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Di Imaging 2 > AVN > Flashcards

AVN Flashcards

1
Q

Where does AVN tend to occur at in a bone?

A

Epiphyseal predisposition

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2
Q

What is the most common etiology of AVN?

A

Spontaneous/idiopathic

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3
Q

What is the first phase of AVN?

A

Avascular phase

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4
Q

What is the main characteristic of stage 1 AVN?

A

Blood supply destroyed

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5
Q

What occurs at the epiphyseal plate during stage 1 AVN?

A

Growth is slowed or stopped

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6
Q

What happens to articular cartilage during stage 1 AVN?

A

Articular cartilage continues to be in place

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7
Q

What is the second phase of AVN?

A

Revascularization phase

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8
Q

What happens during the second phase of AVN?

A

New vessels form, necrotic bone is reabsorbed, new bone deposited on dead bone

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9
Q

What phase of AVN does creeping substitution occur in?

A

Stage 2 AVN

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10
Q

What are the characteristics of creeping substitution?

A

Thickened trabeculation and increased bone density

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11
Q

What phases of AVN can the new bone be easily modeled/deformed?

A

Stage 2 and Stage 3

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12
Q

What is the third phase of AVN?

A

Repair and remodeling phase

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13
Q

What occurs during stage 3 AVN?

A

Continued necrotic resorption and new deposition

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14
Q

What the the fourth phase of AVN?

A

Deformity phase

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15
Q

What occurs during stage 4 AVN?

A

Restoration of normal shape

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16
Q

What causes the deformity during stage 4 AVN?

A

Deformity is due to amount of compressive force during earlier phases

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17
Q

What is the crescent sign seen during?

A

AVN

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18
Q

What is the bite sign seen during?

A

AVN

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19
Q

What is the hanging rope sign seen during?

A

AVN

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20
Q

What is the mushroom deformity seen during?

A

AVN

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21
Q

What are the different radiographic sign?

A
  1. Collapse of articular cartilage
  2. Fragmentation
  3. Mottled trabecular pattern
  4. Bite sign
  5. Mushroom deformity
  6. Sclerosis
  7. Subchondral cysts
  8. Subchondral fractures
  9. Hanging rope sign
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22
Q

What does AVN look like on TI MRI?

A

Loss of signal (darker), bilateral, may have joint effusion

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23
Q

What is AVN in adult femoral head called?

A

Chandler’s Disease

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24
Q

What is Chandler’s Disease?

A

Adult femoral head AVN

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25
Q

What gender is more likely to have Chandler’s Disease?

A

Males

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26
Q

What age range is most likely to be affected by Chandler’s Disease?

A

30-70 year olds

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27
Q

Is Chandler’s Disease unilateral or bilateral?

A

Commonly bilateral

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28
Q

What are the early symptoms of Chandler’s Disease?

A

Vague symptoms early - pain in buttock, groin, thigh, knee, hip

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29
Q

What occurs during Chandler’s Disease over years?

A

Increase in pain, decrease in ROM, limping gait

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30
Q

What is the prognosis for Chandler’s Disease?

A

Better with early diagnosis and treatment, better in younger patients, better in males

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31
Q

Which sex has a poorer prognosis with Chandler’s Disease?

A

Females

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32
Q

What is the name of AVN in the femoral head before the growth plate closure?

A

Legg-Calve-Perthes disease

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33
Q

What Legg-Calve-Perthes Disease?

A

AVN in femoral head before growth plate closure

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34
Q

What age range is affected by Legg-Calve-Perthes disease?

A

4-8 year olds

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35
Q

What sex is affected more commonly by Legg-Calve-Perthes?

A

Males

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36
Q

What are the symptoms of Legg-Calve-Perthes?

A

Vague symptoms - pain in groin, limping gait, loss of ROM (abduction and internal rotation)

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37
Q

What is the etiology of Legg-Calve-Perthes?

A

Unknown

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38
Q

How long until Legg-Calve-Perthes resolves?

A

2-8 years

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39
Q

How long is the avascular in Legg-Calve-Perthes?

A

0-12 months

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40
Q

What radiographic signs appear during the avascular phase of Perthes?

A

Increase teardrop distance and small epiphysis

41
Q

How long is the revascularization phase in Perthes?

A

6 months - 4 years

42
Q

What are the radiographic signs that appear during revascularization phase?

A

Flattened small epiphysis, homogenous or patchy sclerosis, crescent sign

43
Q

How long is the remodeling/repair phase of Perthes?

44
Q

What are some of the radiographic signs that appear during the revascularization phase of Perthes?

A

Coxa vera, coxa magna (enlarged femoral head), mushroom deformity, large greater trochanter

45
Q

What are some radiographic features of Perthes?

A
  1. Soft tissue swelling
  2. Small epiphysis
  3. Lateral displacement of ossification center
  4. Flattening, fissuring and fracture of ossification center
  5. Metaphyseal widening and foreshortening
  6. Widened irregular physis
  7. Intra-epiphyseal gas
46
Q

What is the etiology of osteochondrosis dissecans?

47
Q

What is osteochondrosis dissecans?

A

Focal subchondral infarction of subarticular bone

48
Q

What age range is affected by osteochondrosis dissecans?

A

11-20 years old

49
Q

What sex is more commonly affected by osteochondrosis dissecans?

50
Q

What location is most common for osteochondrosis dissecans?

A

Lateral aspect of the medial femoral condyle close to fossa

51
Q

What other locations is osteochondrosis dissecans found at?

A

Humeral head, capitulum of elbow (Panner’s disease), medial surface of the talus

52
Q

What is osteochondrosis dissecans of the capitulum of the elbow called?

A

Panner’s disease

53
Q

What is Panner’s disease?

A

Osteochondrosis dissecans of the capitulum of the elbow

54
Q

What are the symptoms of osteochondrosis dissecans?

A

Asymptomatic, vague symptoms - clicking, locking, limited ROM, swelling, pain aggravated by movement

55
Q

What does osteochondrosis dissecans predispose the patient to?

56
Q

What are the different outcomes of osteochondrosis dissecans?

A
  1. Heal spontaneously
  2. Become a free fragment - reattach, become joint mouse
  3. Predisposes to DJD
57
Q

What location is most common for spontaneous osteonecrosis?

58
Q

What is spontaneous osteonecrosis?

A

A diagnostic term applied to the aged knee. Idiopathic AVN of the knee

59
Q

What is spontaneous osteonecrosis associated with?

A

Medial meniscal lesions

60
Q

Who is most likely to have spontaneous osteonecrosis?

A

Middle aged females

61
Q

What is Osgood Schlatter’s Disease?

A

Fragmentation of the apophysis of the tibia tuberosity

62
Q

What is the mechanism for Osgood Schlatter’s Disease?

A

Probably traumatic rather than true necrosis

63
Q

What is Sindig-Larsen-Johanssen Disease?

A

Involvement of the inferior pole of the patella in Osgood-Schlatter’s

64
Q

What population is most likely to have Osgood-Schlatter’s Disease?

A

Adolescents 11-15 years old, males

65
Q

What sports are associated with Osgood-Schlatter’s Disease?

A

Running sports

66
Q

What are the symptoms associated with Osgood-Schlatter’s Disease?

A

Localized pain, tenderness, self limiting, soft tissue swelling over tibial tubercle

67
Q

How long to symptoms of Osgood-Schlatter’s Disease usually last?

A

Into adulthood, but usually cease by 18 yrs

68
Q

True or False? Deformity may be present in Osgood-Schlatter’s Disease?

A

True, deformity may be present.

69
Q

True or False? Fragmentation can occur in Osgood-Schlatter’s Disease?

A

True, fragmentation can occur.

70
Q

What is Freiberg’s Disease?

A

AVN of the metatarsal head

71
Q

What location is most common in Freiberg’s Disease?

A

Metatarsal head of MTP 2

72
Q

What population is most commonly affected by Freiberg’s Disease?

73
Q

What is thought to be the cause of Freiberg’s Disease?

A

Possibly high heeled shoes

74
Q

What age range is most commonly affected by Freiberg’s Disease?

A

13-18 year old females

75
Q

What is the mechanism of injury for Freiberg’s Disease?

A

Collapse of the articular surface leading to incongruity and then DJD

76
Q

What are the symptoms of Freiberg’s Disease?

A

Pain and swelling

77
Q

What is Kienbock’s Disease?

A

AVN of the lunate

78
Q

Who is most commonly affect by Kienbock’s Disease?

A

Males, 20-40 years old, engaged in manual labor (jack hammers)

79
Q

What is associated with Kienbock’s Disease?

A

Ulna minus variant/negative ulnar variance (short ulna)

80
Q

What are the symptoms of Kienbock’s Disease?

A

Progressive pain and soft tissue swelling of the wrist

81
Q

What is the usual steps that occur in Kienbock’s Disease?

A
  1. Lunate increases in density/becomes whiter
  2. Fragmentation and collapse
  3. Altered joint congruity and biomechanics precipitates DJD
82
Q

What treatment is possibly with Kienbock’s Disease?

A

Silastic implants

83
Q

What possibly radiography features could be present with Kienbock’s Disease?

A

Mixture of sclerosis and radiolucency

84
Q

What is Kohler’s Disease?

A

AVN/vascular insufficiency or normal variant of tarsal navicular

85
Q

What are the symptoms of Kohler’s Disease?

A

Localized pain and swelling

86
Q

What radiographic signs are present with Kohler’s Disease?

A

Navicular patchy, homogenous sclerosis, collapse of navicular and fragmentation

87
Q

What is Scheuermann’s Disease also called?

A

Juvenile Discogenic Disease

88
Q

What is Scheuermann’s Disease?

A

Abnormality of disco vertebral junction, not likely necrosis but more likely trauma. Unknown etiology.

89
Q

Who is usually affected by Scheuermann’s Disease?

90
Q

What are the symptoms of Scheuermann’s Disease?

A

Chronic back pain, deformity, early DDD, increase kyphosis, anterior body wedging, decrease disc space, Schmorl’s nodes, irregular endplates

91
Q

What is the more common location of Scheuermann’s Disease?

A

Thoracic and lumbar spine

92
Q

How many segments are required to me involved in Scheuermann’s Disease?

A

Three contiguous vertebra

93
Q

What is Severs Disease?

A

Not necrosis, sclerosis and fragmentation of the calcanea apophysis represents normal anatomy

94
Q

What is a common symptom with Severs Disease?

A

Pain with running

95
Q

What does Severs Disease look like radiographically?

A

The calcanea apophysis becomes radio dense and fragmented.

96
Q

What is calcified medullary infarct?

A

Serpiginous regions of calcification within the bone medulla

97
Q

What is calcified medullary infarct associated with?

A

Arteriosclerosis

98
Q

What does calcified medullary infarct look similar to?

A

Enchondroma or chondrosarcoma

Di Imaging 2 (3 decks)

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