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Avascular Necrosis


Presentation

  • All patients had an asymptomatic clinical period after treatment and re-presented 6 months to 7 years later with elbow pain or loss of motion. All patients were treated symptomatically. AVN of the trochlea has a late clinical presentation.[ncbi.nlm.nih.gov]
  • A 26 year old lady presented with right sided hip pain and diagnosed as avascular necrosis of the femoral head. After 6 months she presented a similar pain in left hip, which revealed avascular necrosis of left femoral head as well.[ncbi.nlm.nih.gov]
  • No literature is available on AVN presenting post-adrenal surgery. Here we present a young woman who presented with avascular necrosis of both hips 1 year after adrenalectomy for Cushing's syndrome.[ncbi.nlm.nih.gov]
  • A new case of avascular necrosis of the intermediate cuneiform bone as a very rare cause of limp is presented.[ncbi.nlm.nih.gov]
  • We present this case for its rare presentation of bilateral talar fracture dislocation with bilateral avascular necrosis with sequential radiographs.[ncbi.nlm.nih.gov]
Pain
  • At the initial visit to our department, the patient was noted to have a painful trigger wrist that was brought on by wrist flexion and extension.[ncbi.nlm.nih.gov]
  • She was pain free in the majority of her activities of daily living.[ncbi.nlm.nih.gov]
  • In 2 cases with humeral head replacement, there was painful glenoid wear. Shoulder arthroplasty for nontraumatic avascular necrosis yields satisfactory results with a pain-free shoulder in more than 80% of cases.[ncbi.nlm.nih.gov]
  • We report one more case of this rare condition which can be a cause of wrist pain.[ncbi.nlm.nih.gov]
  • A 13-year-old, right hand-dominant, otherwise healthy boy presented with left wrist pain 19 months after a nonmotorized scooter injury.[ncbi.nlm.nih.gov]
Progressive Hearing Loss
  • Patients complain on progressive hearing loss and tinnitus. The diagnosis is made clinically by conventional audiologic evaluation and radiologically by x-ray mastoid Schuller's view and CT scan.[ncbi.nlm.nih.gov]
Tinnitus
  • Patients complain on progressive hearing loss and tinnitus. The diagnosis is made clinically by conventional audiologic evaluation and radiologically by x-ray mastoid Schuller's view and CT scan.[ncbi.nlm.nih.gov]
Foot Deformity
  • Although, trauma, foot deformity (pesplanovalgus), systemic diseases such as diabetes mellitus and lupus, drugs (steroids, antineoplastic) and excessive alcohol consumption have all been accused in the etiology of avascular necrosis of the tarsal bones[ncbi.nlm.nih.gov]
Short Arm
  • The patient was placed in a short-arm thumb spica cast, with a window for a bone stimulator, for 14 weeks. At the conclusion of the treatment, the pain had resolved and x-ray and computed tomography scan demonstrated bony union.[ncbi.nlm.nih.gov]
Dysphasia
  • AIMS: The aim of this study was to evaluate the correlation between Salter's criteria and Kalamchi's classification of avascular necrosis in patients treated for developmental dysphasia of the hip (DDH).[ncbi.nlm.nih.gov]

Workup

  • This staging system was revised after the widespread use of MRI in the workup of AVN.[orthopaedicsone.com]
  • The purpose of this article is to report a prototypical case with complete radiographic and histologic workup and to provide facts regarding Kummel disease that are salient to the primary care provider.[doi.org]
  • See Workup. Early diagnosis and appropriate intervention can delay the need for joint replacement. However, most patients present late in the disease course.[emedicine.medscape.com]
Cytopenia
  • Features of active organ SLE (CNS, renal, cutaneous vasculitis, serositis, cytopenias) are associated with AVN as are CS, especially early in disease and at high doses. Those with early CS side-effects seem to have the highest risk of AVN.[ncbi.nlm.nih.gov]

Treatment

  • These patients were treated by conservative treatment (non surgical) in three cases, vascularized bone graft in two and palliative treatments (proximal row carpectomy or partial fusion) in five.[ncbi.nlm.nih.gov]
  • At the conclusion of the treatment, the pain had resolved and x-ray and computed tomography scan demonstrated bony union. The authors recommend considering an initial trial of nonsurgical management for treatment of all pediatric scaphoid nonunions.[ncbi.nlm.nih.gov]
  • Thus, the intravenous infusion of cervus and cucumis polypeptides was a safe, effective treatment for ANFH.[ncbi.nlm.nih.gov]
  • To reach these goals, the doctor may use one or more of the following surgical or nonsurgical treatments. Nonsurgical Treatments Usually, doctors will begin with nonsurgical treatments, alone or in combination.[web.archive.org]
  • This case report demonstrates a successful outcome and a review of options for the treatment of AVN secondary to SCFE.[ncbi.nlm.nih.gov]

Prognosis

  • RESULTS: S1 and S2 criteria were predictive of a poor prognosis. The outcome following S3, S4 and S3 S4 varied; 18 (40%) had a good prognosis, 17 (38%) a fair prognosis and ten (22%) a poor prognosis.[ncbi.nlm.nih.gov]
  • Optimal treatment for this condition has not been established and long-term prognosis is unknown. OBJECTIVE: We present two cases of children with AVN of the fourth metacarpal head with a relatively recent history of indirect hand trauma.[ncbi.nlm.nih.gov]
  • In addition, lesion size and location can be more easily assessed on magnetic resonance images, and this has been shown to relate to prognosis and need for treatment.[doi.org]
  • We know that the older the child is, the worse the prognosis. Most agree that children younger than 6 years do not require surgical treatment or even treatment with a brace.[lifebridgehealth.org]

Etiology

  • The most common reported etiology is trauma. We report a case of avascular necrosis of the capitate in a patient with chronic wrist pain that began after a single episode of remote trauma.[ncbi.nlm.nih.gov]
  • Although, trauma, foot deformity (pesplanovalgus), systemic diseases such as diabetes mellitus and lupus, drugs (steroids, antineoplastic) and excessive alcohol consumption have all been accused in the etiology of avascular necrosis of the tarsal bones[ncbi.nlm.nih.gov]
  • Avascular necrosis occur as a result of diverse etiology. Chronic inflammatory conditions such as systemic lupus erythematosus considered as a recognize cause.[ncbi.nlm.nih.gov]
  • Although bone scintigraphy using single photon emission computed tomography (CT) may be nearly as accurate as MRI, MRI offers a more specific diagnosis in the patient who presents with hip pain of uncertain etiology.[doi.org]
  • Better results can be expected with shorter preoperative delay, when preoperative pain is moderate and range of motion preserved and when the etiology is not postradiation avascular necrosis, which in our series yielded the worst results.[ncbi.nlm.nih.gov]

Epidemiology

  • Epidemiology Frequency United States The frequency of AVN depends on the site involved. The most common site is the hip; other locations include the carpals, talus, femur, metatarsal, mandible, and humerus.[emedicine.medscape.com]
  • Epidemiology For oral bisphosphonates used to treat osteoporosis, the number of spontaneous reports of ONJ submitted to their manufacturers indicates a reporting rate of less than 1 per 100,000 patient treatment years.[iofbonehealth.org]
  • At present, the available data are insufficient to conclude that the incidence of AVN in HIV-infected persons is increased, and large epidemiologic studies are needed.[academic.oup.com]
Sex distribution
Age distribution

Pathophysiology

  • Leukostasis is considered to be the pathophysiological mechanism. In view of the rarity, a case is reported, along with compilation of previously reported cases.[ncbi.nlm.nih.gov]
  • We will review the pathophysiologic mechanisms of AVN and the current use of MRI in the diagnosis of this condition.[doi.org]
  • The pathophysiology of avascular necrosis of the femoral head has not been completely accounted for. In some patients there has clearly been a direct cause (trauma, radiation,..), while in others the pathophysiology is still uncertain.[physio-pedia.com]

Prevention

  • OBJECTIVES: To assess the effects of pharmacological interventions for preventing insufficiency fractures and avascular necrosis in adults over 18 years of age undergoing pelvic radiotherapy.[ncbi.nlm.nih.gov]
  • According to Modified Schumock and Thornton's criteria, this reaction was not preventable. The Modified Hartwig and Siegel's scale showed that the reaction was severe (level 6).[ncbi.nlm.nih.gov]
  • Proponents of prophylactic pinning believe that fixation with a single cannulated screw is a safe method to prevent secondary arthrosis from a missed minor slip.[ncbi.nlm.nih.gov]
  • In cases of AVN of the hip, it is very important to diagnose and treat early in order to prevent disability.[hss.edu]

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