Differential diagnosis of aseptic (avascular) necrosis and stress fracture of the sesamoid bone (review)

Abstract

Objective. To clarify the features of differential diagnostics of aseptic (avascular) necrosis and stress fracture of the sesamoid bone. Material and methods. Using as keywords «sesamoid bone», «avascular necrosis», «clinical stage» and «treatment» the search of publications in PubMed, Scopus, and MedLine databases was conducted, in which the features of differential diagnostics of aseptic necrosis and stress fracture of sesamoid bone were summarized and analyzed. Results. Slight sclerosis enhancement detected on computed tomography confirms the presence of osteonecrosis of the sesamoid bone, whereas an irregularly shaped fragment with poorly corticated edges on the radiograph indicates a fracture. When radiologic and clinical findings are equivocal, CT and MRI can help identify true fractures by detecting oblique irregular surfaces of fragments. In osteonecrosis, MRI may show changes in the form of bone marrow edema localized to the sesamoid joints. Conclusions. In the article, based on the analysis of literature sources, the features of sesamoid bone anatomy were clarified and generalized, as well as their blood supply was described and the features of differential diagnostics of aseptic necrosis and stress fracture of the sesamoid bone in various localizations were considered. Radiologic studies, including radiography, CT, and MRI, provide useful information about the presence and pathology involving these bones and should be used in conjunction with clinical findings to guide patient management.