The incidence and clinical and magnetic resonance imaging features of osteonecrosis of the hip were evaluated in patients with aplastic anemia. Two hundred and forty-one patients with aplastic anemia were examined using MR imaging of bone marrow during the five years from 1994 to 1998. Osteonecrosis of the hip was observed on MR imaging in nineteen (15 males and 4 females, mean age 35 yr) of the 241 patients. It was present in both hips in 14 patients, and there were five cases with unilateral occurrence, with a total of 33 involved hips. All except for five hips with associated bone marrow edema revealed increased fatty marrow conversion in the proximal femoral metaphysis. In nine patients, osteonecrosis was detected without any pain. Five patients already had osteonecrosis before any medication was administered. Twelve patients received antilymphocyte globulin, and seven patients received a low dose of steroids before the MR diagnosis of osteonecrosis. Osteonecrosis of the hip frequently develops in patients with aplastic anemia (7.9%), associated with fatty marrow conversion of the proximal femoral metaphysis.
Adipose Tissue/pathology ; Adult ; Anemia, Aplastic/*complications/radiography ; Bone Marrow/pathology ; Female ; Femur Head Necrosis/*complications/radiography ; Hip/*pathology/radiography ; Humans ; Male ; Middle Aged ; Osteonecrosis/*complications/radiography ; Time Factors

OBJECTIVETo investigate the imaging features of dysbaric osteonecrosis.

METHODSThe imaging appearances of four patients with dysbaric osteonecrosis caused by diving, were analyzed retrospectively.

RESULTSIn four cases with dysbaric osteonecrosis including case 1 with stage I, case 2 with stage II, case 3 and case 4 with stage III, there were a case with the lesion in a bone and other 3 cases with lesions in multiple bones,and a case with the lesion in unilateral bone and 3 cases with the lesions in lateral bones. (1) The juxta-articular lesions: there were 10 long bones with the head lesions, including 6 humerus with the head lesions and 4 femurs with the head lesions in 4 cases. In four cases, 10 sclerosis lesions appeared in the heads of long bones, each case had a "snow-capped" sclerosis lesion for case 2, case 3 and case 4. There were 7 small radiolucent lesions and a large radiolucent lesion involved in femur neck. The ringlike, linear, bending and punctuate calcification lesions were found on CT films of case 2. The osseous collapse in one femur head and the fragmentations in three femur heads could be seen in case 3 and case 4; 2 crescent signs can be seen in the bilateral femur heads of case 4 with secondary osteoarthritis in left hip joint. (2) The diaphyseal and metaphyseal lesions: the X ray film of case 4 showed the streak and irregular calcifications in the shaft of right humerus; there are strip calcifications in diaphyseal and metaphyseal of the left humerus on MPR coronal view in case 2.

CONCLUSIONThe diagnosis of dysbaric osteonecrosis suggested that the increased bone density or sclerosis lesions appeared in the heads of long bones, and osteonecrosis lesions were found in multiple bones or lateral bones.

Decompression Sickness ; complications ; diagnostic imaging ; Diving ; Humans ; Male ; Middle Aged ; Osteonecrosis ; diagnostic imaging ; etiology ; Radiography ; Retrospective Studies

We have treated a total of 16 cases of advanced Kienbock's disease, stage III and IV by Lichtman's classification, with triscaphe fusion, tendon ball replacement arthroplasty after excision of lunate, proximal row carpectomy as a salvage procedure and limited wrist fusion, since 1985. All cases were followed for minimal 16 months after each operation. Tendon ball replacement arthroplasty after excision of lunate could not prevent further carpal collapse with persistent chronic wrist pain. The triscaphe fusion or radio-lunate fusion induced a marked limited wrist motion later, and the triscaphe fusion alone was not fit for the treatment of advanced one because of progressive proximal migration of capitate and continuous wrist pain due to ligamentous carpal instability in follow-up. So we tried to simultaneously combine tendon ball replacement arthroplasty after excision of lunate with triscaphe fusion in far advanced Kienbock's disease, and their end results was favorable. Proximal row carpectomy could be done in far advanced Kienbock's disease with reasonably painless wrist motions. The overall end results of proximal row carpectomy are much better than any form of carpal arthrodesis. Conclusively the proper way to treat advanced Kienbock's disease seems to depend on the patient's age, their job and sex, and the stage of disease. And the cause of wrist pain in advanced Kienbock's disease seems due to ligamentous carpal instability rather than osteoarthritis on radio-lunate joint.
Adult ; Arthrodesis ; Carpal Bones ; Case Report ; Comparative Study ; Female ; Hand Strength ; Human ; Joint Prosthesis ; Male ; Middle Age ; Osteochondritis/complications/radiography/*surgery ; Osteonecrosis/etiology/surgery ; Osteotomy ; Patient Selection ; Range of Motion, Articular ; Wrist Joint/radiography/*surgery