Difference between revisions of "Femoral head"

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Femoral head (view source)

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[[Image:Head of femur.jpg|thumb|right|300px|Femoral head. (WC)]]
The '''femoral head''' is a common [[ditzel]] in surgical pathology at centres which have orthopaedic surgeons.
The '''femoral head''' is a common [[ditzel]] in surgical pathology at centres which have orthopaedic surgeons.


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==Avascular necrosis of the femoral head==
==Avascular necrosis of the femoral head==
*[[AKA]] ''avascular necrosis'', abbreviated ''AVN''.
*[[AKA]] ''avascular necrosis'', abbreviated ''AVN''.
===General===
{{Main|Avascular necrosis of the femoral head}}
Risk factors:
*Oral steroids, e.g. prednisone.<ref>URL: [http://www.merckmanuals.com/professional/musculoskeletal_and_connective_tissue_disorders/osteonecrosis/osteonecrosis.html http://www.merckmanuals.com/professional/musculoskeletal_and_connective_tissue_disorders/osteonecrosis/osteonecrosis.html]. Accessed on: 30 April 2012.</ref>
*[[Cushing disease]].
*[[Cushing syndrome]].
*Radiation.
 
===Gross===
Features:<ref name=Ref_Lester224>{{Ref Lester|224}}</ref>
*Wedge-shaped pale yellow abnormality below cartilage.
*+/-Cartilage separates from the bone.
*+/-Deformation of femoral head.
 
Image:
*[http://www.flickr.com/photos/11462589@N05/1126710488/in/photostream AVN (flickr.com)].
 
===Microscopic===
Features:<ref name=pmid20513874>{{Cite journal  | last1 = Steffen | first1 = RT. | last2 = Athanasou | first2 = NA. | last3 = Gill | first3 = HS. | last4 = Murray | first4 = DW. | title = Avascular necrosis associated with fracture of the femoral neck after hip resurfacing: histological assessment of femoral bone from retrieval specimens. | journal = J Bone Joint Surg Br | volume = 92 | issue = 6 | pages = 787-93 | month = Jun | year = 2010 | doi = 10.1302/0301-620X.92B6.23377 | PMID = 20513874 }}
</ref>
*Empty lacunae (indicative of necrotic bone).
 
===Sign out===
<pre>
FEMORAL HEAD, RIGHT, HIP ARTHROPLASTY:
- AVASCULAR NECROSIS OF THE FEMORAL HEAD.
</pre>
 
====Remote AVN====
<pre>
FEMORAL HEAD AND JOINT CAPSULE, LEFT, HIP ARTHROPLASTY:
- FEMORAL HEAD WITH OSTEOARTHRITIS AND MARKED DEFORMATION CONSISTENT WITH HISTORY OF
AVASCULAR NECROSIS.
- JOINT CAPSULE WITH MINIMAL CHRONIC INFLAMMATION.
</pre>
 
=====Micro=====
The sections show a femoral head with loss of cartilage and focal vertical cleft formation in the remaining thinned cartilage.  The underlying bone is viable. Bone marrow is present. The red blood cells have a sickled morphology.


==Osteoarthritis==
==Osteoarthritis==
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==Fracture of bone due to metastatic carcinoma==
==Fracture of bone due to metastatic carcinoma==
{{Main|Fracture of bone}}
{{Main|Fracture of bone}}
*[[AKA]] ''pathologic fracture''.
:''Pathologic fracture'' redirects here, as the underlying cause is usually a carcinoma.
===General===
===General===
*Uncommon ~ 10 of 90 suspected cases.<ref name=pmid15826621>{{Cite journal  | last1 = Ramisetty | first1 = NM. | last2 = Pynsent | first2 = PB. | last3 = Abudu | first3 = A. | title = Fracture of the femoral neck, the risk of serious underlying pathology. | journal = Injury | volume = 36 | issue = 5 | pages = 622-6 | month = May | year = 2005 | doi = 10.1016/j.injury.2004.08.034 | PMID = 15826621 }}</ref>
*Uncommon ~ 10 of 90 suspected cases.<ref name=pmid15826621>{{Cite journal  | last1 = Ramisetty | first1 = NM. | last2 = Pynsent | first2 = PB. | last3 = Abudu | first3 = A. | title = Fracture of the femoral neck, the risk of serious underlying pathology. | journal = Injury | volume = 36 | issue = 5 | pages = 622-6 | month = May | year = 2005 | doi = 10.1016/j.injury.2004.08.034 | PMID = 15826621 }}</ref>
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===Gross===
===Gross===
*Irregular/jagged femoral neck margin.
*Irregular/jagged femoral neck margin - '''important'''.
*Hemorrhage.
*Hemorrhage.


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*[[Pathologic fracture]].
*[[Pathologic fracture]].


Commonly concurrent pathology:
Commonly concurrent pathologies:
*[[Osteoporosis]] - thinner cortex, decreased trabecular thickness and number.<ref name=pmid18708176>{{Cite journal  | last1 = Blain | first1 = H. | last2 = Chavassieux | first2 = P. | last3 = Portero-Muzy | first3 = N. | last4 = Bonnel | first4 = F. | last5 = Canovas | first5 = F. | last6 = Chammas | first6 = M. | last7 = Maury | first7 = P. | last8 = Delmas | first8 = PD. | title = Cortical and trabecular bone distribution in the femoral neck in osteoporosis and osteoarthritis. | journal = Bone | volume = 43 | issue = 5 | pages = 862-8 | month = Nov | year = 2008 | doi = 10.1016/j.bone.2008.07.236 | PMID = 18708176 }}</ref>
*[[Osteoporosis]] - thinner cortex, decreased trabecular thickness and number.<ref name=pmid18708176>{{Cite journal  | last1 = Blain | first1 = H. | last2 = Chavassieux | first2 = P. | last3 = Portero-Muzy | first3 = N. | last4 = Bonnel | first4 = F. | last5 = Canovas | first5 = F. | last6 = Chammas | first6 = M. | last7 = Maury | first7 = P. | last8 = Delmas | first8 = PD. | title = Cortical and trabecular bone distribution in the femoral neck in osteoporosis and osteoarthritis. | journal = Bone | volume = 43 | issue = 5 | pages = 862-8 | month = Nov | year = 2008 | doi = 10.1016/j.bone.2008.07.236 | PMID = 18708176 }}</ref>
*[[Osteoarthritis]].
*[[Osteoarthritis]].


===Sign out===
===Sign out===
<pre>
FEMORAL HEAD AND SURROUNDING TISSUE, RIGHT, HIP ARTHROPLASTY:
- BONE WITH CHANGES CONSISTENT WITH FRACTURE.
- BENIGN FIBROADIPOSE TISSUE AND CARTILAGE.
- NEGATIVE FOR MALIGNANCY.
</pre>
<pre>
<pre>
FEMORAL HEAD AND SURROUNDING TISSUE, LEFT, HIP ARTHROPLASTY:
FEMORAL HEAD AND SURROUNDING TISSUE, LEFT, HIP ARTHROPLASTY:
- NON-VITAL BONE CONSISTENT WITH FRACTURE.
- NON-VITAL BONE CONSISTENT WITH FRACTURE.
- BENIGN FIBROADIPOSE TISSUE.
- BENIGN FIBROADIPOSE TISSUE AND CARTILAGE.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
====With degenerative joint disease====
<pre>
FEMORAL HEAD AND SURROUNDING TISSUE, RIGHT, HIP ARTHROPLASTY:
- BONE WITH CHANGES CONSISTENT WITH FRACTURE.
- DEGENERATIVE JOINT DISEASE.
- BENIGN FIBROADIPOSE TISSUE AND CARTILAGE.
- NEGATIVE FOR MALIGNANCY.
- NEGATIVE FOR MALIGNANCY.
</pre>
</pre>
Michael
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