example in the head of the femur towards the hip joints or down towards the knees. The humerus can be 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:

• Alcoholism
• Fractures
•  bisphosphonates in cancer treatment (rare in osteoporosis treatment).
  • Necrosis of the jawbone
• Blood disease
• Pancreatitis (pancreatitis)
• Diabetes mellitus
• Diving sickness (Caisson's disease)
• Gaucher's disease
• HIV / AIDS infection
• Chemotherapy in cancer treatment
• Cholesterol
• Histiocytosis
  • Rosai-Dorfman's disease
• Dislocations ("out of joint")
• Corticosteroids (Prednisone) in high doses
• Kidney transplant
• Sickle cell anemia
• Radiation injuries in cancer treatment
• Pregnancy
• Systemic lupus erythematosus (SLE),

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

Symptoms of avascular bone necrosis

Pain occurs early and is a typical symptom.

• If the limb is close to the hip joint (most common location), the pain is often felt in the groin and pelvis, especially during strain and movement

Examinations

In early stages, the diagnosis can be difficult to set.

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

Diagnosis

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

Various types of avascular bone necrosis

Own name list here

Shoulder

• Hass disease: Shoulder (humerus head)

collarbone

• Friedrich disease: Collar (medial)

Elbow

• Brailsford disease: Elbow (radius head)
• 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 falanges)

Back Whirls

• Kümmell disease: Vertebra

Hip

• Epiphysiolysis in children (epiphysiolysis capitis femoris)
• Add-Calvé-Perthes disease: in children, hip (thigh bone head)
  • More here (Wikipedia)

Pelvic

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

Knee

• Ahlback disease: knee (medial femur condyl, 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 at talus)
• Liffert-Arkin Disease: Ankle (distal tibia)

Foot

• Freiberg disease: Foot (head to 2 metatars)
• 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 falcons)

Incorrect diagnosis (similar conditions, differential diagnoses)

• Arthritis / joint disease
• Osteoarthritis
• CRMO (child)
• Osteomyelitis (infection)
• Tumor (benign or cancerous)

Treatment

In the early stages it is recommended to relieve the affected area for example by using crutches and using painkillers or NSAIDs as required. Most people will still need surgery afterwards

• In case of major joint injuries in the hips, knees or shoulders, insertion of a joint prosthesis is often chosen

Literature

• Gupta M, 2019 (Bisphosphonates and Jaw Erosis)
• Baig SA, 2018 (hip)
• Grans Compendium in Rheumatology

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