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http://upload.orthobullets.com/topic/8078/images/bone infarct xray.jpg
http://upload.orthobullets.com/topic/8078/images/bone infarct mri.jpg
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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