mani
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whats the most common cause of Avascular necrosis:
1. idiopathic
2. trauma
3. thrombosis
4. steroids
5. gaucher's disease
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| santaclara
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i think trauma.
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| santaclara
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i think trauma.
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| hiwa
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I agree Trauma
in fructure neck of femur
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| mdwannabe
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I d say... long term Corticosterois use...since it is one of the most often use meds.
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| mani
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i too think that its trauma but BRS says its idiopathic
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| mdwannabe
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35% on non-traumatic AVN is caused by Steroids...the question remains.what % of total is it?
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| Gul
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i searched internet too and wherever i read, it had trauma being mentioned first..
CONDITIONS ASSOCIATED WITH AVASCULAR NECROSIS
DEFINITE ASSOCIATION :
FRACTURE OF FEMORAL NECK
HIP DISLOCATION
DECOMPRESSION SICKNESS
SICKLE CELL DISEASE
RADIOTHERAPY
GAUCHER'S DIS.
CORTICOSTEROID HIGH DOSE THERAPY
POSSIBLE ASSOCIATION:
SLE
RENAL TRANSPLANTATION
POLYCYTHEMIA VERA
CUSHING SYNDROME
DIABETES MELLITUS
ATHEROSCLEROSIS
CYTOTOXIC CHEMOTHERAPY
ALCOHOL ABUSE
FATTY LIVER
PSORIAIS
PANCREATITIS
PANCREATIC CA.
GOUT
PLZ. DO TELL ME ABOUT SLE MECH. IS IT THE VASCULITIS?
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| mani
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yes gul, vasculitis seems only possibility. any other ideas?
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| rida
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GUYS, this questions was on my test, but trauma was not one of the choices. The only one that made sense was glucocorticoids, so thats what i had put, hope i was right???
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| mdwannabe
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it was right..no worries :-)
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| rida
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thanx!!!!
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| shawky2005
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the trauma is the most important cause of AVN ....
and see the following article
http://www.emedicine.com/radio/topic70.htm
and this is the most important part
Conditions associated with AVN
Trauma
Trauma is the most common cause of AVN. AVN can occur within 8 hours after traumatic disruption of the blood supply. The superior retinacular vessels and the nutrient artery can be damaged as they enter the femur. The artery of the ligamentum teres (ALT) also may be damaged. Intracapsular hematoma increases intracapsular pressure, which can cause tamponade of the vessels within the joint capsule.
Intertrochanteric and extracapsular fractures of the femur rarely develop AVN. Following hip dislocation, circulation is interrupted because of tears of the ligamentum teres, tearing the ALT. Tearing of the joint capsule compromises the vessels within the capsular reflections. AVN following subcapital fractures of the femur can develop as late as 10 years after fracture.
Alcoholism
Alcohol may have a toxic effect on osteogenic cells. The direct toxic effect of alcohol results in fat deposition in the liver. Livers with fat deposits are a constant source of low-grade asymptomatic fat emboli. Intraosseous fat emboli become hydrolyzed to free fatty acids, which cause endothelial damage. Alcohol intake exceeding 40 mL per week increases the risk of AVN more than 11 times compared to the risk in nondrinkers. A clear dose-response relationship exists.
Steroid use
Six possible mechanisms may be present.
Occlusion of small vessels occurs related to fat emboli from the liver.
Increased intraosseous pressure results from a steroid-related increase in the size of the intramedullary fat cells without an equivalent compensatory loss of trabecular and cortical bone.
Fat emboli become hydrolyzed to free fatty acids, which are toxic to vascular endothelium, causing intravascular coagulation.
Angiogenesis is inhibited by a reduction of proteolytic activity by the synthesis of polyclonal antithyroid hormone receptor alpha-1 antibody (PA).
A direct toxic effect occurs on osteogenic cells.
Steroid use causes conversion of hematopoietic marrow to fatty marrow, a prerequisite for the development of AVN. The conversion may be related to steroid-induced reduced blood flow.
Steroid exposure threshold is approximately 2000 mg of prednisone administered continuously. However, AVN has been described following lower doses. The risk of AVN is greater risk in patients treated for a short duration (6 wk) with high doses (>20 mg). However, the risk of AVN in low-dose steroid therapy is controversial. Studies both link such therapy to the disease and refute the role of such treatment. High doses of steroids administered within a relatively short period are more of a causative factor than cumulative dose or duration of therapy.
AVN can occur up to 3 years following cessation of therapy. Steroid-induced AVN is more severe than AVN caused by other conditions because underlying demineralization and accelerated osteolysis place the weightbearing surface of the femoral head at increased risk of collapse.
Individuals with systemic lupus erythematosus (SLE) and renal allograft recipients treated with steroids have the highest incidence of AVN. In renal transplantation, a high association exists between AVN and prednisone doses greater than 100 mg/d within the first month following transplantation. AVN is uncommon in transplant recipients taking less than 100 mg/d. Risk is increased of underlying bone changes associated with chronic renal disease, such as hypophosphatemia. Reducing renal bone disease with better dialysis (increasing ionized calcium in the dialysate) and medical management significantly reduces the incidence of AVN. A delay in diagnosis may occur because of pain reduction provided by concurrent administration of steroids.
In systemic lupus erythematosus, AVN is the dominant orthopedic problem in patients with SLE. Patients with SLE with vasculitis and Raynaud syndrome are at higher risk for developing AVN. Patients usually are younger and have more active disease with multiple organ involvement.
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| hiwa
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Long term srerion use is the answer according to BSS
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| asmi
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Wow good discussion guys 
I too think trauma is the MCC
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| mani
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thanx asmi
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| ahmedshaheen_2002
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idiopathic
I get it from BRS pathology
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| bozhenka
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Cecil: In adults, the most common cause are ethanol abuse and long term glucocorticoid therapy, both of which demonstrate dose dependent effect
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| mdwannabe
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Here we come back to the controversy... as I said before, I think it is steroid use. But some books maintain that it is trauma.. I guess the age difference may play a role... In elderly trauma may be MCC .. in younger adults and kids .. steroids.
Hows that sound? :-)
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| asmi
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"mdwannabe" wrote:
Here we come back to the controversy... as I said before, I think it is steroid use. But some books maintain that it is trauma.. I guess the age difference may play a role... In elderly trauma may be MCC .. in younger adults and kids .. steroids.
Hows that sound? :-)
Sounds good Mdwannabe. Its a tie between steroid and trauma and both stands correct .I finally agree with both .
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