Difference between revisions of "Femoral head"

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*[[AKA]] ''pathologic fracture''.
*[[AKA]] ''pathologic fracture''.
===General===
===General===
*Uncommon.<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>
**Usually in patients with a known malignancy and bony metastases.
*Should not be missed.
*Should not be missed.
*Classically in older individuals.
*Classically in older individuals.

Revision as of 15:32, 9 November 2012

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]

  • Liberality (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

  • Avascular necrosis of the femoral head.
  • Osteoarthritis.
  • Rheumatologic disease - rheumatoid arthritis.
  • Pathologic fracture.
  • Infection (osteomyelitis).

Specific diagnoses

Avascular necrosis of the femoral head

  • AKA avascular necrosis, abbreviated AVN.

General

Risk factors:

Gross

Features:[4]

  • Wedge-shaped pale yellow below cartilage.
  • +/-Cartilage separates from the bone.
  • +/-Deformation of femoral head.

Image:

Microscopic

Features:[5]

  • Empty lacunae (indicative of necrotic bone).

Sign out

FEMORAL HEAD, RIGHT, HIP ARTHROPLASTY: 
- AVASCULAR NECROSIS OF THE FEMORAL HEAD.

Osteoarthritis

See Osteoarthritis.

Infection

See Osteomyelitis.

Rheumatoid arthritis

Main article: Rheumatoid arthritis

Gross

Features:

  • Pannus[6] - fibrovascular tissue or granulation tissue.

Image: RA (tumorlibrary.com).

Fracture of bone due to metastatic carcinoma

Main article: Fracture of bone
  • AKA pathologic fracture.

General

  • Uncommon ~ 10 of 90 suspected cases.[7]
    • 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:

Sign out

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

Traumatic fracture of the femoral neck

General

Gross

  • Irregular/jagged femoral neck margin.
  • Hemorrhage.

Microscopic

Features:

  • Non-vital bone.
    • Loss of osteocytes.

DDx:

Commonly concurrent pathology:

Sign out

FEMORAL HEAD AND SURROUNDING TISSUE, LEFT, HIP ARTHROPLASTY:
- NON-VITAL BONE CONSISTENT WITH FRACTURE.
- BONE MARROW.
- BENIGN FIBROUS TISSUE.
- 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. ↑ URL: http://www.merckmanuals.com/professional/musculoskeletal_and_connective_tissue_disorders/osteonecrosis/osteonecrosis.html. Accessed on: 30 April 2012.
  4. ↑ Lester, Susan Carole (2005). Manual of Surgical Pathology (2nd ed.). Saunders. pp. 224. ISBN 978-0443066450.
  5. ↑ Steffen, RT.; Athanasou, NA.; Gill, HS.; Murray, DW. (Jun 2010). "Avascular necrosis associated with fracture of the femoral neck after hip resurfacing: histological assessment of femoral bone from retrieval specimens.". J Bone Joint Surg Br 92 (6): 787-93. doi:10.1302/0301-620X.92B6.23377. PMID 20513874.
  6. ↑ Lester, Susan Carole (2005). Manual of Surgical Pathology (2nd ed.). Saunders. pp. 223. ISBN 978-0443066450.
  7. ↑ 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.
  8. ↑ URL: http://www.path.utah.edu/casepath/ms%20cases/ms%20case%205%20comp/case%205.htm. Accessed on: 11 October 2012.
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