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 A 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. Subchondral sclerosis is present. 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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