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Avascular necrosis (AVN), also called osteonecrosis or bone infarction, is death of bone tissue due to interruption of the blood supply. [1] Early on, there may be no symptoms. [ 1 ] Gradually joint pain may develop, which may limit the person's ability to move. [ 1 ]
[3] [5] The third (middle finger) metacarpal head has been reported to be the most common site of necrosis. [6] Though osteonecrosis is a fairly common condition, many cases of avascular necrosis of the metacarpal head go without being diagnosed. This is because presentation of symptoms is variable depending on the patient.
More evidence is needed to assess the use of antibiotics prior to treatment and the use of wound closure to prevent contamination of the bone, as the quality of evidence evaluated was low. [ 49 ] Patients may be advised to limit alcohol consumption, stop smoking, and practice good dental hygiene.
Treatment options have been explored; however, severe cases of ONJ still require surgical removal of the affected bone. [3] A thorough history and assessment of pre-existing systemic problems and possible sites of dental infection are required to help prevent the condition, especially if bisphosphonate therapy is considered.
Preiser disease, or avascular necrosis of the scaphoid, is a rare condition where ischemia and necrosis of the scaphoid bone occurs without previous fracture.It is thought to be caused by repetitive microtrauma or side effects of drugs (e.g., steroids or chemotherapy) in conjunction with existing defective vascular supply to the proximal pole of the scaphoid.
To prevent steroid-induced osteoporosis, the steroid dose and duration should be as low and as short as possible. All patients on long term glucocorticoids (≥3 months) should be encouraged to do weightbearing exercise, avoid smoking and excess alcohol and take fall prevention measures. Daily calcium and vitamin d intake should be sufficient.
Oral steroids are at least as effective as intravenous steroids, [29] except in the treatment of acute visual loss where intravenous steroids appear to offer significant benefit over oral steroids. [30] Short-term side effects of prednisone are uncommon but can include mood changes, avascular necrosis, and an increased risk of infection. [31]
Specifically, Kienböck's disease is another name for avascular necrosis [2] (death and fracture of bone tissue due to interruption of blood supply) with fragmentation and collapse of the lunate. This has classically been attributed to arterial disruption, but may also occur after events that produce venous congestion with elevated interosseous ...