M Jäger1, A Wild, R Krauspe. 1. Orthopädische Universitätsklinik, Heinrich-Heine Universität Düsseldorf, Düsseldorf, Germany. Jaeger@med.uni-duesseldorf.de
Abstract
BACKGROUND: In 25 % of patients who develope gestosis a Hemolysis- Elevated- Liver-enzymes-and- Low- Platelet-count-Syndrome (HELLP-Syndrome) may occur, which is characterized by activation of the coagulation mechanism and bone marrow alterations. Besides this therapeutical steroid application and an elevated age of primigravidity are responsible for an increased osteonecrosis risk in women, too. Because of anatomical and biomechanical reasons the highest incidence of pregnancy-associated osteonecrosis are the subchondral areas of the femoral epiphysial head. PATIENTS/ METHODS: In this investigation data of pathogenesis, diagnostic work up and therapy in HELLP-associated osteonecrosis are reviewed and discussed based on a case report. We report of a 37-year old HELLP-patient showing bilateral femoral head osteonecrosis, who sustained a proximal femur fracture after bone marrow core decompression surgery. RESULTS/ CONCLUSIONS: In pregnant patients with joint or bone associated pain an early MRI screening is recommended to detect osteonecrosis at early stages. This allows for therapeutic procedures which may be successful at early stages. If steroids are applicated for HELLP-treatment, the risk of osteonecrosis is elevated. DISCUSSION: Only early stages of osteonecrosis can be treated curatively. Sometimes it can be difficult to differentiate between early osteonecrosis stages, a bone marrow edema syndrome and a transient osteoporosis.
BACKGROUND: In 25 % of patients who develope gestosis a Hemolysis- Elevated- Liver-enzymes-and- Low- Platelet-count-Syndrome (HELLP-Syndrome) may occur, which is characterized by activation of the coagulation mechanism and bone marrow alterations. Besides this therapeutical steroid application and an elevated age of primigravidity are responsible for an increased osteonecrosis risk in women, too. Because of anatomical and biomechanical reasons the highest incidence of pregnancy-associated osteonecrosis are the subchondral areas of the femoral epiphysial head. PATIENTS/ METHODS: In this investigation data of pathogenesis, diagnostic work up and therapy in HELLP-associated osteonecrosis are reviewed and discussed based on a case report. We report of a 37-year old HELLP-patient showing bilateral femoral head osteonecrosis, who sustained a proximal femur fracture after bone marrow core decompression surgery. RESULTS/ CONCLUSIONS: In pregnant patients with joint or bone associated pain an early MRI screening is recommended to detect osteonecrosis at early stages. This allows for therapeutic procedures which may be successful at early stages. If steroids are applicated for HELLP-treatment, the risk of osteonecrosis is elevated. DISCUSSION: Only early stages of osteonecrosis can be treated curatively. Sometimes it can be difficult to differentiate between early osteonecrosis stages, a bone marrow edema syndrome and a transient osteoporosis.