Avascular Necrosis & Bursitis
Avascular Necrosis (AVN) is a rare but severe complication of certain fractures. It occurs when
the blood supply to a segment of bone is affected.
The loss of blood supply to a major bone segment impairs healing because the avascular segment
cannot participate on the reparative process. This defective healing makes the bone weak and
susceptible to external forces. This results in collapse of the bone and late osteoarthritic changes.
Causes
Extensive stripping of soft tissues, which damage the periosteal blood supply
In certain bones where the blood supply is unique and unidirectional
Other causes like steroid therapy, Caisson's disease etc which may cause embolic block of the
blood vessels
Clinical features
Avascular necrosis of a bone is usually asymptomatic in the early stages. In the late stage, the
patient may complain of pain, limp and slight loss of movements. In very advanced cases, the
patient will show features of osteoarthritis.
, Investigation
Bone scan, radioscopic study.
In the later stages, radiography shows dense changes in the bone, collapse and osteoarthritic
features.
Management
Early stages require no treatment, protective braces may be given to prevent bone collapse. Delay
weight bearing until the bone is revascularized. It may take 6-8 months for the bone to
revascularize.
Surgical decompression has a doubtful role.
In the late stages, total hip replacement is advocated for AVN head of femur. AVN in scaphoid
needs open reduction and bone grafting.
Bursitis
Avascular Necrosis (AVN) is a rare but severe complication of certain fractures. It occurs when
the blood supply to a segment of bone is affected.
The loss of blood supply to a major bone segment impairs healing because the avascular segment
cannot participate on the reparative process. This defective healing makes the bone weak and
susceptible to external forces. This results in collapse of the bone and late osteoarthritic changes.
Causes
Extensive stripping of soft tissues, which damage the periosteal blood supply
In certain bones where the blood supply is unique and unidirectional
Other causes like steroid therapy, Caisson's disease etc which may cause embolic block of the
blood vessels
Clinical features
Avascular necrosis of a bone is usually asymptomatic in the early stages. In the late stage, the
patient may complain of pain, limp and slight loss of movements. In very advanced cases, the
patient will show features of osteoarthritis.
, Investigation
Bone scan, radioscopic study.
In the later stages, radiography shows dense changes in the bone, collapse and osteoarthritic
features.
Management
Early stages require no treatment, protective braces may be given to prevent bone collapse. Delay
weight bearing until the bone is revascularized. It may take 6-8 months for the bone to
revascularize.
Surgical decompression has a doubtful role.
In the late stages, total hip replacement is advocated for AVN head of femur. AVN in scaphoid
needs open reduction and bone grafting.
Bursitis
