A Combined Intracapsular and Extracapsular Fracture of the Hip

2002 ◽  
Vol 12 (1) ◽  
pp. 43-46
Author(s):  
S. Shabat ◽  
G. Mann ◽  
V. Barchilon ◽  
B. Kish ◽  
B. Fredman ◽  
...  
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Blood Supply ◽  
Weight Bearing ◽  
Surgical Techniques ◽  
Optimal Solution ◽  
Anatomical Site ◽  
Rare Type ◽  
Non Union ◽  
Extracapsular Fracture

We report a case of an unusual hip fracture that involved the intracapsular area and continued vertically to the extracapsular region below the trochanteric line. The division between these two types of fractures is based on the anatomical site, the blood supply and the mechanical forces that act on the hip. This division is important and influences the different surgical techniques to treat these individual fractures. Femoral neck fractures (intracapsular), particularly those with displacement, can disrupt the blood supply to the femoral head and may be associated with an increased incidence of complications, especially non-union and avascular necrosis (AVN) of the femoral head. These fractures are usually treated either by reduction and fixation, or by hemiarthroplasty. Non-union and avascular necrosis following extracapsular fractures are rare. Treatment involves reduction of the fracture and insertion of a dynamic hip screw. The combination of these two types of fractures is extremely rare and creates a surgical problem without any optimal solution. The focus of this case report is placed on the mechanical axis and weight-bearing forces that play a role in the hip and on the optional surgical techniques in such a rare type of fracture in an elderly osteoporotic patient.

scholarly journals Corticosteroid induced avascular necrosis and COVID-19: The drug dilemma

2021 ◽  
Vol 11 (3) ◽  
pp. 1049-1052
Author(s):  
Indrajit Banerjee ◽  
Jared Robinson ◽  
Brijesh Sathian
Keyword(s):  
Adverse Effect ◽  
Femoral Head ◽  
Avascular Necrosis ◽  
Steroid Therapy ◽  
Case Reports ◽  
Weight Bearing ◽  
Inflammatory Cells ◽  
High Dose ◽  
Intraosseous Pressure ◽  
Femoral Head Osteonecrosis

The severe and life-threatening nature of the COVID-19 infection, the ARDS (acute respiratory distress syndrome) as well as the cytokine storm induced by the infection, commands lifesaving high doses of steroid therapy. As in all pharmacological therapies adverse effects are present. One such adverse effect which is being reported is corticosteroid induced avascular necrosis of the femoral head/ osteonecrosis of the femoral head. It must be noted that AVN principally affects the femoral head and most commonly the anterolateral aspect thereof as it is the crux of weight bearing.  Corticosteroids induce fat mobilization and this thus innately enhances the likelihood of fat emboli developing from the liver to occlude minor blood vessels in the femur, this thereby compromises the microvascular environment. Superadded to this the steroid therapy disrupts calcium metabolism and homeostasis which induces hypertrophy in the intramedullary fat cells, Gaucher cells and inflammatory cells; whilst increasing the activity of osteoclasts, thus increasing bone resorption and decreasing calcium uptake and deposition; ultimately leading to an insufficiency in the trabecular and cortical bone. This insufficiency thus equates to an increased intraosseous pressure which impedes intramedullary circulation and results in avascular necrosis.  It is evident that avascular necrosis is directly caused by high dose steroid therapy, however the case reports have very clearly indicated that the rapid onset of AVN post recovery from the COVID-19 infection cannot be solely attributed to steroid therapy and that another benefactor induced by the COVID-19 infection is at play. It is thus vital for treating physicians to take cognisance of this adverse effect post recovery and therefore should ensure that prophylactic bisphosphonate therapy is initiated timeously and congruently.

scholarly journals Tissue Engineering Strategies for Treating Avascular Necrosis of the Femoral Head

2021 ◽  
Vol 8 (12) ◽  
pp. 200
Author(s):  
Sumit Murab ◽  
Teresa Hawk ◽  
Alexander Snyder ◽  
Sydney Herold ◽  
Meghana Totapally ◽  
...  
Keyword(s):  
Tissue Engineering ◽  
Stem Cells ◽  
Femoral Head ◽  
Avascular Necrosis ◽  
Hip Replacement ◽  
Surgical Techniques ◽  
Significant Activity ◽  
X Rays ◽  
Early Stages ◽  
Surgical Methods

Avascular necrosis (AVN) of the femoral head commonly leads to symptomatic osteoarthritis of the hip. In older patients, hip replacement is a viable option that restores the hip biomechanics and improves pain but in pediatric, adolescent, and young adult patients hip replacements impose significant activity limitations and the need for multiple revision surgeries with increasing risk of complication. Early detection of AVN requires a high level of suspicion as diagnostic techniques such as X-rays are not sensitive in the early stages of the disease. There are multiple etiologies that can lead to this disease. In the pediatric and adolescent population, trauma is a commonly recognized cause of AVN. The understanding of the pathophysiology of the disease is limited, adding to the challenge of devising a clinically effective treatment strategy. Surgical techniques to prevent progression of the disease and avoid total hip replacement include core decompression, vascular grafts, and use of bone-marrow derived stem cells with or without adjuncts, such as bisphosphonates and bone morphogenetic protein (BMP), all of which are partially effective only in the very early stages of the disease. Further, these strategies often only improve pain and range of motion in the short-term in some patients and do not predictably prevent progression of the disease. Tissue engineering strategies with the combined use of biomaterials, stem cells and growth factors offer a potential strategy to avoid metallic implants and surgery. Structural, bioactive biomaterial platforms could help in stabilizing the femoral head while inducing osteogenic differentiation to regenerate bone and provide angiogenic cues to concomitantly recover vasculature in the femoral head. Moreover, injectable systems that can be delivered using a minimal invasive procedure and provide mechanical support the collapsing femoral head could potentially alleviate the need for surgical interventions in the future. The present review describes the limitations of existing surgical methods and the recent advances in tissue engineering that are leading in the direction of a clinically effective, translational solution for AVN in future.

scholarly journals ROLE OF PANCHTIKTA KSHIRA BASTI IN MANAGEMENT OF AVASCULAR NECROSIS: A CASE STUDY

2021 ◽  
Vol 12 (01) ◽  
Author(s):  
Dr Pankaj Sharma ◽  
Dr Pankaj Sharma
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Blood Supply ◽  
Musculoskeletal Disorder ◽  
Bone Cells ◽  
Modern Medicine ◽  
Surgical Operation ◽  
Bone Necrosis

Avascular necrosis additionally referred to as osteo-necrosis or Ischemic bone necrosis is a condition that occurs when there is a loss of blood supply of bone. An interruption in the blood supply causes bone cells to die. AVN of femoral head is that the commonest sort of necrosis affecting the bone. In Ayurveda, It correlated with asthimajjagata vaat (musculoskeletal disorder). An effort has been made within the present study to gauge the efficacy of panchtikta kshir basti in conservative management of femoral head necrosis of the bone. In Modern medicine, no any unique remedy as opposed to surgical operation is available.

scholarly journals Neuromuscular Electric Stimulation Versus Traditional Treatment on Harris Hip Score in Cases of Avascular Necrosis of Femoral Head After Kidney Transplantation

2021 ◽  
Vol 11 (3) ◽  
pp. 181-188
Author(s):  
Manal Youssef ◽  
Keyword(s):  
Kidney Transplantation ◽  
Femoral Head ◽  
Avascular Necrosis ◽  
Public Transportation ◽  
Electric Stimulation ◽  
External Rotation ◽  
Weight Bearing ◽  
Harris Hip Score ◽  
Traditional Treatment ◽  
Strengthening Exercises

Purpose: Usually, about 25% of the patients treated with corticosteroids after kidney transplantation suffer from the complication of Avascular Necrosis (AVN) of the femoral head. This study aims to compare the effect of Neuromuscular Electric Stimulation (NMES) and traditional treatment (infrared and decrease weight-bearing) on Harris hip score. Methods: Twenty patients who developed AVN of the femoral head after kidney transplantation were divided into two groups. The first group was treated by NMES and stretching and strengthening exercises 3 sessions a week for 3 months. The second group was treated by Traditional Treatment (TT) and stretching and strengthening exercises 3 sessions a week for 3 months. Results: Harris hip score component was measured before the intervention and then three months after the intervention using the t-test. After the intervention, significant differences were found between both groups in pain, support, distance walked, limping, putting on shoes and socks, climbing stairs, sitting, flexion (all P<0.001), external rotation (P=0.014), abduction (P=0.030), adduction (P<0.001), public transportation (P=0.010), and total hip score (P<0.001). Conclusion: TT exercises accompanied by NMES were more effective than TT alone for AVN of femoral head patients and could stop the progressive worsening of hip joint mobility.

scholarly journals AYURVEDIC INSIGHTS OF AVASCULAR NECROSIS OF FEMORAL HEAD

2021 ◽  
Vol 9 (07) ◽  
pp. 51-54
Author(s):  
Surendra Kumar ◽  
◽  
Gopesh Mangal ◽  
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Blood Supply ◽  
Direct Reference ◽  
Femur Head ◽  
Middle Aged ◽  
Bone Necrosis ◽  
Aged Population ◽  
Necrosis Of Femoral Head

Avascular necrosis of the femur head (AVNFH) is a debilitating disease caused due to the use of alcohol, steroids, following trauma or unclear (idiopathic) etiology, affecting mostly the middle aged population. Clinically AVNFH is associated with impaired blood supply to the femoral head resulting in bone necrosis and collapse.In Ayurveda, there is no direct reference of disease resembling to Avascular necrosis of femoral head, hence it can be understand on the basis of Vikaraprakriti of disease caused by vitiation of Dosa, Adhisthana (abodesite) and Hetu (causes of vitiation of Dosa). In the present study an effort has been made to understand AVN on the ground of Ayurveda.

Legg–Calve–Perthes disease

2011 ◽  
Author(s):  
Colin Bruce
Keyword(s):  
Femoral Head ◽  
Natural History ◽  
Avascular Necrosis ◽  
Blood Supply ◽  
Poor Prognosis ◽  
Management Strategies ◽  
Current Treatment ◽  
Perthes Disease ◽  
Treatment Methods ◽  
History Of

♦ Avascular necrosis of the femoral head initiated by unknown factors is followed by gradual restoration of blood supply and regeneration♦ Current treatment methods aim to prevent development of an aspherical and incongruent femoral head and acetabulum♦ Treatment should be offered to the child with a poor prognosis so that the natural history of the condition can be improved: identification of such cases is difficult♦ Early and late management strategies differ significantly.

scholarly journals A retrospective study of avascular necrosis of the femoral head in dogs in Delta State, Nigeria

2021 ◽  
Vol 19 (3) ◽  
pp. 208-216
Author(s):  
E.A. Uwagie-Ero ◽  
C.N. Abiaezute
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Hind Limb ◽  
Weight Bearing ◽  
Radiographic Appearance ◽  
Study Results ◽  
High Prevalence ◽  
Management Approaches ◽  
The Right

The study evaluated the prevalence of avascular necrosis of the femoral head in dogs in Delta State, Nigeria. For ten years, data of cases presented to Veterinary Clinics in five government clinics in Delta state were evaluated and analysed. The breed of dog, sex, age on presentation, the limb affected and the radiographic appearance of the lesions on presentation were reviewed. The treatment and clinical management approaches were also reviewed and discussed. Of the cases of avascular necrosis of the femoral head recorded (N = 24) for the period under review, breed prevalence recorded 62.5% (Alsatians); 16.67% (Caucasians) and 20.83% (Mixed Breeds). Sex prevalence recorded 79.17% females and 20.83% males. According to age at the time of the first presentation, 83.83% of the affected dogs were 6-12month old, 12.5% were 13-24month old, and 4.16% were 25–36 month-old. Lameness was observed in 91.67%, while 8.33% of cases presented non-weight bearing lameness. Pain in the limbs during palpation of the hip joint was detected in 100% of the cases. Atrophy in the hind limb was identified in 41.66% of the patients, while 62.5% of the dogs showed different degrees of medial patellar luxation. In 91.6% of cases, the disease was unilateral, with 63.63% unilateral lesions in the right hind limb and 36.37% in the left hind limb. The study results showed a high prevalence of avascular necrosis of the femoral head in large breeds of dogs in the Delta state. The management of the disease is mainly conservative with poor follow-up. Cost of surgery and management may discourage owners from follow up. However, surgery remains the gold stand of care for managing avascular necrosis of the femoral head in dogs.

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