Download PDF
Semin Musculoskelet Radiol 2012; 16(03): 192-204
DOI: 10.1055/s-0032-1320060
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Imaging of Postoperative Avascular Necrosis of the Ankle and Foot

Craig A. Buchan
1   Joint Department of Medical Imaging,Mount Sinai Hospital, Toronto, Ontario, Canada
2   University Health Network and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
3   Department of Medical Imaging, Gold Coast Hospital, Southport, Australia
,
Dawn H. Pearce
4   Department of Radiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
,
Johnny Lau
5   Department of Orthopedic Surgery, Toronto Western Hospital, University Health Network and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
,
Lawrence M. White
1   Joint Department of Medical Imaging,Mount Sinai Hospital, Toronto, Ontario, Canada
2   University Health Network and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
› Author Affiliations
Further Information

Publication History

Publication Date:
31 July 2012 (online)

Also available at
   Permissions and Reprints

Abstract

Avascular necrosis (AVN) of the ankle and foot is an uncommon and often unexpected postoperative complication in patients with persistent pain and disability postprocedure. Artifacts from metallic implants may obscure characteristic imaging signs of AVN, and radiography and computer tomography are the mainstay imaging modalities of the postoperative ankle and foot. MRI and nuclear medicine imaging play an important complementary role in problem solving and excluding differential diagnostic considerations including infection, nonunion, occult fracture, and secondary osteoarthritis.

This review article evaluates different imaging modalities and discusses characteristic sites of AVN of the ankle and foot in the postoperative setting including the distal tibia, talus, navicular, and first and lesser metatarsals. Radiologists play a key role in the initial diagnosis of postoperative AVN and the surveillance of temporal evolution and complications including articular collapse and fragmentation, thus influencing orthopedic management.

Keywords

avascular necrosis - osteonecrosis - foot and ankle - postoperative - magnetic resonance imaging
 

  • References

  • 1 McCarthy I. The physiology of bone blood flow: a review. J Bone Joint Surg Am 2006; 88 (Suppl 3) 4-9
    CrossrefPubMedGoogle Scholar
  • 2 Assouline-Dayan Y, Chang C, Greenspan A, Shoenfeld Y, Gershwin ME. Pathogenesis and natural history of osteonecrosis. Semin Arthritis Rheum 2002; 32 (2) 94-124
    CrossrefPubMedGoogle Scholar
  • 3 DiGiovanni CW, Patel A, Calfee R, Nickisch F. Osteonecrosis in the foot. J Am Acad Orthop Surg 2007; 15 (4) 208-217
    CrossrefPubMedGoogle Scholar
  • 4 Steffen RT, Athanasou NA, Gill HS, Murray DW. Avascular necrosis associated with fracture of femoral head after hip resurfacing. J Bone Joint Surg Br 2010; 92 (6) 787-793
    CrossrefPubMedGoogle Scholar
  • 5 Bartonícek J, Fric V, Skála-Rosenbaum J, Dousa P. Avascular necrosis of the femoral head in pertrochanteric fractures: a report of 8 cases and a review of the literature. J Orthop Trauma 2007; 21 (4) 229-236
    CrossrefPubMedGoogle Scholar
  • 6 Pape D, Seil R, Anagnostakos K, Kohn D. Postarthroscopic osteonecrosis of the knee. Arthroscopy 2007; 23 (4) 428-438
    PubMedGoogle Scholar
  • 7 Pearce DH, Mongiardi CN, Fornasier VL, Daniels TR. Avascular necrosis of the talus: a pictorial essay. Radiographics 2005; 25 (2) 399-410
    CrossrefPubMedGoogle Scholar
  • 8 Koulouris G, Morrison WB. Foot and ankle disorders: radiographic signs. Semin Roentgenol 2005; 40 (4) 358-379
    CrossrefPubMedGoogle Scholar
  • 9 Lafforgue P. Pathophysiology and natural history of avascular necrosis of bone. Joint Bone Spine 2006; 73 (5) 500-507
    CrossrefPubMedGoogle Scholar
  • 10 Hawkins LG. Fractures of the neck of the talus. J Bone Joint Surg Am 1970; 52 (5) 991-1002
    CrossrefPubMedGoogle Scholar
  • 11 Rammelt S, Zwipp H. Talar neck and body fractures. Injury 2009; 40 (2) 120-135
    CrossrefPubMedGoogle Scholar
  • 12 Resnick D, Sweet DE, Madewell JE. Osteonecrosis: pathogenesis, diagnostic techniques, specific situations, and complications. In: Diagnosis of bone and joint disorders. 4th ed. Philadelphia, PA: Saunders; 2002: 3599-3685
    Google Scholar
  • 13 Buckwalter KA, Parr JA, Choplin RH, Capello WN. Multichannel CT imaging of orthopedic hardware and implants. Semin Musculoskelet Radiol 2006; 10 (1) 86-97
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Lee MJ, Kim S, Lee SA , et al. Overcoming artifacts from metallic orthopedic implants at high-field-strength MR imaging and multidetector CT. Radiographics 2007; 27 (3) 791-803
    CrossrefPubMedGoogle Scholar
  • 15 O'Hare A, Shortt C, Napier N, Eustace SJ. Bone marrow edema: patterns and clinical implications. Semin Musculoskelet Radiol 2006; 10 (4) 249-257
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Gyftopoulos S, Bencardino JT. Normal variants and pitfalls in MR imaging of the ankle and foot. Magn Reson Imaging Clin N Am 2010; 18 (4) 691-705
    CrossrefPubMedGoogle Scholar
  • 17 Elias I, Zoga AC, Schweitzer ME, Ballehr L, Morrison WB, Raikin SM. A specific bone marrow edema around the foot and ankle following trauma and immobilization therapy: pattern description and potential clinical relevance. Foot Ankle Int 2007; 28 (4) 463-471
    CrossrefPubMedGoogle Scholar
  • 18 Weishaupt D, Schweitzer ME. MR imaging of the foot and ankle: patterns of bone marrow signal abnormalities. Eur Radiol 2002; 12 (2) 416-426
    CrossrefPubMedGoogle Scholar
  • 19 Hintermann B. What the orthopaedic foot and ankle surgeon wants to know from MR imaging. Semin Musculoskelet Radiol 2005; 9 (3) 260-271
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Mont MA, Ulrich SD, Seyler TM , et al. Bone scanning of limited value for diagnosis of symptomatic oligofocal and multifocal osteonecrosis. J Rheumatol 2008; 35 (8) 1629-1634
    PubMedGoogle Scholar
  • 21 Hain SF, Fogelman I. Nuclear medicine studies in metabolic bone disease. Semin Musculoskelet Radiol 2002; 6 (4) 323-329
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Palestro CJ, Love C, Bhargava KK. Labeled leukocyte imaging: current status and future directions. Q J Nucl Med Mol Imaging 2009; 53 (1) 105-123
    PubMedGoogle Scholar
  • 23 Love C, Tomas MB, Tronco GG, Palestro CJ. FDG PET of infection and inflammation. Radiographics 2005; 25 (5) 1357-1368
    CrossrefPubMedGoogle Scholar
  • 24 Lagier R. Case report 552: Post-traumatic remodelling of the distal tibial epiphysis: a form of aseptic osteonecrosis. Skeletal Radiol 1989; 18 (4) 331-333
    CrossrefPubMedGoogle Scholar
  • 25 Assal M, Sangeorzan BJ, Hansen ST. Post-traumatic osteonecrosis of the lateral tibial plafond. Foot Ankle Surg 2007; 13: 24-29
    CrossrefPubMedGoogle Scholar
  • 26 Nelson Jr GE, Kelly PJ, Peterson LF, Janes JM. Blood supply of the human tibia. J Bone Joint Surg Am 1960; 42-A: 625-636
    PubMedGoogle Scholar
  • 27 Borrelli Jr J, Prickett W, Song E, Becker D, Ricci W. Extraosseous blood supply of the tibia and the effects of different plating techniques: a human cadaveric study. J Orthop Trauma 2002; 16 (10) 691-695
    CrossrefPubMedGoogle Scholar
  • 28 Zalavras C, Thordarson D. Ankle syndesmotic injury. J Am Acad Orthop Surg 2007; 15 (6) 330-339
    PubMedGoogle Scholar
  • 29 van den Bekerom MP, Hogervorst M, Bolhuis HW, van Dijk CN. Operative aspects of the syndesmotic screw: review of current concepts. Injury 2008; 39 (4) 491-498
    CrossrefPubMedGoogle Scholar
  • 30 Fanter NJ, Inouye SE, McBryde Jr AM. Safety of ankle trans-syndesmotic fixation. Foot Ankle Int 2010; 31 (5) 433-440
    CrossrefPubMedGoogle Scholar
  • 31 Canale ST, Kelly Jr FB. Fractures of the neck of the talus. Long-term evaluation of seventy-one cases. J Bone Joint Surg Am 1978; 60 (2) 143-156
    CrossrefPubMedGoogle Scholar
  • 32 Inokuchi S, Ogawa K, Usami N. Classification of fractures of the talus: clear differentiation between neck and body fractures. Foot Ankle Int 1996; 17 (12) 748-750
    CrossrefPubMedGoogle Scholar
  • 33 Rammelt S, Zwipp H. Talar neck and body fractures. Injury 2009; 40 (2) 120-135
    CrossrefPubMedGoogle Scholar
  • 34 Jones CK, Nunley JA. Osteonecrosis of the lateral aspect of the talar dome after triple arthrodesis. A report of three cases. J Bone Joint Surg Am 1999; 81 (8) 1165-1169
    PubMedGoogle Scholar
  • 35 Hermus JPS. Osteonecrosis of the talus after talonavicular arthrodesis: a case report and review of the literature. J Foot Ankle Surg 2011; 50 (3) 343-346
    PubMedGoogle Scholar
  • 36 Thordarson DB, Triffon MJ, Terk MR. Magnetic resonance imaging to detect avascular necrosis after open reduction and internal fixation of talar neck fractures. Foot Ankle Int 1996; 17 (12) 742-747
    CrossrefPubMedGoogle Scholar
  • 37 Sizensky JA, Marks RM. Imaging of the navicular. Foot Ankle Clin 2004; 9 (1) 181-209
    CrossrefPubMedGoogle Scholar
  • 38 Sangeorzan BJ, Benirschke SK, Mosca V, Mayo KA, Hansen Jr ST. Displaced intra-articular fractures of the tarsal navicular. J Bone Joint Surg Am 1989; 71 (10) 1504-1510
    CrossrefPubMedGoogle Scholar
  • 39 DiGiovanni CW. Fractures of the navicular. Foot Ankle Clin 2004; 9 (1) 25-63
    CrossrefPubMedGoogle Scholar
  • 40 Beaman FD, Bancroft LW, Peterson JJ, Kransdorf MJ, Menke DM, DeOrio JK. Imaging characteristics of bone graft materials. Radiographics 2006; 26 (2) 373-388
    CrossrefPubMedGoogle Scholar
  • 41 Malal JJG, Shaw-Dunn J, Kumar CS. Blood supply to the first metatarsal head and vessels at risk with a chevron osteotomy. J Bone Joint Surg Am 2007; 89 (9) 2018-2022
    CrossrefPubMedGoogle Scholar
  • 42 Prasad MG, Shankar NS. Clinical results of Keller's arthroplasty. Foot 1998; 8: 223-225
    CrossrefPubMedGoogle Scholar
  • 43 Brosky II TA, Menke CRD, Xenos D. Reconstruction of the first metatarsophalangeal joint following post-cheilectomy avascular necrosis of the first metatarsal head: a case report. J Foot Ankle Surg 2009; 48 (1) 61-69
    PubMedGoogle Scholar
  • 44 Weinraub GM, Meberg R, Steinberg JS. Vascular perfusion of the long dorsal arm versus chevron osteotomy: a cadaveric injection study. J Foot Ankle Surg 2004; 43 (4) 221-224
    PubMedGoogle Scholar
  • 45 Jones KJ, Feiwell LA, Freedman EL, Cracchiolo III A. The effect of chevron osteotomy with lateral capsular release on the blood supply to the first metatarsal head. J Bone Joint Surg Am 1995; 77 (2) 197-204
    PubMedGoogle Scholar
  • 46 Shortt CP. Magnetic resonance imaging of the midfoot and forefoot: normal variants and pitfalls. Magn Reson Imaging Clin N Am 2010; 18 (4) 707-715
    CrossrefPubMedGoogle Scholar
  • 47 Aigner N, Petje G, Steinboeck G, Schneider W, Krasny C, Landsiedl F. Bone marrow edema of the forefoot after chevron osteotomy—a rare cause of metatarsalgia: a case report. Foot Ankle Int 2002; 23 (5) 447-451
    PubMedGoogle Scholar
  • 48 Torriani M, Thomas BJ, Bredella MA, Ouellette H. MRI of metatarsal head subchondral fractures in patients with forefoot pain. AJR Am J Roentgenol 2008; 190 (3) 570-575
    CrossrefPubMedGoogle Scholar
  • 49 Petersen WJ, Lankes JM, Paulsen F, Hassenpflug J. The arterial supply of the lesser metatarsal heads: a vascular injection study in human cadavers. Foot Ankle Int 2002; 23 (6) 491-495
    PubMedGoogle Scholar
  • 50 Espinosa N, Maceira E, Myerson MS. Current concept review: metatarsalgia. Foot Ankle Int 2008; 29 (8) 871-879
    CrossrefPubMedGoogle Scholar