Paper Example on Avascular Necrosis: Death of Bones Due to Poor Blood Supply

Introduction

The death of bones due to lack of blood supply is called Avascular necrosis. Also called osteonecrosis, it can cause small fractures and the final collapse of the bone. A displaced or a fractured bone joint can interrupt blood flow in a bony section (Ahmed, Sriskandarajah, Burd, Riddell, Boyd,Kaiser & Messiou, 2019). The disease is also associated with prolonged use of steroids in high doses and excessive alcohol consumption. Everyone may be affected, but the disease is more common in people 30 to 50 years.

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Symptoms

During the onset of avascular necrosis, most people do not experience any symptoms. Once the disease worsens, the affected joint could be injured when it becomes cumbersome. This will cause the person to feel prolonged pain. Most people do not differentiate the type of pain that occurs in their body (Ahmed et al., 2019). The pain might be mild or severe, and it gradually develops. Pain associated with avascular necrosis of the hip may be centered in the groin, thigh or buttocks. The affected areas are located near the knee, hip of the shoulder hand and foot. Some people develop bilateral vascular necrosis on either sides or both knees

Causes

The cause of the blood circulation problem in the bones is not always clear. Sometimes AVN affects people in good health. It may appear spontaneously, seemingly without cause. Reference is made to the spontaneous AVN of the knee. Although some possible causes are:

Dislocation or fracture of the femur.

This type of injury can affect blood flow to the bones and cause traumatic avascular necrosis (Couturier & Gold, 2019). AVN can be developed in 20% or more of the people who are displaced in the hip. Chronic use of corticosteroids. The long-term use of these anti-inflammatory drugs, both orally and intravenously, is associated with 35% of all cases of non-traumatic AVN (Couturier et al., 2019). Although the reason is not entirely established, doctors suspect that these drugs can affect the body's ability to break down fat. These substances accumulate in the blood vessels, narrowing them and reducing the amount of blood in the bones.

Excessive consumption of alcohol.

As with corticosteroids, excess alcohol can lead to decreased blood flow to the bones, fat accumulation in blood vessels, inflammation, blood clots and damage to the arteries. All this can block the flow of blood to the bones.

Prognosis

The amount and location of avascular necrosis bone, determine the outcome to some extent of the disease. Larger areas of avascular necrosis usually cannot be repaired with joint preservation methods and, finally, joint replacement is required. If the cause is an underlying disease, optimal treatment of the disease may be aggravated to reduce the risk of vascular necrosis or affect other regions of the bone.

Treatment

X-rays

X-rays may appear normal in early AVN. If a person has AVN, their doctor may use X-rays to monitor their progress.

Magnetic resonance imaging

This type of imaging may help doctors detect AVN at an early stage and before the onset of symptoms. This method can also show which part of the bone is affected.

CT scan

Provides a three-dimensional image of the bone, but is less sensitive than a CT scan.

Bone analysis, also called fundamental analysis or bone scanning

The doctor may recommend a bone scan if the X-rays are normal and in the absence of risk factors. This test requires a fall of a harmful radioactive substance before the holding. The substance allows the doctor to examine the bones. A single bone scan detects all bones affected by AVN.

Bone testing function

If the doctor still suspects that AVN, although X-rays, MRI and bone scintigraphy are normal, tests can be performed to measure the pressure exerted on the painful bones. These tests require surgery.

If the pain in the joint worsens, surgery may be needed to relieve pain, prevent bone collapse, and maintain the joint. The doctor may suggest one or more surgical options. When decompressing the core, a surgeon makes one or more holes to remove a bony nucleus from the affected joint (Schmitz, Baier, Knuttel & Baumann, 2018). The goal is to relieve joints and create channels for new blood vessels to improve blood flow. If AVN is detected early, this surgery can prevent bone collapse and arthritis. One can then avoid core decompression, hip replacement. Although blood will increase and enrich blood supply, a person may need to use a walker or crutch. Recovery can take several months, but many people who suffer from this procedure have complete pain relief.

Bone grafting is often performed at the same time as core decompression. A surgeon takes a small piece of healthy bone from another part of the body and graft (transplant) to replace the dead bone (Schmitz et al., 2018). Alternatively, the surgeon may use a synthetic donor or graft. This operation improves blood circulation and helps the joint. If the surgeon also removes the blood vessels with the bone, it is called a bone graft. It may take several months to recover from a bone graft.

A vascularized fibular graft is a specific type of bone graft used for AVN in the hip. This procedure is more complicated than other options. A surgeon removes the small bone from the leg called the fibula, as well as the artery and vein. The surgeon inserts this bone into the hole created by decompression of the nucleus. This reduces stress and improves joint support so you can make better use of it. The operation may take several months to recover from this operation.

To restore hip use and relieve pain, the surgeon can replace the hip with a prosthesis. This operation is called total hip replacement or stenting. Hip replacement relieves pain and allows full joint use in approximately 90% to 95% of people who suffer from it.

The latest research on Avascular Necrosis

Avascular necrosis (AVN) is a worrying complication in the treatment of hip dysplasia. As the name suggests, when the ball of the femur is being put back into its socket during surgery, it may cause a lot of blood loss. Often, the child recovers without long term consequences, but a significant loss of blood can cause growth disorders and other operations. Known risk factors include excessive pressure on the head of the femur when the hip is severely displaced. This is because the muscles contract as the hips descend to the cavity level (Putnam, DiGiovanni, Mitchell, Castaneda & Edwards, 2019). Extreme positions in a garbage can, or a raise may increase the risk of AVN, especially during severe dislocations. A question that intrigued physicians has an answer according to an article published in May 2017 in the Journal of Bone and Joint Surgery and is a co-author of a member of the advisory council of the Inequality-adjusted Human Development Index (Putnam et al., 2019). The question is whether the hips should show the first signs of growth before trying to position the new hip into orbit forcefully. The femoral head is total cartilage before the age of approximately six to twelve months, without it being possible to see its bones in the radiography. As the hips develop, the bones form in the middle of the balloon to provide additional support. This bony center is called "ossific nucleus," but the appearance of the ossific nucleus may be delayed when the hip changes

Some doctors believe that the ball of cartilage is softer and more likely to be damaged before the center of the x-ray appears. This caused them to delay the reduction open or open until the child was more significant after the hip had developed the center of the bone. The report recently published in the Journal of Bone and Joint Surgery, however, finally established that the presence of the bone center does not affect the risk of AVN.

The study authors included the results of 21 published articles describing a reduction in hip dislocation. In total, 608 cases were reduced to the presence of bone centers and 969 instances after the occurrence of the center (Putnam et al., 2019).In a previous study, published in 2009, the results were similar, but this report covers four times more patients than the 2009 report. This makes the present study, due to a large number of patients studied, be more reliable.

This means that the closed reduction may continue, if necessary, instead of waiting for the center of the bone to appear on the radiograph. This is good news because early reduction usually produces better hip development. The fact that the ossified nucleus played a role in the risk of AVN is troubling, but the amount of AVN remains very high. IHDI and other researchers are trying to find ways to reduce the risk of AVN, but now we can eliminate the center of the bone as a factor that has cost a lot of time and research costs.

References

Ahmed, N., Sriskandarajah, P., Burd, C., Riddell, A., Boyd, K., Kaiser, M., & Messiou, C. (2019). Detection of avascular necrosis on routine diffusion-weighted whole body MRI in patients with multiple myeloma. The British journal of radiology, 92(xxxx), 20180822.

Couturier, S., & Gold, G. (2019). Imaging Features of Avascular Necrosis of the Foot and Ankle. Foot and ankle clinics, 24(1), 17-33.

Putnam, J. G., DiGiovanni, R. M., Mitchell, S. M., Castaneda, P., & Edwards, S. G. (2019). Plate Fixation With Cancellous Graft for Scaphoid Nonunion With Avascular Necrosis. The Journal of hand surgery, 44(4), 339-e1.

Schmitz, P., Baier, L., Knuttel, H., & Baumann, F. (2018). Search Strategies for an ongoing Systematic Review: Avascular Necrosis of the Femoral Head following an Acetabular Fracture.