Orthopaedic Surgery

Answer 4 Osteonecrosis of the femoral head. Figure 2 shows collapse of the femoral head and acetabular changes, classic findings of advanced osteonecrosis of the femoral head. Excessive alcohol intake (> 400 mL/wk) has been associated with an increased risk for developing osteonecrosis of the femoral head.4 This patient does not fit the appropriate age category for Legg-Calve-Perthes disease (age range, 4-8 yr), and the history and physical examination findings are not consistent with ankylosing spondylitis (typically low back symptoms). A negative C-reactive protein, normal white blood cell count, and a 2-month history of pain make septic arthritis less likely. The lack of lower extremity deformity (shortened and externally rotated, typically for femoral neck fracture) and ability to perform some range of motion of the hip rule out an acute femoral neck fracture. REFERENCES 4. Lieberman JR, Berry DJ, Mont MA, et al. Osteonecrosis of the hip: management in the twenty-first century. Instr Course Lect 2003;52:337-55. Click here to return to the questions

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