sarika
Forum Guru
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its a real life situation
A 35 yrs old female with no prior history of trauma is diagnosed with avascular necrosis of head of femur caused by vasculitis confirmed with MRI and Angiography. History and examination is negative for any associated signs and systemic diseases as well as any prior use of medications. While long term steroids are a well known cause of AVN, can we treat this type of vasculitis-induced-AVN with steroids(since almost all vasculitis is commonly treated with steroids) or should it be contraindiated?
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| MDcooper
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causes of avascular necrosis can be trauma,steroids,coagulation problems or alchohol.Doctors are not very sure how steroids cause avascular necrosis.One theory is increased lipid breakdown that accumulates in the blood vessel and cause ischemia.
A doctor should order an Xray to rule out trauma.If Xray is normal,then MRI is the most sensitive test to diagnose avascular necrosis.
in order to design a proper treatment for avascular necrosis,the doctor must keep 4 points in mind.
1.Pts history
2.pts age
3.stage of disease
4.area involved.
Conservative treatment
A.medicines:aiming towards decrease fatty acid deposition by break down of lipids by steroids,or anticoagulation in pts with coagulation pbs.NSAIDS for pain.
B.weight bearing is limited on affected joint
C.excercises to increase the range of motion
D.electrical stimulation to improve bone growth.
****THESE CONSERVATIVE METHODS RARELY PROVIDE ANY IMPROVEMENT AND PT HAS TO MOVE ON TO SURGERY EVENTUALLY.
surgical options are
1.core decompression(usually in early disease)
2.osteotomy
3.bone graft
4.total joint replacement
I dont think sarika steroids are ever used in the treatment of avascular necrosis.They sure are a culprit.I hope it helps.
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| ssrpk
Forum Fanatic
Topics: 154
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hey nice description MDCooper!
yeah i agree, steroids are definitely out! maybe immunosuppressants help, not sure though!
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