جستجوی مقالات مرتبط با کلیدواژه "avascular necrosis" در نشریات گروه "پزشکی"

This study aimed to determine the prevalence of avascular necrosis of the femoral head in COVID-19 patients receiving corticosteroids at Baqiyatallah Hospital.

In this cross-sectional study, COVID-19 patients who have received corticosteroids and at least six months have passed since receiving corticosteroids were contacted, and they were contacted about any pain in the area. Hip pain, lameness, and movement restrictions were assessed. If the patient had a suspicious history, we invited them to undergo an MRI.

The findings of this study showed that the prevalence of avascular necrosis is 9.2%, and none of the variables of age, sex, body mass index, dose of prednisolone, or remdesivir have a suitable predictive role in the occurrence of this complication (P<0.05).

The study's findings showed that steroid treatment in COVID-19 is valuable. However, the adverse effects of this treatment are very severe. High-dose steroid therapy causes avascular necrosis, but case reports clearly show that steroid therapy cannot fully account for the rapid onset of avascular necrosis after recovery from COVID-19 infection, although it is a contributing factor.

Kienböck disease is a rare condition characterized by severe pain and restricted wrist movement. Variouspalliative methods have been proposed as therapeutic strategies for alleviating symptoms. Mesenchymal stromal cell transplantationhas been suggested as an innovative and promising approach due to its potential for inducing regeneration andimmunomodulation in the necrotic tissue. This study aims to evaluate the safety of autologous bone marrow derivedmesenchymal stromal cells (BM-MSCs) transplantation after core decompression in Kienböck disease. In this phase I of an open-label clinical trial, three patients (one female and two males) withstage 2 Kienböck disease underwent autologous BM-MSCs transplantation following lunate core decompression. Thepatients were followed up for six months to assess safety as well as secondary clinical outcomes, including pain level,range of motion (ROM), and functional disability. Safety of BM-MSCs injection following the core decompression was evaluated by recording post-treatmentcomplications during the six-month follow-up. No adverse events (AEs) or severe AEs (SAEs) were reported, indicatingthat BM-MSCs injection after core decompression is a safe intervention. All patients showed a remarkable reductionin visual analog scale (VAS) scores and "Disabilities of the Arm, Shoulder, and Hand" (DASH) questionnaire scores,suggesting the therapeutic potential of this intervention. Moreover, an increase in the ROM indicated that BM-MSCstransplantation can improve wrist functionality. Additionally, radiographic assessments before and after cell infusiondemonstrated a reduction in lunate sclerosis after six months of follow-up. The transplantation of autologous BM-MSCs following lunate core decompression seems to be a safeclinical intervention and may lead to pain relief in patients with Kienböck disease. Furthermore, this procedure may helpprevent disease progression during the follow-up period (registration number: NCT02646007).

Avascular necrosis of the femoral head typically occurs in the young population. Core decompression in the precollapse stage provides pain relief and preservation of the femoral head. The results of core decompression vary considerably despite the early diagnosis. Clinicians concur that primary treatment should focus on preserving the natural surface of the joint. This study investigated the predictive risk factors of failure in femoral head decompression. We retrospectively reviewed 135 patients and 207 hips (77 male (127 hips) and 58 female (80 hips)) who underwent core decompression (mean age: 34.7 years [age range: 21-71]) from April 2010 to December 2017. All patients were followed by a mean of 57 months. All hips were in the precollapse stage (Ficat I, II).  A total of 207 hips were treated with core decompression surgery, and the overall success rate was 58%. The higher grade of Kerboul, Ficat, ARCO classifications, multifocal avascular necrosis of the femoral head, smoking, opium, and corticosteroids were significantly associated with a higher failure rate after core decompression in univariate analysis. In multivariate logistic regression analysis, the Kerboul and Ficat classifications, alcohol consumption, and multifocal avascular necrosis of the femoral head were significantly correlated with core decompression failure. The most common predictive factors in core decompression failure were Ficat II, Kerboul stage 3, multifocal avascular necrosis of the femoral head, and alcohol consumption.  In conclusion, we had an overall 58 % success rate in core decompression of femoral head avascular necrosis. Based on the results of this study, imaging evaluation and imaging-based classifications are the most valuable predictor factors for the success of core decompression. Consistent with previous reports, corticosteroid was not a significant predictor of core decompression failure.Level of evidence: III

We report a case of a 40-year-old man who presented with left shoulder pain and marked functional impairment two days after receiving the second dose of the Pfizer COVID-19 vaccine. Advanced imaging demonstrated focal avascular necrosis (AVN) of his humeral head. Initial management included simple analgesics, activity modification, and an ultrasoundguided intra-articular hydrodilatation injection. The patient subsequently had an improved range of motion but persistent severe shoulder pain. He has now been offered surgical intervention. Despite having risk factors for developing AVN previously, the patient did not demonstrate any recent risk factors for developing the disease. COVID-19 vaccination is known to cause severe joint pain and stiffness rarely. However, avascular necrosis is not a known or documented side effect. His symptoms arose directly after the administration of the vaccine, with no other demonstrable cause. Therefore, we are reporting COVID-19 vaccination as a potential new risk factor for AVN of the humeral head.Level of evidence: V

Avascular necrosis(AVN), known as osteonecrosis, aseptic necrosis, or ischemic bone necrosis, results in the destruction of bone cells. In the present study, we aimed to report the most common causes of AVN in in patients referred to Isfahan educational and medical centers.

This study is a cross‑sectional study that was performed on all patients with AVN in medical educational centers in Isfahan during 2019 and 2020. We included all patients diagnosed with AVN. Patients’ information including age, sex, cause of femoral head necrosis, medical history, and drug usage were collected. Finally, reliable data from 99 patients were recorded.

We collected data of 99 patients in this study. The most prevalent cause of ANV was corticosteroids use (32.3%), and it was more prevalent among women (51.4%); the second prevalent cause of AVN in our study sample was trauma (28.28%), and it was more prevalent among men (32.8%).

The most common cause of AVN was corticosteroids, which was consistent with previous studies. Other main causes of AVN were traumatic or idiopathic issues.

Avascular necrosis of the lunate or Kienböck‎ disease is a rare disorder with unknown etiology and challenging treatment. 

In this study, we evaluated the effects of local deferoxamine injection as an angiogenic molecule and core decompression to treat Kienböck‎ disease.

In a pilot clinical trial, 8 patients with stage I to IIIA of Kienböck‎ disease were treated with core decompression and local deferoxamine injection (0.5 mL 500 mg/mL). The outcome measures included wrist range of motions, pinch and grip strength, patient-rated ‎wrist/hand evaluation (PRWE), a short form of disabilities of the arm, shoulder, and hand (Quick-DASH), and visual analog scale (VAS) for pain. The assessment of lunate revascularization was also done by T1- and T2-weighted magnetic resonance imaging. All measurements were done before the intervention and 3, 6, and 12 months after the intervention.

Wrist flexion, extension, ulnar and ‎radial deviation, and pinch and grip strength were continuously improved over the postoperative periods. These improvements were statistically significant. The mean final pinch and grip strength averaged 87.4% and 72.8% of the non-involved hand, respectively. PRWE, Quick-DASH, and VAS scores were also continuously and significantly improved over the study period. The lunate vascularization revealed a continuous improvement in 6(75%) patients.

Local deferoxamine injection in addition to core decompression could improve the radiologic and clinical outcomes of patients suffering from Kienböck‎ disease.

Avascular necrosis(AVN) of multiple carpal bones is a very rare condition. This case report presents a patient with concomitant AVN of the lunate and proximal pole of the scaphoid that had led to severe joint space narrowing and degenerative arthritis in the radiocarpal and distal radioulnar joints (DRUJs). She was known to have thalassemia minor hemoglobinopathy. Wrist arthrodesis and distal ulna hemiresection‑interposition arthroplasty (Bowers technique) for a DRUJ were offered and performed. The patient was satisfied with the clinical outcomes.

The avascular necrosis (AVN) of the femur head due to the death of the osteocytes of the bone marrow occurs because the organ is not supplied with sufficient blood. The prevalence of the problem is 10%-50% in adults. The etiology of the disease includes various factors such as trauma, cigarette smoking, drinking spirits, taking corticosteroids, genetics, metabolic disorders, human immunodeficiency virus, pregnancy, and the like. The treatment of necrosis can be conducted regarding the degree of the problem. In the present paper, a case was reported whose femur head necrosis was treated by applying Iranian Medicine without using common drugs in modem Medicine. The patient was a 46-year-old man who had felt severe pain in his left hip since a month before referring. The pain had gradually increased and the AVN of the femur head was diagnosed after magnetic resonance imaging. Finally, the surgery and arthroplasty of the femur head were recommended in this regard. In general, surgery and arthroplasty were recommended regarding the hard medicinal and complicated treatment of the AVN of the femur head. However, it is noteworthy that applying Iranian medicine capacities is possible for curing the disease.

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.

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. 

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).

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.

Core decompression is one of the commonest used techniques in the handling of osteonecrosis of the pre-collapsed head of the femur. Core decompression had succeeded in preserving the hip joint and delaying the requisite for total hip replacement, but it had failed in the induction of osteogenesis in the necrotic area, thus augmenting core decompression with biological agents to induce osteogenic activity. To assess the effects of platelet-rich plasma in non-traumatic avascular necrosis of the hip joint (early stage) after core decompression. Interventional comparative study for twenty-four patients (32 hip joints) with AVN of the head of the femur was involved in this prospective study, and they were separated into two groups of 16 hips, group (A) treated by core decompression and PRP injection and group (B) treated by core decompression alone. There was a significant statistical difference in Harris Hip Score and Visual Analogue of the two groups at six months follow up (P<0.05), but this difference was insignificant statistically at 12 months follow up. The radiological success was better in the group (A) as compared to group (B) (13 of 16 versus 10 of 16 hips). The addition of PRP to core decompression for pre-distorted stages of the head of the femur had resulted in improved pain alleviation and functional results and had slowed the disease progression in the one year of follow up.

Special attention is needed to assess constant wrist pain to avoid missed carpal bone fractures subsequent to traumatic events. Also, the consideration of avascular necrosis of carpal bones such as scaphoid bone after a traumatic or stress fracture is very important. We hereby report a young elite wrestler who has been complaining about pain in his both wrists for about two years before his visit to our clinic. The interesting point about this athlete is bilateral involvement and that the second pathology was probably overuse without any trauma.

Traumatic dislocation of the hip is rare in children. Complications occur in cases with associated injuries and delayed treatment. Treatment options are limited in case of avascular necrosis. In this paper, we present the case of a 6-year-old girl who was unable to walk for the last 3 months. She had a traumatic hip dislocation at the age of 18 months, which was treated with a 48-hour delay. With the diagnosis of femoral head AVN, a femoral head reduction osteotomy was planned. 3D-models were printed, and the surgery was simulated on the models. The patient is now walking painless and with minimal limp. A femoral head reduction osteotomy, with some small modification, can be performed in children as young as 6-years old. 3D-modeling is a great addition to the tools a surgeon can use, in the preoperative planning of difficult osteotomies, as well as education of the residents and fellows.

There is no concrete information about many aspects of femoral fracture, including its best management. We hypothesized that reporting the outcomes of patients managed with the same therapeutic algorithm would help the selection of best management strategies. 

In this study, we report the outcomes and complications of femoral head fracture in patients treated according to our therapeutic algorithm.

In a retrospective review of a prospectively collected orthopedic database, 41 patients with femoral head fractures were evaluated. Fractures were classified by the Pipkin classification system. The clinical outcome was assessed with the Harris Hip Score (HHS). In brief, our therapeutic algorithm included conservative treatment for the congruous joint of Pipkin type I and II, total hip arthroplasty for unfixable fractures of Pipkin type III, and IV, and fixation via three approaches otherwise (Smith-Peterson, Kocher, or surgical dislocation).

Of 41 cases, 34 cases (82.9%) had uncomplicated outcomes. The number of associated injuries was significantly more in patients with complicated outcomes (P=0.049). Avascular necrosis was the most common complication (n=5, 12.2%). Their Mean±SD HHS was 85.1±109. Accordingly, HHS scoring had poor, fair, good and excellent results in 4 (9.8%), 6 (14.6%), 13 (31.7%), and 17 (41.5%) patients, respectively. The mean HHS score was significantly lower in patients with complicated outcomes (P=0.007). The mean HHS score was not associated with types of fracture (P=0.071).  

The outcome of femoral head treatment was good to excellent in the majority of patients. However, patients who underwent total hip arthroplasty or had associated injuries are at higher risk of an inferior outcome.

No consensus regarding optimal treatment or etiology of Preiser disease exists. We described the epidemiology,classification and treatment characteristics of 18 patients with Preiser disease. Patients with changes related to previoustrauma, and without radiographs were excluded. Based on the radiographs at diagnosis, we classified 13 scaphoids asHerbert Lanzetta stage II, four as stage III, and one as stage IV. In 12 patients nonspecific treatment was offered andonly two patients received surgical treatment. We found that chosen treatment is not associated with the severity ofHerbert Lanzetta stage and the outcome is not influenced by chosen treatment.Level of evidence: I

Avascular necrosis of the femoral head (AVNFH) is a leading cause of end-stage joint disease in the young populationthat can lead to total hip replacement in early life. There are various risk factors, including trauma, corticosteroids,thrombosis, hypertension, and alcohol. There is a growing number of patients with AVNFH and history of self-medicationwith herbal supplement used for weight gain in Iran. The present study aimed to demonstrate the prevalence rate ofusing unapproved weight gain supplements (UWGS) in patients with AVNFH.An observational and cross-sectional study was conducted to estimate the prevalence rate of using UWGSs in patientswith osteonecrosis at Imam Khomeini Hospital, Tehran, Iran, from January 2012 to 2018. The data were analyzed inSPSS software (version 24) through descriptive statistics and tests of means.Out of 207 patients with AVNFH, 115 cases were male. In total, 44 patients (20.95%) had a history of using UWGSs,and there had no other risk factors of osteonecrosis of FH.In conclusion, UWGSs can be a risk factor for AVNFH, and it is necessary to develop educational programs to alertyoung population about the side effects of these supplements.Level of evidence: III

Avascular necrosis (AVN) is very rare in capitate bone. It mostly occurs due to direct trauma to wrist. However, it could also occur as the result of disturbed blood supply due to repetitive micro-trauma in rare cases. Case Report: In this report, a 30-year-old man who was an air compressor jack hammer worker with chronic wrist pain was presented. Imaging revealed a low-signal intensity lesion on T1-weighted which supported AVN of capitate. Blood supply damage was due to continuous stress to palmar hand as the consequence of working with air compressor jack hammer which led to AVN of capitate. AVN of capitate could occur as the result of repetitive micro-trauma. It has a high correlation with the job of patients. Radiography does not help in the first stages. Magnetic resonance imaging (MRI) has high diagnostic sensitivity. In the primary stages in patients with occupation-induced AVN, it could be improved by changing the job and temporary immobilization.

More than 20,000 people annually develop avascular necrosis (AVN) worldwide, most of whom aged 20 to 50 years, and should refer to orthopedic surgeons for treatment. The quality of life of such patients is low due to chronic pain and sometimes they are deprived of their occupation and social life.

A 57-year-old male patient who developed AVN due to long-term treatment with corticosteroids and their complications was significantly recovered following EPT therapy in a three-year follow-up. Regarding the correlation between chronic diseases and SDH, to treat such patients, improve their quality of life, and help them back normal life, safe complementary therapies, such as bioresonance, are recommended.

Avascular necrosis (AVN) of the femoral head is an increasingly common cause of musculoskeletal disability with unknown etiology. Traumatic and non-traumatic factors can be effective in its occurrence. About 50% of cases are bilateral. The underlying treatment is prosthetic replacement surgical procedure.
We report a case of bilateral AVN of femoral heads who was a candidate for prosthetic replacement surgery but improved significantly, using laser acupuncture. The patient was a 55-year-old woman with a diagnosis of bilateral osteonecrosis of the femoral head for five years. As the patient declined the surgical option, laser acupuncture was started for pain control. Regarding the signs of bilateral femoral head recovery (according to the MRI scan criteria), a total of 3 courses of laser acupuncture (each course was 20 sessions) with 2 months intervals was performed. Ten acupuncture points: Li4, Li11, St36, SP6, LIV3, GB4, GB5, GB6, GB13, GB14, GB20, GB30, GB31, GB34, were irradiated bilaterally using red 650 nm laser, 100 mW, 1505 Hz frequency, duty cycle 50 3 J/point and near infrared 810 nm laser, 100 mW, 1705 Hz frequency, duty cycle 50 3 J/point, for 2 minutes. The patient received 3 laser therapy courses. During the first-course, laser therapy was done every other day to reduce pain. For the second and third courses, according to pain decrease, therapy was done every week.
The results of the MRI scans and x-ray studies show progressive regeneration of the right femoral head from VI to B II and of the left from V to C II (based on the standard table of Pennsylvania).
It seems that this procedure may be mentioned in future research projects, especially in cases with high risks of surgery.

Fractures of the scaphoid are the most common fractures of the carpal bones. Because of the distal perfusion of the bone, there is a great chance to present complications such as avascular necrosis, delayed union of the fracture and subsequently, early osteoarthritis (up to 32%). For those reasons, the treatment of scaphoid fractures remains a challenge. Pulsed electromagnetic fields (PEMF) have been used for decades as an alternative option in delayed bone healing fractures with good results. However, to the best of our knowledge, there are scarce reports, if any, on scaphoid fractures. The objective of this case report was to show delayed union fracture as a common complication of scaphoid fracture and to postulate PEMF as an effective treatment option for such a condition, reflected by our clinical and radiological evaluations and supported by a thorough review of the literature. The patient received 20 sessions of PEMF, using the QS Magneto therapy device®, with a dose of 20Hz-50Gauss-20 minutes, 5 times a week for 4 weeks. PEMF could recover delayed nonunion of scaphoid fracture and decreased pain as evaluated clinically and radiologically in our case report.