Definition: AVN or osteonecrosis is a condition where Usually by the time pt presents, lesion is often advanced
the bone has impaired blood supply or severe cell
damage which is due to traumatic and non-traumatic 1. Pain near joint a/w stiffness
conditions that will lead to ischemia n necrosis of the 2. Local tenderness
bone itself. 3. Swollen nearby joint
4. Restricted movements
Sites (most common): 5. Advanced AVN can cause bone deformity n ms
wasting
1. Femoral head 6. Neurologic deficit bcoz if the nerve affected by
2. Femoral condyles necrosis and compression of affected bones
3. Head of humerus
4. Proximal poles of scaphoid & talus Investigation
Because they lie at the outskirts of the bones main X-ray subarticular segment of increased bone density
vascular supply and are largely enclosed by articular Stage 1: Bone death w/o structural change because of reactive new bone formation in the
cartilage -> avascular structure and restrict area for surrounding living tissue which increases total mass of
entry of BV Within 48 hours after infarction there is marrow necrosis calcified bone. Usually when detected by x-ray the dz is
n cell death at advanced stage
Non-traumatic causes of osteonecrosis
Hypercortisolemia Marrow infiltration Stage 2: repair and early structure failure
Cortisol administration Gauchers Dz **
Cushings Dz Malignancy Some days/weeks after infarction, the surrounding,
Hyperlipidemia Infection living bone shows a vascular rxn: new bone is laid down
Alcohol abuse Septic arthritis upon the dead trabeculae n the increase in bone mass
Hemoglobinopathy Other shows on the x ray as exaggerated density. Despite this
Sickle-cell dz Perthes dz (children) active repair, small fractures begin to appear in the dead
Capillary occlusion SLE bone.
Dysbaric osteonecrosis Clotting disorders
Stage 3: Major structural failure MRI & CT usually show more detailed results
Better sensitivity in early stage of AVN as compared to 1. Subchondral necrosis -> subchondral fracture n
plain film better blood flow and osteoblastic activity. fracture of the bone affected
2. Deformity of the articular surface
Shows doughnut phenomenon- central area of 3. OA
decreased uptake is surrounded by an area of increased 4. In later stages, sclerosis and total destruction
uptake indicates the reactive zone surrounding the of joint can occur
necrotic area. 5. Non-union of fracture
6. secondary muscle wasting
NB **