Diagnosis and operative treatment of bone infarction

ZHANG Yao; ZHAO De-wei; WANG Wei-ming; LIU Yu-peng; YU Xiao-bing

doi:10.3969/j.issn.2095-252X.2014.06.015

Abstract：Objective To investigate the diagnosis and operative treatment results of long bone infarction and the understanding of this disease.Methods From September 2009 to August 2012, 15 patients underwent operative treatment for the long bone infarction. There were 9 males and 6 females, whose average age was 46 years old ( range: 23-58 years ). The lesions were located in the proximal humerus (n=1 ), the proximal femur (n=2 ), the distal femur (n=7 ), the proximal tibia (n=4 ) and the distal femur together with the proximal tibia (n=1 ). Bilateral bone infarction was noticed in the distal femur (n=4 ) and in the proximal tibia (n=2 ). The etiology of bone infarction was idiopathic or unknown in 5 cases, which was caused by corticosteroids in 3 cases, a traumatic event in 3 cases, alcohol abuse in 2 cases and caisson disease in 2 cases. The deifnite diagnosis was determined before the operation through the clinical and imaging examinations and aspiration biopsy or pathological examination. The surgical fenestration of bone segments was performed locally. The lesions and sclerotic region were completely resected, and the blocked medullary cavity was broken through. The defects were packed fully with autogenous bone and allogeneic bone grafts. The locking titanium plate was then ifxed crossing the lesion area in order to increase the mechanical strength of the bone. All the patients underwent the clinical and radiographic examinations at every 4 weeks postoperatively, and they were reviewed since full weight bearing on the affected limbs at 2 to 3 months intervals thereafter. The changes of symptoms and the recurrence of bone infarction were observed, and the union of the planted bone was checked based on the X-ray in the follow-up.Results All the patients were followed up for an average period of 23 months ( range: 14-37 months ). The postoperative pain and uncomfortable symptoms were alleviated in 14 patients, whose limb functions were also restored. Mild pain would occur occasionally at the internal ifxator in 1 patient, and it disappeared after the ifxator was removed. The union of the planted bone was achieved at an average period of 7 months after the operation ( range: 5-9 months ), with the recanalization of the medullary cavity. No recurrence of bone infarction was found in the follow-up period.Conclusions The clinical symptoms of bone infarction are often atypical, and no speciifc signs exist in the early stage based on the X-ray examination. Therefore, it is dififcult to make a deifnite diagnosis. The MRI examination can help improve the diagnostic accuracy. Operative treatment is needed for the patients with bone infarction because of the severe pain or the risk of fractures or articular surface collapse, and satisfactory therapeutic effects can be achieved.