avascular necrosis

Management

Management Summary

 

Stage 0

 

Natural history mixed

- depends on size of lesion and diagnosis

- treat if becomes asymptomatic

- may benefit from bisphosphonates

 

Stage 1 / Normal X-ray, abnormal MRI

 

Forage: 80% G/E

Bisphosphonates

 

Stage 2 / Abnormal X-ray with cysts and sclerosis

 

A:  As for Stage I

Background

Bilateral Hip AVN Xray

 

Definition

 

Non-traumatic or traumatic condition of femoral head with bone death

 

Epidemiology

 

20 - 50 yo (average 38)

- M: F 4:1

 

NHx  

 

70-80% with AVN will progress within 1 year

 

Talar Neck Complications

AVN  

 

Largely related to degree of displacement

 

Incidence

 

Hawkins Type I

- 0% to 13% 

 

Talus AVN Hawkins 1

 

Hawkins Type II 

- 20% to 50% 

- usually only patchy and not a problem (rarely collapses)

Kienbock's Disease

Definition 

 

Avascular necrosis & subsequent disintegration of lunate

 

Aetiology

 

50-75% history of trauma

 

Occasionally seen in sickle cell / steroid use

 

Pathogenesis

 

Vascular Theory

 

Trauma disrupting vascularity

- single incident with disruption of blood supply

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