{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T02:11:20Z","timestamp":1774577480986,"version":"3.50.1"},"reference-count":18,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,11,22]]},"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:p>Bone infarction describes bone marrow necrosis that occurs within a long bone\u2019s metaphysis or diaphysis. Multiple causative factors lead to ischaemia and subsequent necrosis of bone marrow. The role of hypercoagulability in bone ischaemia is a well-established phenomenon. Orthopaedic specialists play a crucial role in managing affected individuals due to their risk of developing malignancy. We had a case of a man in his late 20s with multifocal osteonecrosis. He was evaluated for hypercoagulability and was found to have mild hyperhomocysteinaemia. He also had an elevated level of factor VIII activity. He was managed conservatively and showed good improvement on vitamin supplementation for hyperhomocysteinaemia. As malignant transformation of the infarction can occur, orthopaedic surgeons need to be aware of this and keep such patients under regular follow-up.<\/jats:p>","DOI":"10.1136\/bcr-2024-261958","type":"journal-article","created":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T20:31:26Z","timestamp":1733344286000},"page":"e261958","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Role of hypercoagulability in multifocal osteonecrosis"],"prefix":"10.1136","volume":"17","author":[{"given":"Nirvin","family":"Paul","sequence":"first","affiliation":[{"name":"Sports Injury Division, Department of Trauma Surgery, All India Institute of Medical Sciences (AIIMS) Rishikesh, Rishikesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ajay","family":"Sharma","sequence":"additional","affiliation":[{"name":"Sports Injury Division, Department of Trauma Surgery, All India Institute of Medical Sciences (AIIMS) Rishikesh, Rishikesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arvind","family":"Yadav","sequence":"additional","affiliation":[{"name":"Sports Injury Division, Department of Trauma Surgery, All India Institute of Medical Sciences (AIIMS) Rishikesh, Rishikesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3291-198X","authenticated-orcid":false,"given":"Anurag","family":"Bhakhar","sequence":"additional","affiliation":[{"name":"Sports Injury Division, Department of Trauma Surgery, All India Institute of Medical Sciences (AIIMS) Rishikesh, Rishikesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,12,4]]},"reference":[{"key":"2025082708044234000_17.12.e261958.1","first-page":"415","article-title":"Fractures of the neck of the femur, dislocation of hip, and obscure vascular disturbances producing aseptic necrosis of the head of the femur","volume":"59","author":"Phemister","year":"1934","journal-title":"Surg Gynec Obstet"},{"key":"2025082708044234000_17.12.e261958.2","doi-asserted-by":"crossref","first-page":"108","DOI":"10.17727\/JMSR.2021\/9-17","article-title":"Imaging in ischemia of bone \u2013 A pictorial essay","volume":"9","author":"Kakarla","year":"2021","journal-title":"J Med Sci Res"},{"key":"2025082708044234000_17.12.e261958.3","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1097\/BPB.0000000000000217","article-title":"Vascular evaluation after cervical hip fractures in children: a case series of eight children examined by scintigraphy after surgery for cervical hip fracture and evaluated for development of secondary radiological changes","volume":"25","author":"Jur\u00e9us","year":"2016","journal-title":"J Pediatr Orthop B"},{"key":"2025082708044234000_17.12.e261958.4","doi-asserted-by":"crossref","unstructured":"Ryu KN , Jin W , Park JS . 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