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Forum Name: Bone trauma and fractures

Question: avascular nercrosis


 jbelectric777 - Fri Dec 22, 2006 12:58 am

Dear Doctors,
Years ago I consumed alcohol on a daily basis after work (Beer) I stopped from drinking completly after being warned by my Doctor about rising enzyme levels. I guess I consumed beer for about 15 years or so on a regular basis and probably too much I admit. After I refrained from alcohol I was feeling stronger than ever and was actually praised by my PCP for taking such good care of myself. I was working out, lost a ton of weight and just never felt better in my life. After that I was helping my brother move some heavy items into his apartment and I felt a snap of some sort and had very minor pain, so minor I was not even going to go to the hospital but my mother said I had better just in case. So I went to ER and x-rays were taken and at that time the attending radiologist and attending nurse at the ER said I was fine , that it was a mucsle strain and noted is was an unremarkable hip and pelvis , gave me some ALEVE for pain and sent me home. I was so thrilled it wasnt serious and I continued on with my work and life as usual. About 4 to 6 months later I awoke from sleep in the morning and could not walk on that leg. I went to the local hospital where I was living and the ER doctors told me I had a partially healed non displaced fracture (old) which now was infected with nercrosis and collapse , further MRI proved it needed total replacement which I had done a few years back and have nothing but praise for my surgeons top skills. I guess my question is: Why didnt the first hospital just tell me I had a fracture ? And what that could cause, or if there was anything I could do to save my hip. I value your opinion and I thank you for your generous donation of your knowledge. Jim
 Dr. Chan Lowe - Fri Dec 22, 2006 2:49 am

User avatar It is quite possible that the fracture was too small to notice initially when it occurred. Often, if there is suspicion of a fracture, but it cannot be seen on x-ray, the films can be repeated in about a week. By that point a callous will have formed where the fracture was, allowing it to be seen.

If in that week's time, the symptoms resolve, often the films are not repeated. Without being able to see the fracture on the initial films, it is often much more likely to be a muscular problem.

The avascular necrosis is a known, but not frequently seen, outcome with fracture of the femoral head and neck.

In terms of what could have been done to prevent this, there isn't much, unfortunately. If the fracture were identified the doctors may have wanted to follow you a bit more closely for the possibility of this complication; however, it sounds as if your symptoms occurred quite quickly, so even knowing a fracture had been present would likely have not caused anyone to be concerned enough to have looked for developing avascular necrosis.

Hope this helps.
 rjaacc - Sat May 09, 2009 7:50 am

In November 2008 I had a c-section & tubal. During tubal, iliac artery was nicked. Code-blue, loss too much blood, doctor removed uterus thinking that was where the blood was coming from. Then they noticed artery was cut. Cardiac surgeon repaired artery. Ureter was sewed up in process. I had to wear a bag for 2 weeks to drain kidney. Stint was then put in. Stint removed after approx 6 weeks. Since this ordeal, I have been having pain with my leg on the same side as the problems. The pain is on the left side in my groin area. I have been to several doctors and none can determine the cause of my leg pain. My leg was in so much pain 2 times that I had to use crutches and not put pressure on it for a few days. That seemed to help relieve the severe pain. The pain is becoming more constant instead of getting better with time as doctors are suggesting. I am just hoping someone can give me any ideas of what could be causing this pain and what I can do to fix it. Thank you for any help. I have been to an orthopedic who thought it may be this avascular nercrosis because of the trauma during the surgery, but the MRI proved negative on that. Is it even possible that the surgery could have caused this, or would it have had to been like a fracture to that area to be avascular necrosis? I am just trying to figure out what could be causing this pain. It is getting worse and no one can, or will help me. Any ideas or suggestions of what can be causing this and what I can do. I am starting PT next week to see if it will help, but how long should I do physical therapy to see if it works? What if it does not help? Any help will be greatly appreciated. Thank you in advance for your time.
 Tom Plamondon PA-C - Thu May 14, 2009 11:45 am

User avatar Hello,
It may be worthwhile to check the blood flow status of the fixed iliac artery. Compromised blood flow to any tissue will cause pain.
An MRA and/or arterial doppler study on the iliac and femoral artery may be revealing.
The problem does not sound like a nerve problem -- I would expect numbness with a nerve problem.

Otherwise, examining the sacral illiac joints, the lumbar area, the hip joint itself are all source of hip and groin pain.

Take care and let us know how is goes.

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