AVN Flashcards
(98 cards)
1
Q
Where does AVN tend to occur at in a bone?
A
Epiphyseal predisposition
2
Q
What is the most common etiology of AVN?
A
Spontaneous/idiopathic
3
Q
What is the first phase of AVN?
A
Avascular phase
4
Q
What is the main characteristic of stage 1 AVN?
A
Blood supply destroyed
5
Q
What occurs at the epiphyseal plate during stage 1 AVN?
A
Growth is slowed or stopped
6
Q
What happens to articular cartilage during stage 1 AVN?
A
Articular cartilage continues to be in place
7
Q
What is the second phase of AVN?
A
Revascularization phase
8
Q
What happens during the second phase of AVN?
A
New vessels form, necrotic bone is reabsorbed, new bone deposited on dead bone
9
Q
What phase of AVN does creeping substitution occur in?
A
Stage 2 AVN
10
Q
What are the characteristics of creeping substitution?
A
Thickened trabeculation and increased bone density
11
Q
What phases of AVN can the new bone be easily modeled/deformed?
A
Stage 2 and Stage 3
12
Q
What is the third phase of AVN?
A
Repair and remodeling phase
13
Q
What occurs during stage 3 AVN?
A
Continued necrotic resorption and new deposition
14
Q
What the the fourth phase of AVN?
A
Deformity phase
15
Q
What occurs during stage 4 AVN?
A
Restoration of normal shape
16
Q
What causes the deformity during stage 4 AVN?
A
Deformity is due to amount of compressive force during earlier phases
17
Q
What is the crescent sign seen during?
A
AVN
18
Q
What is the bite sign seen during?
A
AVN
19
Q
What is the hanging rope sign seen during?
A
AVN
20
Q
What is the mushroom deformity seen during?
A
AVN
21
Q
What are the different radiographic sign?
A
- Collapse of articular cartilage
- Fragmentation
- Mottled trabecular pattern
- Bite sign
- Mushroom deformity
- Sclerosis
- Subchondral cysts
- Subchondral fractures
- Hanging rope sign
22
Q
What does AVN look like on TI MRI?
A
Loss of signal (darker), bilateral, may have joint effusion
23
Q
What is AVN in adult femoral head called?
A
Chandler’s Disease
24
Q
What is Chandler’s Disease?
A
Adult femoral head AVN
25
What gender is more likely to have Chandler's Disease?
Males
26
What age range is most likely to be affected by Chandler's Disease?
30-70 year olds
27
Is Chandler's Disease unilateral or bilateral?
Commonly bilateral
28
What are the early symptoms of Chandler's Disease?
Vague symptoms early - pain in buttock, groin, thigh, knee, hip
29
What occurs during Chandler's Disease over years?
Increase in pain, decrease in ROM, limping gait
30
What is the prognosis for Chandler's Disease?
Better with early diagnosis and treatment, better in younger patients, better in males
31
Which sex has a poorer prognosis with Chandler's Disease?
Females
32
What is the name of AVN in the femoral head before the growth plate closure?
Legg-Calve-Perthes disease
33
What Legg-Calve-Perthes Disease?
AVN in femoral head before growth plate closure
34
What age range is affected by Legg-Calve-Perthes disease?
4-8 year olds
35
What sex is affected more commonly by Legg-Calve-Perthes?
Males
36
What are the symptoms of Legg-Calve-Perthes?
Vague symptoms - pain in groin, limping gait, loss of ROM (abduction and internal rotation)
37
What is the etiology of Legg-Calve-Perthes?
Unknown
38
How long until Legg-Calve-Perthes resolves?
2-8 years
39
How long is the avascular in Legg-Calve-Perthes?
0-12 months
40
What radiographic signs appear during the avascular phase of Perthes?
Increase teardrop distance and small epiphysis
41
How long is the revascularization phase in Perthes?
6 months - 4 years
42
What are the radiographic signs that appear during revascularization phase?
Flattened small epiphysis, homogenous or patchy sclerosis, crescent sign
43
How long is the remodeling/repair phase of Perthes?
1-2 years
44
What are some of the radiographic signs that appear during the revascularization phase of Perthes?
Coxa vera, coxa magna (enlarged femoral head), mushroom deformity, large greater trochanter
45
What are some radiographic features of Perthes?
1. Soft tissue swelling
2. Small epiphysis
3. Lateral displacement of ossification center
4. Flattening, fissuring and fracture of ossification center
5. Metaphyseal widening and foreshortening
6. Widened irregular physis
7. Intra-epiphyseal gas
46
What is the etiology of osteochondrosis dissecans?
Unknown
47
What is osteochondrosis dissecans?
Focal subchondral infarction of subarticular bone
48
What age range is affected by osteochondrosis dissecans?
11-20 years old
49
What sex is more commonly affected by osteochondrosis dissecans?
Males
50
What location is most common for osteochondrosis dissecans?
Lateral aspect of the medial femoral condyle close to fossa
51
What other locations is osteochondrosis dissecans found at?
Humeral head, capitulum of elbow (Panner's disease), medial surface of the talus
52
What is osteochondrosis dissecans of the capitulum of the elbow called?
Panner's disease
53
What is Panner's disease?
Osteochondrosis dissecans of the capitulum of the elbow
54
What are the symptoms of osteochondrosis dissecans?
Asymptomatic, vague symptoms - clicking, locking, limited ROM, swelling, pain aggravated by movement
55
What does osteochondrosis dissecans predispose the patient to?
DJD
56
What are the different outcomes of osteochondrosis dissecans?
1. Heal spontaneously
2. Become a free fragment - reattach, become joint mouse
3. Predisposes to DJD
57
What location is most common for spontaneous osteonecrosis?
Knee
58
What is spontaneous osteonecrosis?
A diagnostic term applied to the aged knee. Idiopathic AVN of the knee
59
What is spontaneous osteonecrosis associated with?
Medial meniscal lesions
60
Who is most likely to have spontaneous osteonecrosis?
Middle aged females
61
What is Osgood Schlatter's Disease?
Fragmentation of the apophysis of the tibia tuberosity
62
What is the mechanism for Osgood Schlatter's Disease?
Probably traumatic rather than true necrosis
63
What is Sindig-Larsen-Johanssen Disease?
Involvement of the inferior pole of the patella in Osgood-Schlatter's
64
What population is most likely to have Osgood-Schlatter's Disease?
Adolescents 11-15 years old, males
65
What sports are associated with Osgood-Schlatter's Disease?
Running sports
66
What are the symptoms associated with Osgood-Schlatter's Disease?
Localized pain, tenderness, self limiting, soft tissue swelling over tibial tubercle
67
How long to symptoms of Osgood-Schlatter's Disease usually last?
Into adulthood, but usually cease by 18 yrs
68
True or False? Deformity may be present in Osgood-Schlatter's Disease?
True, deformity may be present.
69
True or False? Fragmentation can occur in Osgood-Schlatter's Disease?
True, fragmentation can occur.
70
What is Freiberg's Disease?
AVN of the metatarsal head
71
What location is most common in Freiberg's Disease?
Metatarsal head of MTP 2
72
What population is most commonly affected by Freiberg's Disease?
Females
73
What is thought to be the cause of Freiberg's Disease?
Possibly high heeled shoes
74
What age range is most commonly affected by Freiberg's Disease?
13-18 year old females
75
What is the mechanism of injury for Freiberg's Disease?
Collapse of the articular surface leading to incongruity and then DJD
76
What are the symptoms of Freiberg's Disease?
Pain and swelling
77
What is Kienbock's Disease?
AVN of the lunate
78
Who is most commonly affect by Kienbock's Disease?
Males, 20-40 years old, engaged in manual labor (jack hammers)
79
What is associated with Kienbock's Disease?
Ulna minus variant/negative ulnar variance (short ulna)
80
What are the symptoms of Kienbock's Disease?
Progressive pain and soft tissue swelling of the wrist
81
What is the usual steps that occur in Kienbock's Disease?
1. Lunate increases in density/becomes whiter
2. Fragmentation and collapse
3. Altered joint congruity and biomechanics precipitates DJD
82
What treatment is possibly with Kienbock's Disease?
Silastic implants
83
What possibly radiography features could be present with Kienbock's Disease?
Mixture of sclerosis and radiolucency
84
What is Kohler's Disease?
AVN/vascular insufficiency or normal variant of tarsal navicular
85
What are the symptoms of Kohler's Disease?
Localized pain and swelling
86
What radiographic signs are present with Kohler's Disease?
Navicular patchy, homogenous sclerosis, collapse of navicular and fragmentation
87
What is Scheuermann's Disease also called?
Juvenile Discogenic Disease
88
What is Scheuermann's Disease?
Abnormality of disco vertebral junction, not likely necrosis but more likely trauma. Unknown etiology.
89
Who is usually affected by Scheuermann's Disease?
Teens
90
What are the symptoms of Scheuermann's Disease?
Chronic back pain, deformity, early DDD, increase kyphosis, anterior body wedging, decrease disc space, Schmorl's nodes, irregular endplates
91
What is the more common location of Scheuermann's Disease?
Thoracic and lumbar spine
92
How many segments are required to me involved in Scheuermann's Disease?
Three contiguous vertebra
93
What is Severs Disease?
Not necrosis, sclerosis and fragmentation of the calcanea apophysis represents normal anatomy
94
What is a common symptom with Severs Disease?
Pain with running
95
What does Severs Disease look like radiographically?
The calcanea apophysis becomes radio dense and fragmented.
96
What is calcified medullary infarct?
Serpiginous regions of calcification within the bone medulla
97
What is calcified medullary infarct associated with?
Arteriosclerosis
98
What does calcified medullary infarct look similar to?
Enchondroma or chondrosarcoma
