Role of hypercoagulability in multifocal osteonecrosis

Bone infarction describes bone marrow necrosis that occurs within a long bone's 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.