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there is cellular death (necrosis) of bone components due to [3] [2] interruption of the blood supply. Without blood, the bone tissue dies and the bone collapses. If avascular necrosis involves the bones of a joint, it often leads to destruction of the joint articular surfaces. (see Osteochondritis dissecans).
Contents
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[1]
1 Causes 2 Cell death and repair 3 Presentation 4 Diagnosis 5 Treatment 6 Prognosis 7 See also 8 References 9 External links
Front X-ray of right knee of anadolescent (epiphyseal plates are open): arrows point to avascular necrosis and developing osteochondritis dissecans in the outer medial condyle of femur
Orthopaedic doctors most often diagnose the disease except when it affects the jaws, when it is usually diagnosed and treated by dental and maxillofacial surgeons. In the early stages, bone scintigraphy
[22]
and MRI
[23]
X-ray images of avascular necrosis in the early stages usually appear normal. In later stages it appears relatively more radio-opaque due to the nearby living bone becoming resorbed secondary to reactive [1] hyperemia. The necrotic bone itself does not show increased radiographic opacity, as dead bone cannot [1] undergo bone resorption which is carried out by living osteoclasts. Late radiographic signs also include
a radiolucency area following the collapse of subchondral bone (crescent sign) and ringed regions of radiodensity resulting from saponification and calcification of marrow fat following medullary infarcts.
Radiography of total avascular necrosis of right humeral head. Woman of 81 years old with diabetes of long evolution.
Radiography of avascular necrosis of left femoral head. Man of 45 years old with AIDS.
Nuclear magnetic resonance of avascular necrosis of left femoral head. Man of 45 years old with AIDS.
prescribe bisphosphonates (e.g. alendronate) which reduces the rate of bone breakdown by osteoclasts, thus preventing