Bone Infarction - Symptoms, Causes and Treatment

Infarct in the bone area

Bone infarction is an extremely dangerous bone degeneration, which in the end stage not only unbearable pain, but also significant movement restrictions. Sometimes such infarctions spontaneously heal themselves. Also, the disease often goes unnoticed, especially in the early stages, because it causes little discomfort at the beginning. In severe cases, however, it is not only creeping to increasingly extreme pain, but also to a complete destruction of the affected bone components.

• Definition: "Bone infarction" is a tissue termination (infarct) of the bone or a bone section.
• Typical symptoms are joint and bone pain, restricted mobility, swelling in the area of ​​bones and joints
• causes For example, atherosclerosis, osteoporosis, Lyme disease, streptococcal infection, fractures, or other injuries.
• Further risk factors are frequent stays under pressure (for example when diving), radiation therapies and certain medications.
• Therapy: The conservative treatment includes rest and relief, moderate exercise and a change in diet. Support is provided by herbal remedies. Depending on the cause, a drug therapy or surgery may be necessary.

contents

• Infarct in the bone area
• Structure and structure of bones
• Bone infarction - Definition and genesis
• Causes of aseptic bone infarction
• Causes of septic bone disease
• Posttraumatic causes of an infarct in the bone
• Symptoms of bone infarction
• diagnosis
• Therapy for bone infarction

Structure and structure of bones

Even if it does not seem from the outside, there is a human bone (Os) from a variety of different tissue layers. The outer bone layer is made of connective tissue periosteum (Periosteum) educated. It represents the externally visible part of the bone and already contains a variety of different nerves and blood vessels, which make the bone sensation and circulation.

Bones are made up of a variety of tissue layers. (Image: 7activestudio / fotolia.com)

Under the periosteum closes the so-called cortical (Substantia corticalis) on. The term comes from the Latin word cortex for "bark" and describes an extremely stable bone tissue, which acts as a protective cover and is especially strong in the middle part of the bone to give the relatively slender, usually rod-shaped bone section the necessary stability and resistance to pressure and weight loads.

Inside the bone lies the cancellous (Substantia spongiosa). Again a term derived from the Latin, the word spongia is borrowed for "sponge" and refers to the sponge-like structure of cancellous bone.

One can imagine this inner part of the bone as a Swiss cheese, in whose cavities the actual one bone marrow (Medulla ossium) located. This is formed except in cancellous bone only in another bone segment, namely the so-called Mark cave (Cavitas medullaris). It is located in the already mentioned middle section of the bone and is therefore relatively well protected by the hard cortical bone.

The situation is different at the head of the bone. Here goes the middle bone part, also known as diaphysis, first in the relatively short section of the metaphysis over, which finally flows into the bulbous epiphysis, the head of the bone.

The cortical bone, which is generously present in the middle part, changes more and more to the spongy and spongy bone at the bone end. The bone marrow, as well as the delicate vessels of the cancellous bone, are therefore not as well protected in this area as in the middle of the bone.

Bone infarction - Definition and genesis

For bone infarction, this particular structure of the bone is important in that the disease usually begins at the articular surfaces formed by the head of the bone. As an infarct in the bone area in this regard the demise of bone tissue is referred to as a result of poor tissue perfusion. The blood vessels in cortical bone and cancellous bone in such a case therefore suffer from a vascular occlusion for certain reasons.

As a result, this leads to a lack of nutrients in the bone tissue, which in turn impairs the formation of new bone tissue. Since this, however, like all body tissue must constantly renew itself, it comes through the infarct in the long run to a downfall of the tissue, with unchecked disease course up to a osteonecrosis (Osteonecrosis) can lead. In this context, three different types of bone infarct can be differentiated medically:

• aseptic bone infarction
• septic bone infarction
• Post-traumatic bone disease

Causes of aseptic bone infarction

The developmental mechanisms of aseptic bone infarcts have not yet been fully investigated. However, it appears that there are a number of risk factors that favor aseptic bone necrosis. These include, inter alia, certain therapeutic measures which have heavily impacted the bone substance by using aggressive treatment methods.

Bone infarction can occur, for example, as a result of aggressive chemotherapy. (Image: RFBSIP / fotolia.com)

It is conceivable in this context, for example, a bone infarct in the course of a immunotherapy, treated with high dose cortisone or sirolimus. Likewise, an aggressive chemotherapy to be responsible. In particular, chemotherapeutic measures for the treatment of cancers of the hematopoietic system (e.g., leukemias and lymphomas) here carry a high risk of infarction. The situation is similar for cancer treatment in the context of a radiation therapy with radioactive UV radiation. While this helps destroy cancer cells, it also attacks healthy body cells such as those of the blood vessels of the bone tissue.

Further, bone-infarctive treatment measures are in the area of bisphosphonate on. Bisphosphonates are drug substances that are actually used to inhibit bone loss in osteoporosis. As a side effect, these drugs also inhibit the formation of new blood vessels in the bones, causing a deficiency of the bone tissue with blood and nutrients are under threat. Aseptic jawbone necrosis is feared in this context.

In addition to chemotherapeutic agents and bisphosphonates, there are a number of other medications that can seriously affect the bone's own blood vessels. Particularly noteworthy here are corticosteroids and immunosuppresives such as sirolimus. All these medicines have in common that they interfere massively in the blood clotting of the organism and so change the flow characteristics of the blood change. This can lead to microvascular occlusions in the blood vessels.

In addition to the mentioned treatment aspects, aseptic bone infarction is also possible as a result of unhealthy lifestyle habits and certain diseases. In terms of diseases, the following health complaints can be mentioned in particular:

• arthrosis
• Arteriosclerosis (arteriosclerosis)
• Lupus erythematosus
• Gaucher's disease
• osteoporosis
• Sickle cell anemia

As risk groups in everyday life can be called on the one hand people who often dive. In fact, low pressure can cause sustained compression of bone vessels. In general, frequent stays in extreme pressure conditions are a cause for an infarct in the bones that should not be underestimated. A special occupational risk exists here, for example, in mining.

Furthermore, chronic alcohol consumption and obesity have an enormous influence on the blood circulation capacity of the bones. Both health effects are thought to contribute to the enlargement of fat cells in the blood, thus provoking a decreased blood flow in the area of ​​the bone marrow.

Regardless of the underlying risk factor, the sequence of events is the same. It comes to a reduced blood flow and associated lack of supply of the bone concerned with nutrients, which has a degradation of the bone substance with concomitant loss of function.

Divers have an increased risk of an infarct in the bone. (Image: Cara-Foto / fotolia.com)

Causes of septic bone disease

Bone necroses that develop during or as a result of infection are also referred to as septic bone infarcts. The bones themselves are actually well protected against infectious agents due to their strong structure and surrounding protective devices consisting of periosteum and ligaments. For this reason, a bone infection occurs only after massive pathogen exposure, either directly (see post-traumatic causes of bone infarction) or just by a sepsis. It refers to a blood poisoning by infectious agents, the pathogens move from the original focus of infection in the body in other parts of the body. Consequently, in the case of septic infarction, this part of the body is a bone.

Such blood poisoning is usually caused by bacteria such as staphylococci, as they are particularly fond of attacking bone substances. But other bacteria and viruses can attack bone tissue and affect the circulation function of the vessels located therein. The pathogens enter here sepsisbedingt the bloodstream in the bones, remain there and multiply.

As the infection progresses, an abscess often occurs, because the body tries to keep the pathogens at bay via the body's own defense mechanisms. A common example of this process is a suppurative tooth root, which leads to a cross infection on the nearby jawbone. In the later stages, however, the process of abscesses transforms into a tangible degeneration of the bone, and the tissue descent takes its course. Typical infectious diseases that lead to bone infarction on this path are:

• Lyme disease
• HIV infection
• staph infection
• streptococcal infection
• tuberculosis

Posttraumatic causes of an infarct in the bone

It can also come as a result of accidental trauma, such as soft tissue injuries, fractures or surgical treatment errors, bone infarcts. These post-traumatic infarct variants can occur with or without involvement of an infection event. If infections are not involved, it is usually a major traumatic event that leads to tissue loss and associated bone loss. A common scenario would be, for example, a bone fracture or a capsule tear as a result of a fall.

Triggers can also be surgical procedures. If, for example, blood vessels of the bone are massively damaged during bone or joint surgery, an infarct can not be ruled out. In addition, in post-traumatic bone infarcts after surgery also play a lack of sanitary measures and the so-called hospital germs a major role.

Whether in planned surgery, such as arthroscopy of the knee joint, or emergency surgical treatment after bone fractures, in any case, the medical staff to highly hygienic approach is stopped, because germs are despite the usual surface and skin disinfection is a danger dar By unhygienic work, during the operation or the aftercare, access to the body, they can quickly cause significant damage. In addition, the so-called hospital germs have the annoying property of reacting to the common antibiotics to react and thereby make treatment even more difficult.

Bone infarction of the hip (hip head necrosis) often manifests itself at the beginning by a slow onset in the groin or sudden groin pain. (Image: Bolko von Haslingen / fotolia.com)

Symptoms of bone infarction

At the beginning, an infarct in the bone is still relatively inconspicuous. Often he runs even completely symptom-free, which makes an early diagnosis difficult. Later, however, there are clearer complaints in the area of ​​the bones and joints, which are mainly expressed in increasing pain symptoms. The pain initially occurs only when moving, but can be noticeable at rest from a certain point of time. Overall, in the case of bone infarct the following symptoms can be expected.

• pain on movement
• joint pain
• bone pain
• pain-related movement restrictions
• Swelling in the area of ​​bones and joints

Warning: The most dreaded complication is bone necrosis. The death of the bone mass implies an additional danger to bone stability and, at some point, can only be reversed to a limited extent or not at all.

diagnosis

It is not possible to determine a tissue sinking of the bone or of a bone section solely on the basis of a patient survey. However, existing symptoms and information on pre-existing conditions and ongoing treatment can substantiate an initial suspicion. Subsequently, the examination of the bones by means of imaging procedures is necessary. Ultrasound and X-rays are just as conceivable as CT and MRI. In addition, blood tests help to detect any infectious agents in the blood.

Therapy for bone infarction

The treatment measures depend on the severity of the course and the causes. Frequently, a purely conservative treatment is sufficient to achieve a recovery. In severe cases, however, additional measures may be required. The conservative treatment for bone infarction consists of the 3 pillars:

1. Rest and relief
2. Moderate exercise
3. dietary changes

Relief and relief measures

In the acute phase, the affected bone, as well as the adjacent joints must be absolutely sedated to prevent further substance damage by vibration or weight bearing. These immobilization measures may possibly be supported by a fixation of the bone, for example by means of orthoses, protective bandages or walking aids.

physical therapy

In the further course of the tissue should be gradually brought back to its normal movement, or the everyday normal load. Here, a physiotherapist can demonstrate appropriate exercises that should also be used at home. Through this process, in the long term full mobility is to be achieved again and metabolic products, which arise as a result of the rebuilding process, can be better transported away thanks to the physiotherapeutic measures.

dietary changes

Nutrition is also credited with some importance in the treatment of bone infarcts. To avoid here are in particular high-fat foods and the consumption of alcohol, since both, as already mentioned, favors vascular occlusions. Also of acidic food (e.g., citrus fruits) should be avoided, as too high an acid value extracts additional minerals from the bone.

Instead, pay attention to a balanced diet, which contains especially bone-strengthening nutrients. These include, in particular, minerals such as folic acid, calcium, magnesium, phosphorus and zinc and the trace element selenium. These nutrients can be found in all sorts of whole grains and vegetables such as cabbage (for example kale and broccoli) or legumes (e.g., beans, lentils and peas).

Dairy products also have a high content of these minerals, which is especially true for the particularly important bone minerals calcium, magnesium and folic acid. However, care should be taken here to incorporate primarily low-fat dairy products, such as natural yoghurt, cottage cheese, feta cheese or curd cheese in the diet.

In addition to minerals, vitamins A, C, E and B are important for strong bones. The daily need for patients with bone infarct can be wonderfully covered by conventional types of fruit such as apples or bananas. These are also low in acid and thus balance the acid-base balance outstanding.

For a healthy bone structure, various vitamins and minerals, such as calcium and magnesium, are necessary. (Image: bit24 / fotolia.com)

Phytotherapy

Medicinal measures usually can not treat an infarct in the bone, but they can be used very supportively. For example, anti-inflammatory and analgesic envelopes with cabbage, apple cider vinegar or sea salt are possible. Local rubbings with horse chestnut extracts or arnica can bring relief. To strengthen the blood vessels, cures with garlic or willow bark have proven.

Medical therapy

If conservative treatment alone is unsuccessful, or if the infarction is based on severe inflammation, drug therapy is necessary. It consists in septic bone infarctions in the choice of the appropriate antibiotic. Often it is necessary to resort to the application via the vein, since antibiotics in tablet form otherwise often do not adequately act locally. In addition, analgesics such as ibuprofen or Voltaren are included in the medication. On the one hand, they are supposed to alleviate existing pain, on the other hand to mitigate existing inflammatory reactions.

Other active substances are mainly used on the basis of the risk factors. These medicines are either given as preventive measures to prevent the recurrence of tissue loss, or as an adjunctive support to major treatments performed, for example, to alleviate concomitant symptoms of underlying disorders. For example, cholesterol-lowering drugs like simvastatin or atorvastatin, which counteract blood vessel obstruction caused by too many blood lipids, are part of this complementary medication.

Also, the use of blood thinners (e.g., ASS or Marcumar) To improve the flow rate of the blood and avoid blood clots is conceivable. Also suitable are osteoporosis drugs such as alendronic acid to prevent the spread of existing necrosis.

Important: Since osteoporosis medications are also suspected to accelerate the undersupply of the bone, a close monitoring of the treatment success is necessarily indicated here.

Operational measures

Remains a conservative and / or drug treatment without effective treatment success, or is a serious infection with appropriate tissue descent obvious, often leads to no way past surgery. In cases with little tissue descent, however, it is often sufficient if rinsing with antibiotically active substances is carried out directly on the bone.

Furthermore, methods are used which provide relief in the bone itself and stimulate a rebuilding of bone tissue. They are often performed not in isolation, but in combination. These methods include, but are not limited to, relief drilling, bone cutting, and bone grafting.

In very severe cases, it is sometimes necessary to remove the dead tissue and replace the joint with metal prostheses.

Bone infarction diseases: arteriosclerosis, arhtrosis, lupus erythematosus, Gaucher disease, osteoporosis sickle cell anemia, Lyme disease, HIV infection, staphylococcal infection, streptococcal infection, tuberculosis (ma)