Difference between revisions of "Femoral head"

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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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==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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*[[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]].
Note:
*There isn't a number for "thin" trabeculae. Anecdotally, I suspect "thin" is 0.15-0.2 mm.
**Crude guess at normal thickness is ~ 0.4 mm.<Ref name=pmid24271010>{{Cite journal  | last1 = Klintström | first1 = E. | last2 = Smedby | first2 = O. | last3 = Moreno | first3 = R. | last4 = Brismar | first4 = TB. | title = Trabecular bone structure parameters from 3D image processing of clinical multi-slice and cone-beam computed tomography data. | journal = Skeletal Radiol | volume =  | issue =  | pages =  | month = Nov | year = 2013 | doi = 10.1007/s00256-013-1766-5 | PMID = 24271010 }}</ref>


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Latest revision as of 02:28, 23 October 2014

Femoral head. (WC)

The femoral head is a common ditzel in surgical pathology at centres which have orthopaedic surgeons.

Many of these can be "gross only".

Gross

Features to comment on:[1]

  • Laterality (on requisition).
  • Dimensions of head and neck.
  • Shape of head (round? deformed?).
  • Resection margin (irregular?).
  • Cartilage (thinning/eburnation? separation from the cartilage).
  • Bone (subchondral cysts? subchondral sclerosis?).
  • Presence of soft tissue.
  • Other (osteophytes? pannus?).

Notes:

  • Some advocate the use of cardboard when cutting[2] -- weird.

Criteria for gross only

Main article: Gross pathology

Must be fulfilled:

More stringent - in addition to the above:

  • No history of cancer.

Diagnoses to consider

Specific diagnoses

Avascular necrosis of the femoral head

  • AKA avascular necrosis, abbreviated AVN.
Main article: Avascular necrosis of the femoral head

Osteoarthritis

See Osteoarthritis.

Infection

See Osteomyelitis.

Rheumatoid arthritis

Main article: Rheumatoid arthritis

Fracture of bone due to metastatic carcinoma

Main article: Fracture of bone
Pathologic fracture redirects here, as the underlying cause is usually a carcinoma.

General

  • Uncommon ~ 10 of 90 suspected cases.[3]
    • Usually in patients with a known malignancy and bony metastases.
  • Should not be missed.
  • Classically in older individuals.

Gross

Features:

  • Irregular resection margin.†
  • Focal, irregular, tan-white discolouration at the fracture site, i.e. margin, and in the marrow space.

Note:

  • † Non-fracture resections have a flat resection margin, as they were cut by the surgeon.

Image:

Microscopic

Features:

DDx:

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FEMORAL HEAD, LEFT, HIP ARTHROPLASTY: 
- METASTATIC SMALL CELL CARCINOMA.

Non-pathologic fracture of the femoral neck

Hip fracture, traumatic hip fracture and traumatic fracture of the femoral neck redirect here.

General

Gross

  • Irregular/jagged femoral neck margin - important.
  • Hemorrhage.

Microscopic

Features:

  • Non-vital bone.
    • Loss of osteocytes.

DDx:

Commonly concurrent pathologies:

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FEMORAL HEAD AND SURROUNDING TISSUE, RIGHT, HIP ARTHROPLASTY:
- BONE WITH CHANGES CONSISTENT WITH FRACTURE.
- BENIGN FIBROADIPOSE TISSUE AND CARTILAGE.
- NEGATIVE FOR MALIGNANCY.

FEMORAL HEAD AND SURROUNDING TISSUE, LEFT, HIP ARTHROPLASTY:
- NON-VITAL BONE CONSISTENT WITH FRACTURE.
- BENIGN FIBROADIPOSE TISSUE AND CARTILAGE.
- NEGATIVE FOR MALIGNANCY.

With degenerative joint disease

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.

See also

References

  1. ↑ Lester, Susan Carole (2005). Manual of Surgical Pathology (2nd ed.). Saunders. pp. 225. ISBN 978-0443066450.
  2. ↑ Dimenstein, IB. (Jun 2008). "Bone grossing techniques: helpful hints and procedures.". Ann Diagn Pathol 12 (3): 191-8. doi:10.1016/j.anndiagpath.2007.06.004. PMID 18486895.
  3. ↑ Ramisetty, NM.; Pynsent, PB.; Abudu, A. (May 2005). "Fracture of the femoral neck, the risk of serious underlying pathology.". Injury 36 (5): 622-6. doi:10.1016/j.injury.2004.08.034. PMID 15826621.
  4. ↑ URL: http://www.path.utah.edu/casepath/ms%20cases/ms%20case%205%20comp/case%205.htm. Accessed on: 11 October 2012.
  5. ↑ Blain, H.; Chavassieux, P.; Portero-Muzy, N.; Bonnel, F.; Canovas, F.; Chammas, M.; Maury, P.; Delmas, PD. (Nov 2008). "Cortical and trabecular bone distribution in the femoral neck in osteoporosis and osteoarthritis.". Bone 43 (5): 862-8. doi:10.1016/j.bone.2008.07.236. PMID 18708176.
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