AVASCULAR NECROSIS, FEMORAL HEAD (AVN)
Ischemic bone necrosis
M87.1 Osteonecrosis due to drugs
M87.2 Osteonecrosis due to previous trauma
M87.3 Other secondary osteonecrosis
M87.8 Other osteonecrosis
M87.9 Osteonecrosis, unspecified
PREFERRED PRACTICE PATTERNS
4H: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Joint Arthroplasty1
4I: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Bony or Soft Tissue Surgery2
Patient is a 48-year-old male who was hit by a car while riding his bicycle. Patient has a fractured pelvis and subluxed hip. After 6 weeks, patient began walking increased distances and was starting to feel better. Six months later, his hip began to become painful and stiff. Patient noticed an increase limp and difficulty putting weight onto his leg. Physician ordered an X-ray, which showed avascular necrosis (AVN) changes in the hip bone.
AVN results from disrupted or lost blood flow to a joint or bone, resulting in damage to or death of bone tissue
Femoral head is the most vulnerable site for development of AVN
Coronal T1-weighted MR image of the pelvis in a patient with bilateral hip avascular necrosis. Note the serpiginous low signal abnormality in the subchondral regions of the femoral heads (arrowheads). (From Chen MYM, Pope TL, Ott DJ. Basic Radiology. 2nd ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
Avascular necrosis, bilateral hips (Stage 4). (Reproduced with permission from Simon RR, Sherman SC, Koenigsknecht SJ. Emergency Orthopedics, The Extremities. 5th ed. © 2007, McGraw-Hill Inc., New York, NY.)
Known causes can be traumatic or atraumatic, including:
Early imaging with MRI is imperative as success of conservative treatment correlates with earlier stages
AVN of the hip in children is known as Legg–Calvé–Perthes syndrome
Can be idiopathic
Clinical AVN affects the ends of long bones
May result from local edema (compartment syndrome), occlusive vessel disease, fat embolism, or hypertrophy of fat cells, which block blood supplies and result in necrosis/death of marrow cells and osteocytes...
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