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Friday, November 28, 2014

Necrosis Definition

What is necrosis?


The femoral head necrosis or is a disorder that is characterized by a death of a portion of the bony femoral head. The disease is one of the aseptic bone necrosis. Cause is a decreased blood flow, which leads to necrosis. Does this happen in children, the disease is called Perthes disease. The disease occurs especially in humans and domestic dogs.

In adults, the exact causes are not completely clarified, frequently occur femoral head necrosis in diabetes mellitus, alcoholism, and after high-dose (usually systemic) corticosteroid treatment. A longer treatment with anticoagulants may have osteonecrosis result. Femoral head necrosis can occur after injury of the femoral head. This is called post-traumatic femoral head necrosis. Typically, the femoral head after shearing of the femoral head in patients with traumatic dislocation of the hip.

Disease


Without apparent cause, such as an accident, a hip suddenly starts to hurt. The mobility of the joint limits are mostly internal rotation and extension is inhibited. The normal radiograph may reveal no pathological changes, only the study with the MRI shows the changes in the early stages of metabolism in the diseased bone in the first stage. Below the disease progresses further, show up in the still vibrant part of the bone remodeling, the body tries to foreclose the dead part. The necrotic portion of the femoral head eventually collapses, the joint can be hardly loaded.

From this clinical picture differs destructive coxarthrosis rapidly (CDR), which is accompanied by a rapid destruction of the femoral head and the cup within a few months with clinically and diagnostically same appearances.

The femoral head necrosis, however, is mostly a walk over the years, the process that is often detected late.

In the picture is a representation of a femoral head MRI right (left of the observer). A sharply defined district of the bone is swollen edematous, the boundary layer is particularly striking here is the body with the disease process apart. The other hip is normal here, a simple comparison.

Necrosis treatment


Earlier it was mostly trying with little success to eliminate the dead part of the bone to be underpinned with cancellous bone and thus again to achieve a viable femoral head. Furthermore, with even lower expression of necrosis characters in MRI and X-ray examination in younger patients, the vascular pedicle bone graft implantation is still a useful alternative to the joint conservation. Especially in younger patients can be useful if this connection is stable. The leg is then indeed bad move, but fully loaded. Meanwhile, the operational use of an artificial hip joint (prosthesis) is the drug of choice to get back to give the patients a resilient leg. Arthrodesis, so the operating stiffening of the hip joint is today rarely used.

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