PANCE Blueprint Musculoskeletal (10%)

Avascular necrosis Hip

Patient will present with → Persistent pain in a patient with history of hip trauma or long term steroid use.  May have a dull ache or throbbing localized to the groin, lateral hip, or buttocks.

In adults avascular necrosis may be from trauma, steroid use, sickle cell as well as several other etiologies

 

"AVN will start as groin pain that is followed by thigh and buttocks pain, associated with weight bearing activities that progresses to pain at rest and night pain."
  • In children AVN is known as Legg-Calve' Perthes disease: it typically presents in children ages 2-11 years old with a peak incidence of 4-8 years of age.
  • Children with Legg-Calve' Perthes disease will present with → persistent pain and a limp.

MRI is the study of choice for early detection.

Treatment may be conservative or may eventually need joint replacement

Question 1
Identification of hip fracture and initiation of treatment is imperative to avoid such complications as avascular necrosis (AVN). Which of the following groups are most at risk for AVN?
A
Children and adolescents
B
Teenagers
C
Adults in middle age
D
The elderly
Question 1 Explanation: 
AVN is more common in patients in the pediatric and adolescent age groups. This outcome is due to the precarious nature of the blood supply to the subchondral region of the femoral head, which does not stabilize until years after skeletal maturity, after which collateral flow develops.
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