Avascular Necrosis: The Daily PANCE Blueprint

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Avascular Necrosis: The Daily PANCE Blueprint

A 71-year-old male with a history of chronic alcoholism, hypertension, hyperlipidemia, and a previous hip fracture presents to your clinic complaining of worsening right groin and buttock pain. You suspect possible avascular necrosis of the femur. Which of the following types of hip fractures did the patient most likely have in the past?

A. Greater trochanteric fracture
B. Femoral neck fracture
C. Intertrochanteric fracture
D. Subtrochanteric fracture
E. None of the above

Answer and topic summary

The answer is B. Femoral neck fracture

Avascular necrosis (AVN) of the hip is defined by “death” and architectural collapse of the femur. It can either be caused by direct damage to the bone vasculature or bone marrow elements. Risk factors include trauma (MC), chronic alcohol or steroid usage, and radiation/chemotherapy. Patients who have had a previous femoral neck fracture specifically are at the highest risk for AVN and non-union. Patients will often complain of groin and buttock pain. On radiographs, you may see multiple bone cysts and sclerosis of bone with lucency in areas of bone death (aka crescent sign). MRI is the gold standard for diagnosis.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Musculoskeletal ⇒ Disorders of the hip (PEARLS) ⇒ Avascular necrosis/Osteonecrosis (Lecture)

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