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The Journal of Hand Surgery, European... Oct 2022
Topics: Carpal Bones; Child; Humans; Osteonecrosis; Pisiform Bone
PubMed: 35642533
DOI: 10.1177/17531934221101825 -
Seminars in Hematology Jan 2012Advances in transplantation technology and supportive care measures have resulted in significant decrease in early mortality resulting in continued growth in the number... (Review)
Review
Advances in transplantation technology and supportive care measures have resulted in significant decrease in early mortality resulting in continued growth in the number of long-term hematopoietic cell transplantation (HCT) survivors. The intensity of chemotherapy and total body irradiation regimen used pretransplantation to eradicate the primary disease can lead to organ toxicities, including significant bone complications after HCT. Bone loss is frequent in HCT recipients and results from impaired bone mineralization through disturbances of calcium and vitamin D homeostasis, osteoblast and osteoclast dysfunction, and deficiencies in growth or gonadal hormone secretion. Exposure to glucocorticoids and calcineurin inhibitors for prevention and treatment of graft-versus-host disease (GVHD) represents one of the major causes for the increased risk of osteoporosis and avascular necrosis of bone (AVN) in recipients of allogeneic HCT. In this article we review the incidence, pathogenesis, and risk factors for osteoporosis and AVN after allogeneic HCT and discuss general guidelines for their treatment and monitoring based on the limited available reports.
Topics: Bone Diseases; Hematopoietic Stem Cell Transplantation; Humans; Osteonecrosis; Risk Factors; Transplantation, Homologous
PubMed: 22221785
DOI: 10.1053/j.seminhematol.2011.10.007 -
Medicina (Kaunas, Lithuania) Nov 2021: The course of SARS-CoV-2 (COVID-19) is still under analysis. The majority of complications arising from the infection are related to the respiratory system. The...
: The course of SARS-CoV-2 (COVID-19) is still under analysis. The majority of complications arising from the infection are related to the respiratory system. The adverse effect of the viral infection on bone and joint tissue has also been observed. : We present a group of 10 patients with degeneration of large joints and adjacent epiphyses of long bones and the spine, with a background of bone infarctions and avascular necrosis (AVN) immediately after infection with the COVID-19 virus. In MR imaging, changes in the characteristics of AVN were documented. Observation of this group showed a clear correlation among the history of COVID-19 disease in the patients, moderately severe symptoms, high levels of IgG antibodies, and the time of occurrence of joint changes. No other clinically significant complications were observed following COVID-19 infection in the study group. No other risk factors for AVN or autoimmune or degenerative diseases were found in the study group. The group of patients responded well to empirical treatment with steroids, which normalized acute inflammatory symptoms and pain in the joints. During coronavirus (COVID-19) infection, there are complications in the locomotor system, such as microembolism and the formation of AVN; hence, more research is needed.
Topics: COVID-19; Humans; Immunoglobulin G; Magnetic Resonance Imaging; Osteonecrosis; SARS-CoV-2
PubMed: 34946256
DOI: 10.3390/medicina57121311 -
The New England Journal of Medicine May 1992
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Topics in Magnetic Resonance Imaging :... Aug 1996Avascular necrosis (AVN) is characterized by death of both trabecular bone as well as bone marrow elements. Weight-bearing bone becomes mechanically weakened and may... (Review)
Review
Avascular necrosis (AVN) is characterized by death of both trabecular bone as well as bone marrow elements. Weight-bearing bone becomes mechanically weakened and may eventually collapse, secondarily leading to osteoarthritis and debilitating pain. Early diagnosis and treatment of this entity are crucial because it affects relatively young individuals, and treatment options for advanced disease are limited. Magnetic resonance imaging (MRI) has emerged as the modality of choice for the evaluation of avascular necrosis of bone. We will discuss applications of MRI for early diagnosis, for monitoring therapy, and for its potential role in assessing individuals at risk of AVN. Although bone scintigraphy using single photon emission computed tomography (CT) may be nearly as accurate as MRI, MRI offers a more specific diagnosis in the patient who presents with hip pain of uncertain etiology. In addition, lesion size and location can be more easily assessed on magnetic resonance images, and this has been shown to relate to prognosis and need for treatment. We will review the pathophysiologic mechanisms of AVN and the current use of MRI in the diagnosis of this condition.
Topics: Contrast Media; Femur Head Necrosis; Hip Joint; Humans; Magnetic Resonance Imaging; Osteonecrosis; Prognosis; Sensitivity and Specificity; Severity of Illness Index
PubMed: 8870181
DOI: 10.1097/00002142-199608000-00003 -
Current Opinion in Rheumatology Feb 1990
Review
Topics: Adult; Aged; Aged, 80 and over; Humans; Middle Aged; Osteonecrosis
PubMed: 2223452
DOI: 10.1097/00002281-199002010-00006 -
European Radiology 1997The etiology of avascular necrosis (AVN) is multifactorial. Independent of its etiology and localization it shows typical pathologies and radiological images. In the... (Review)
Review
The etiology of avascular necrosis (AVN) is multifactorial. Independent of its etiology and localization it shows typical pathologies and radiological images. In the early stages localized subchondral edema is characteristic. In 50 % of all cases accompanying joint effusion may be found. Due to necrosis of the cells of bone marrow and bone fibrovascular, reactions with hyperemia can be delineated. These reactions allow us to visualize necrosis indirectly. The best imaging methods are MRI and, to a lesser extent, bone scintigraphy. In later stages calcification as well as new bone formation and microfractures are typically demonstrated and visualized best with plain X-rays and CT. Why reparations in many cases, particularly in the hip, are incomplete and may stop in any stage is unknown. Over years clinically complete silent AVNs are not an uncommon finding. Prognosis depends on the localization and size of the AVN. The number of repair mechanisms is best outlined with contrast-enhanced MRI and return of fatty marrow.
Topics: Bone and Bones; Humans; Magnetic Resonance Imaging; Osteonecrosis; Radionuclide Imaging; Tomography, X-Ray Computed
PubMed: 9038111
DOI: 10.1007/s003300050131 -
Der Unfallchirurg May 2018Kienböck's disease, also known as avascular necrosis of the lunate bone describes the slowly progressive osteonecrosis of the lunate bone with secondary development of... (Review)
Review
Kienböck's disease, also known as avascular necrosis of the lunate bone describes the slowly progressive osteonecrosis of the lunate bone with secondary development of osteoarthritis and carpal collapse. In order to emphasize the atraumatic origin of the disease, this is normally referred to as aseptic, idiopathic or avascular lunate necrosis. There are thought to be a number of factors predisposing to Kienböck's disease, such as ulnar negative variance, the shape of the lunate itself and various types of vascular anatomy. The ongoing development of radiographic techniques in recent years has contributed to a better understanding of the progression of the disease and led to a modification of the standard classifications. New sophisticated classification methods provide the basis for a differentiated treatment. This article provides an overview of the current state of knowledge about the etiology and pathogenesis as well as the clinically relevant diagnostic procedures and classifications.
Topics: Carpal Bones; Humans; Lunate Bone; Osteonecrosis; Radiography; Wrist Joint
PubMed: 29644422
DOI: 10.1007/s00113-018-0495-6 -
Zeitschrift Fur Orthopadie Und... Aug 2015The bone necrosis of the hand is a common disease of the bone-cartilage complex. In principle, every bone of the hand can be affected. Compared to other osteonecroses of... (Review)
Review
The bone necrosis of the hand is a common disease of the bone-cartilage complex. In principle, every bone of the hand can be affected. Compared to other osteonecroses of the hand the necrosis of the lunate occurs most frequently. Other diseases such as osteonecrosis of the Os scaphoideums (Morbus Preiser) are much rarer. Unfrequent diseases such as osteonecrosis of the metacarpal heads or all carpal bones are restricted to case descriptions. The lunate osteonecrosis leads to osteoarthritis of the wrist if untreated. A detailed clinical examination and adequate radiological diagnosis are essential. The lunate osteonecrosis is classified according to Lichtman and Ross based on radiographs. The treatment is being executed either conservatively or surgically, depending on the stage. In surgical treatment pressure relieving and revascularization procedures and rescue operations have been established. For all other osteonecroses of the hand no standardized therapy can be assigned because sufficient data are not available. Generally, the treatment for bone necroses of the hand should be found for each patient individually.
Topics: Adult; Evidence-Based Medicine; Female; Hand Bones; Humans; Male; Osteonecrosis; Osteotomy; Radiography; Plastic Surgery Procedures; Treatment Outcome
PubMed: 26274559
DOI: 10.1055/s-0035-1546236 -
Annals of Allergy, Asthma & Immunology... Aug 2009To provide information about risk factors for, diagnosis of, and potential treatments and prevention of avascular necrosis (AVN) in patients frequently given systemic... (Review)
Review
OBJECTIVE
To provide information about risk factors for, diagnosis of, and potential treatments and prevention of avascular necrosis (AVN) in patients frequently given systemic corticosteroid therapy for the management of allergic and/or inflammatory diseases.
DATA SOURCES
Articles on AVN cited in PubMed from 1975 through 2008.
STUDY SELECTION
Publications consisted of case reports, reviews of osteonecrosis, and animal and human studies (mostly open, nonrandomized, and observational).
RESULTS
Case reports of rare and infrequent use of corticosteroids and the development of osteonecrosis are of great concern to physicians, but most patients affected may also be at risk of developing osteonecrosis because of repetitive systemic corticosteroid use with underlying hyperlipidemia, alcoholism, smoking, connective tissue disorders, and/or previous trauma to the affected area. The use of statins for patients with hyperlipidemias may be useful in decreasing the risk of osteonecrosis but is considered investigational. Enhanced magnetic resonance imaging is the most sensitive tool for diagnosing AVN early. Prophylaxis with bisphosphonates may be worthwhile in certain patients for the early management of pain due to AVN, but eventually surgical intervention is warranted in the treatment of osteonecrosis.
CONCLUSIONS
Recognition of risk factors and educating (enabling) the patient remain the most effective ways of preventing AVN caused by corticosteroid use.
Topics: Adrenal Cortex Hormones; Animals; Bone and Bones; Causality; Humans; Osteonecrosis; Respiratory Hypersensitivity
PubMed: 19739420
DOI: 10.1016/S1081-1206(10)60159-7