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Bone Infarct

Author: Jan Szatkowski

Topic updated on 03/06/14 7:59pm

Introduction
Overview bone infarcts are often thought to be in the same spectrum of disease as osteonecrosis occurs within the metaphysis or diaphysis of long bone Epidemiology & Incidence similar risk factors as those seen in osteonecrosis trauma, sickle cell disease, connective tissue disorders, Gaucher's disease, steroid use Mechanism interruption of blood supply by intrinsic or extrinsic factors
Presentation
Symptoms usually asymptomatic often found when imaging the extremities for other reasons
Imaging
Radiographs medullary lesion of sheet-like central lucency surrounded by sclerosis with a serpiginous border "smoke up the chimney" MRI key feature is that central signal remains of normal marrow T1 weighted images peripheral low signal due to grannulation tissue and to lesser extent sclerosis periphery may enhance post gadolinium T2 weighted images acute infarct may show ill-defined non-specific area of high signal intense inner ring of granulation tissue and a hypointense outer ring of sclerosis Bone Scan cold in early phases hot in late resorptive and revascularisation phase
Treatment
Nonoperative observation indications usually asymptomatic and do not require treatment

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(OBQ08.167) A 45-year-old female twists her knee suddenly while playing tennis. She denies any history of knee pain in the past. Radiographs are shown in Figure A. What is the diagnosis? Topic

Review Topic

FIGURES: A

1. Bone infarct

2. Osteonecrosis

3. Metastatic carcinoma

4. Osteosarcoma

5. Enchondroma

PREFERRED RESPONSE ▶

Idiopathic bone infarcts often occur in the metaphysis of long bones such as the femur and tibia. They are often asymptomatic and found on imaging studies for other reasons. The infarcted area undergoes progressive, but incomplete resorptive replacement. The bone infarct becomes surrounded by a thick and calcified fibro-osseous wall in a healing attempt. This accounts for the blotchy medullary and linear peripheral shadows seen in radiographs of old bone infarcts resembling “smoke up the chimney”.

Bone scans are cold in the early stages and hot as revascularisation occurs. The etiology is thought to be related to intrinsic/extrinsic vascular compromise such as atherosclerosis, arteritis, and thrombosis. Biopsy (usually unnecessary) shows mineralization of necrotic marrow elements. Bone infarcts usually are asymptomatic, and no treatment is required. If a patient presents with pain, another etiology should be sought. Rarely, malignancy, such as a malignant fibrous histiocytoma, can occur at the site of a bone infarct

REFERENCES:

1. Dorfman HD, Czerniak B: Bone Tumors. St. Louis, MO, Mosby 1998, p 1209

2. Marcove RC, Arlen M: Atlas of Bone Pathology. Philadelphia, PA, JB Lippincott, 1992, pp 190-201

Question Authors:

Jan Szatkowski MD, Michael Hughes MD,

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Cases

http://upload.orthobullets.com/cases/1803/dimi2.jpg

http://upload.orthobullets.com/cases/1803/dimi3.jpg

Transient Osteoporosis of the Knee / AVN Femoral Condyle (C1803)

Pathology - Radiology Rounds - Bone Infarct

HPI - Insidious right knee pain without trauma 4 weeks ago

Whati is the diagnosis?

2/27/2014

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Oral Boards: Bone Infarct

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7/29/2011

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Evidence & References Show References

Textbooks

Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012
AAOS Comprehensive Orthopaedic Review, Jay R. Leiberman. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2009
Orthopaedic Knowledge Update 10, John M Flyn. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2011
Hoppenfeld SP. Surgical Exposures in Orthopaedics: The Anatomic Approach. Lipponcott, Williams, and Wilkins, Philadelphia, PA, Copyright 2009
Orthopaedic In-training Examination (OITE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
Self-Assessment Examination (SAE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
Marcove RC, Arlen M: Atlas of Bone Pathology. Philadelphia, PA, JB Lippincott, 1992, pp 190-201
Dorfman HD, Czerniak B: Bone Tumors. St. Louis, MO, Mosby 1998, p 1209

Bone Infarct

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