Updated: 10/6/2016

Bone Infarct

Topic
Review Topic
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Questions
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https://upload.orthobullets.com/topic/8078/images/bone infarct xray.jpg
https://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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Questions (1)

(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? Review Topic

QID: 553
FIGURES:
1

Bone infarct

81%

(1406/1728)

2

Osteonecrosis

2%

(32/1728)

3

Metastatic carcinoma

1%

(18/1728)

4

Osteosarcoma

0%

(7/1728)

5

Enchondroma

15%

(255/1728)

ML 2

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PREFERRED RESPONSE 1
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