What are the main symptoms of osteonecrosis in the leg. How is osteonecrosis diagnosed and treated. Who is at risk for developing osteonecrosis. What are the long-term complications of untreated osteonecrosis.

Understanding Osteonecrosis: A Comprehensive Overview

Osteonecrosis, also known as avascular necrosis or aseptic necrosis, is a serious condition that occurs when blood flow to a bone is disrupted, leading to the death of bone tissue. This can ultimately result in the breakdown of the bone and collapse of the affected joint. While osteonecrosis can affect any bone in the body, it most commonly develops in the ends of long bones, particularly the femur (thigh bone) and humerus (upper arm bone).

The primary symptom of osteonecrosis is pain, which typically worsens over time. Initially, pain may only be present when bearing weight on the affected joint, but as the condition progresses, it can become constant and severe. In advanced stages, the joint may stiffen and lose its range of motion, potentially leading to the development of osteoarthritis.

Key Facts About Osteonecrosis

• Most common in people aged 30-50
• Can be traumatic (injury-related) or non-traumatic
• Often affects the hip joint, causing groin or buttock pain
• May lead to joint collapse and severe arthritis if left untreated

Recognizing the Symptoms of Osteonecrosis in the Leg

Early detection of osteonecrosis is crucial for effective treatment and prevention of joint damage. However, the condition may not present symptoms in its initial stages. As it progresses, individuals may experience the following symptoms:

• Gradual onset of pain, especially in weight-bearing bones
• Pain in the groin or buttock area when the hip is affected
• Increased pain when putting weight on the affected joint
• Pain that eventually persists even at rest
• Joint stiffness and reduced range of motion
• Sudden, intense pain if the bone collapses

The time between the onset of symptoms and loss of joint function can vary significantly, ranging from a few weeks to over a year. This variability underscores the importance of seeking medical attention promptly if you experience persistent joint pain or discomfort.

Risk Factors and Causes of Osteonecrosis

While the exact cause of osteonecrosis is not always clear, several risk factors have been identified that may increase an individual’s likelihood of developing the condition. These risk factors can be broadly categorized into traumatic and non-traumatic causes.

Traumatic Causes

• Bone fractures or dislocations
• Joint injuries that damage surrounding blood vessels

Non-Traumatic Risk Factors

• Long-term use of high-dose corticosteroids
• Excessive alcohol consumption
• Tobacco use
• Certain medical conditions (e.g., sickle cell disease, lupus, HIV)
• Cancer treatments (chemotherapy, radiation)
• Organ transplantation

It’s important to note that some individuals who develop osteonecrosis have no identifiable risk factors, highlighting the complex nature of this condition.

Diagnostic Approaches for Osteonecrosis

Accurate diagnosis of osteonecrosis is essential for developing an effective treatment plan. Healthcare professionals typically employ a combination of methods to diagnose the condition:

1. Medical history and physical examination
2. Imaging studies:
   • X-rays: May show bone changes in later stages
   • MRI (Magnetic Resonance Imaging): Can detect early stages of osteonecrosis before X-rays show changes
   • CT (Computed Tomography) scans: Provide detailed images of bone structure
   • Bone scans: Can help identify areas of reduced blood flow
3. Blood tests: To check for underlying conditions or risk factors
4. Bone biopsy: In rare cases, to confirm the diagnosis

Early diagnosis is crucial, as treatment outcomes are generally better when the condition is caught in its early stages. If you experience persistent joint pain or have risk factors for osteonecrosis, consult a healthcare professional for a thorough evaluation.

Treatment Options for Osteonecrosis

The treatment of osteonecrosis aims to prevent further bone damage, protect the affected bones and joints, and improve joint function. The appropriate treatment approach depends on several factors, including the stage of the disease, the location and extent of bone damage, and the patient’s overall health.

Non-Surgical Treatments

• Medications:
  • Pain relievers to manage discomfort
  • Blood thinners to improve blood flow
  • Bisphosphonates to slow bone breakdown
• Physical therapy to improve joint function and strength
• Assistive devices (crutches, canes) to reduce weight on the affected joint
• Electrical stimulation to promote bone growth

Surgical Interventions

• Core decompression: Removing part of the inner layer of bone to relieve pressure and improve blood flow
• Bone grafting: Replacing damaged bone with healthy bone from another part of the body or a donor
• Osteotomy: Reshaping the bone to reduce stress on the affected area
• Joint replacement: For advanced cases with significant joint damage

The choice of treatment depends on individual circumstances, and a combination of approaches may be used for optimal results. Early intervention is key to preventing joint collapse and the need for more invasive procedures.

Long-Term Outlook and Complications of Osteonecrosis

The prognosis for individuals with osteonecrosis varies depending on several factors, including the extent of bone damage at the time of diagnosis, the underlying cause, and the effectiveness of treatment. Early diagnosis and appropriate management can significantly improve outcomes and potentially prevent joint collapse.

Potential Complications

• Progressive joint damage and loss of function
• Development of severe osteoarthritis
• Bone collapse requiring joint replacement
• Chronic pain and disability

Regular follow-up with healthcare providers is essential for monitoring the progression of the condition and adjusting treatment plans as needed. Lifestyle modifications, such as maintaining a healthy weight and avoiding activities that put excessive stress on the affected joint, can also help manage symptoms and slow disease progression.

Preventing Osteonecrosis: Strategies for Reducing Risk

While not all cases of osteonecrosis can be prevented, there are several steps individuals can take to reduce their risk of developing the condition or minimize its impact if it does occur:

• Limit alcohol consumption
• Quit smoking or avoid tobacco use
• Manage underlying medical conditions effectively
• Use corticosteroids judiciously and under medical supervision
• Seek prompt treatment for joint injuries or fractures
• Maintain a healthy lifestyle with regular exercise and a balanced diet

For individuals at high risk of osteonecrosis, such as those undergoing long-term corticosteroid therapy or those with certain medical conditions, regular screening and preventive measures may be recommended by healthcare providers.

Research and Future Directions in Osteonecrosis Treatment

The field of osteonecrosis research is continually evolving, with ongoing efforts to improve diagnosis, treatment, and prevention strategies. Some promising areas of investigation include:

• Gene therapy to promote bone regeneration
• Stem cell treatments to enhance bone healing
• Development of new medications to improve blood flow and prevent bone death
• Advanced imaging techniques for earlier and more accurate diagnosis
• Minimally invasive surgical procedures to preserve joint function

As research progresses, it is hoped that new treatment options will emerge, offering better outcomes for individuals affected by osteonecrosis. Patients are encouraged to stay informed about the latest developments and discuss potential new treatments with their healthcare providers.

Understanding osteonecrosis, its symptoms, causes, and treatment options is crucial for early detection and effective management of this potentially debilitating condition. By recognizing the risk factors and seeking prompt medical attention when symptoms arise, individuals can improve their chances of preserving joint function and maintaining their quality of life. As research continues to advance our understanding of osteonecrosis, new and more effective treatments may become available, offering hope to those affected by this challenging condition.

Osteonecrosis (Avascular Necrosis) Symptoms & Causes

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Overview of Osteonecrosis

The bones of the human body are made up of living cells that need a blood supply to stay healthy. In osteonecrosis, blood flow to part of a bone is disrupted. This results in death of bone tissue, and the bone can eventually break down and the joint will collapse. Osteonecrosis is also called:

• Avascular necrosis.
• Aseptic necrosis.
• Ischemic necrosis of bone.

Osteonecrosis can happen to any bone, but most often it develops in the ends of long bones, such as the: 

• Thigh bone (femur), especially the upper part—the ball in the hip socket. The lower end, which is part of the knee joint, is also often affected.
• Upper arm bone (humerus), especially the upper part—the ball in the shoulder joint.

When the disease involves part of a bone in a joint, it can lead to the breakdown of the bone and arthritis.

Less often, the bones of the elbows, ankles, feet, wrists and hands are affected.  

The primary symptom of osteonecrosis is pain, and doctors usually diagnose the disease using imaging methods such as x-rays or magnetic resonance imaging (MRI). Most people require surgical treatment to prevent further bone damage, to protect the bones and joints, and to improve use of the joints.

Who Gets Osteonecrosis?

People of any age can get osteonecrosis, but it is most common in people in their 30s and 40s. Cases of osteonecrosis that stem from an injury are said to be traumatic, while all other cases are considered nontraumatic or atraumatic.

Doctors have identified a number of risk factors that may make a person more likely to get osteonecrosis. However, some people who get the disease do not have any known risk factors. The risk factors may include:

Injury

A broken or dislocated bone or a joint injury may damage the surrounding blood vessels. This can decrease the blood supply to the bone and lead to osteonecrosis.

Medications

• Corticosteroids. These medicines, commonly used to treat asthma, arthritis, systemic lupus erythematosus (lupus), and other conditions, act by reducing inflammation. While the reasons are unclear, they increase the risk of osteonecrosis when they are used for long periods at high doses. The risk of osteonecrosis is low when they are used on a short-term basis at lower doses.

Excessive Alcohol and Tobacco Use

Excessive use of alcohol is a risk factor for osteonecrosis, but why it makes people more likely to develop the disease is unclear. Overuse of alcohol can cause fatty substances to build up in the blood vessels and can increase cortisol (hormone that can cause blood vessels to narrow) levels in the blood. Together, these may decrease blood flow to the bone and lead to osteonecrosis. Research has also shown that excessive tobacco use is also a risk factor.

Medical Conditions

Some medical conditions may increase the risk of osteonecrosis, including:

• Certain blood disorders, such as sickle cell disease.
• Certain types of cancer, such as leukemia.
• Decompression sickness, also known as divers’ disease, the bends, or caisson disease.
• Gaucher disease.
• Gout.
• HIV infection.
• Pancreatitis.
• Rheumatoid arthritis.
• Lupus.

Medical Interventions

Some medical interventions may increase the risk of osteonecrosis, including:

• Chemotherapy.
• Kidney or other organ transplantation. The use of corticosteroids to avoid organ rejection may be a contributing factor.
• Radiation treatment.

Types of Osteonecrosis

Health care professionals describe two types of osteonecrosis:

• Traumatic, which follows an injury. The most common causes of traumatic osteonecrosis are a bone fracture or dislocation.
• Nontraumatic (or atraumatic), when there is no history of injury.

Symptoms of Osteonecrosis

There may be no symptoms of osteonecrosis at first, but as the disease progresses, you may gradually start to feel pain, especially in weight-bearing bones such as the thigh bone (femur). The disease most commonly affects the hip joint, and the pain is usually felt in the groin or, less commonly, in the buttock area.

Most people first experience pain when they put weight on the affected joint, but eventually the joint may feel painful even when resting. Over time, the joint may stiffen and lose its range of motion, and osteoarthritis may set in. If the end of the bone collapses, the pain may intensify abruptly.

The time period between the start of symptoms and loss of function of the joint varies from person to person and ranges from a few weeks to more than a year.

Cause of Osteonecrosis

Osteonecrosis happens when the blood supply to part of a bone is disrupted, depriving bone tissue of essential nutrients and oxygen. If the affected part of the bone is small and not subject to major weight-bearing forces, it may not cause a problem or the body’s repair processes may be able to rebuild the damaged area. But in most cases, the repair mechanisms do not work and the bone erodes or develops fractures; eventually, it may break down and collapse.

In traumatic osteonecrosis, which develops from an injury, the loss of blood flow is likely due to damage to blood vessels. The reasons for the loss of blood supply are less clear in nontraumatic cases, but may be due to blood clots blocking the circulation or elevated pressure within the bone constricting the vessels and decreasing blood flow.

While the underlying causes of nontraumatic osteonecrosis are not fully understood, scientists believe that genetics, along with other factors—such as alcohol overconsumption, certain medications, or other diseases–may play a role.

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Also called: Aseptic necrosis, Avascular necrosis, Ischemic necrosis

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Osteonecrosis is a disease caused by reduced blood flow to bones in the joints. In people with healthy bones, new bone is always replacing old bone. In osteonecrosis, the lack of blood causes the bone to break down faster than the body can make enough new bone. The bone starts to die and may break down.

You can have osteonecrosis in one or several bones. It is most common in the upper leg. Other common sites are your upper arm and your knees, shoulders and ankles. The disease can affect men and women of any age, but it usually strikes in your thirties, forties or fifties.

At first, you might not have any symptoms. As the disease gets worse, you will probably have joint pain that becomes more severe. You may not be able to bend or move the affected joint very well.

No one is sure what causes the disease. Risk factors include :

• Long-term steroid treatment
• Alcohol misuse
• Joint injuries
• Having certain diseases, including arthritis and cancer

Doctors use imaging tests and other tests to diagnose osteonecrosis. Treatments include medicines, using crutches, limiting activities that put weight on the affected joints, electrical stimulation and surgery.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

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• ClinicalTrials. gov: Legg-Calve-Perthes Disease

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• ClinicalTrials.gov: Osteonecrosis

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• Article: Exosomes Derived from Adipose Tissue-Derived Mesenchymal Stromal Cells Prevent Medication-Related Osteonecrosis. ..

• Article: The feasibility of discriminating BRONJ lesion bone with Raman spectroscopy.

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How gangrene begins and manifests itself

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• How gangrene starts

Content:

• How gangrene of the legs starts

• How gangrene begins in diabetes mellitus

• How gangrene of the lower extremities begins: comparison of different forms

• How to act

Gangrene is the necrosis of tissues that can no longer be repaired. But not all patients know how gangrene begins. There are a number of symptoms that you should pay attention to in order to prevent tissue death and loss of part of the limb.

How gangrene of the legs begins

The disease can develop over years or appear abruptly: in the latter case, it is often necessary to save not the limb, but the life of the patient.

Types and causes:

• Violation of the blood supply to the legs for a long time leads to the development of dry gangrene.
• With a sharp deterioration in nutrition, the phenomenon of hypoxia is observed: tissues do not receive nutrition, die, decay products are released: this is how wet gangrene begins.
• In the worst-case scenario, bacteria enter the wound, and a rapid process of poisoning the body begins. This is how gas gangrene develops.

If you are in the high-risk category, you should know how gangrene of the extremities begins: any minor damage to the skin can lead to a critical situation. Examine your toes, feet, and lower legs as carefully as possible.

On the background of what diseases and conditions necrosis can develop:

• Malignant tumors.
• SD.
• Atherosclerosis.
• CVD.
• Autoimmune pathologies.
• Kidney diseases.
• Coronavirus.
• Taking oral hormonal contraception.
• Physical inactivity and immobility due to lifestyle, disease or injury.
• Compression bandage, tourniquet, plaster.
• Exposure to low and high temperatures, chemicals, electricity.
• Wounded by any type of weapon.
• Past surgery, especially on the pelvic joint.
• Obesity.
• Old age.
• Pregnancy.
• Postmenopausal.
• Smoking.

The highest risk of developing gangrene is on the battlefield. But even in civilian life there is a risk of infection getting into the wound, which is why the most dangerous form of the disease develops – gas.

How gangrene starts in diabetes mellitus

DM disrupts blood microcirculation and develops neurotrophic disorders. Gangrene in diabetes is a complication of diabetic foot. 10-15% of diabetic patients develop permanent leg wounds. Shoes, blisters, dry skin, increased pressure on the limbs due to weight gain – all this leads to the appearance of microtraumas, and subsequently to inflammation of the skin and ulcers. Due to nerve damage and against the background of ischemia in patients with DM, the risk of necrosis increases significantly, and the prognosis is unfavorable – the affected limb often has to be amputated, otherwise there is a high risk of sepsis and death. At risk, patients with type 2 diabetes are 10 times more likely to experience diabetic foot and gangrene than people with type 1 type.

How to recognize diabetic foot syndrome:

• Limbs lose sensation.
• Loss of hair on the legs begins.
• The appearance of the foot changes: pigmentation, pallor, and overflow with blood appear.
• Nails become brittle, darkened, which is explained by hemorrhage under the nail plate.
• The skin is dry, flaky.
• The shape of the foot is changing.
• Wounds heal for a long time, after healing, traces remain.
• Feet and shins become cold, react weakly to touch, cold, heat, pain and other irritants.
• Ulcers appear, often painless.
• In the late stage, dry or wet gangrene appears.

To reduce the risks, patients with diabetes need to constantly monitor their glucose levels, carefully select the size of shoes (according to the insole, if the sensitivity is reduced and it is not clear whether the shoes are tight or not), do not walk without socks to avoid cuts and insect bites. You can not get rid of corns, burns and cold exposure should be avoided. Legs are inspected daily for damage. With a decrease in vision, it is worth bringing relatives to examinations.

How gangrene of the lower extremities begins: a comparison of different forms

Dry gangrene does not develop rapidly, but this form should not be underestimated. The disease can go into a wet form, which significantly worsens the prognosis.

What gangrene of the leg looks like in the dry form:

• The skin becomes darker, the limb dries out, and becomes smaller in volume than the unaffected limb.
• The pulse in the vessels disappears.
• The boundary between necrosis and healthy tissue can be clearly defined.
• A finger may fall off: this is how the body gets rid of dead tissue.
• General condition is normal: no fever, no blood poisoning. The infection does not enter the body.

How gangrene of the lower extremities begins when wet:

• The limb swells, turns red, then darkens.
• It is not possible to clearly distinguish between healthy and diseased tissues.
• The foot becomes cold.
• Blood pressure increases.
• The patient’s condition is severe: toxins enter the general circulation, an unfavorable outcome is possible.

Pain occurs in both forms. An exception is the death of neurons, for example, in diabetes, when the patient is limited in mobility, but does not complain of pain. A critical danger to life is gas gangrene, when the wet form is complicated by the addition of an infection. The limb quickly decomposes, smells bad, gases accumulate under the skin.

Patient action

Ideally, gangrene should be prevented, although this is not always possible in severe injuries. If you have CVD, smoke, are overweight, are bedridden, or have diabetes, you need to be on the lookout. Pay attention to the appearance of lameness, aches, wounds and ulcers on the skin. When identifying a dry form, it is important to prevent its transition to a wet one. It should be understood that the dead areas are removed, if necessary, a patchwork operation is performed.

Even the loss of a small part of a leg, such as a toe, is a serious damage to health. Vascular examination, thromboprophylaxis, blood sugar and cholesterol control, moderate exercise, treatment of bedsores – all these measures are essential for patients at risk. If you notice symptoms of damage to the legs, contact the specialized medical institution – the Chekhov Vascular Center. We deal with the problem of blood vessels, identify factors that predispose to the development of gangrene, and in difficult cases, carry out amputation strictly according to indications. Make an appointment at the Chekhov Vascular Center in the Moscow Region – they use an individual approach, carefully study the problem of each patient in order to offer the best solution.

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Symptoms of gangrene – How to treat gangrene?

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• Signs and symptoms of gangrene

Content:

• What are the signs of gangrene

• Cause of symptoms of gangrene

• First signs of gangrene

• Dry gangrene

• Wet gangrene

• General symptoms of gas gangrene

• Treatment

Signs of gangrene are most pronounced when the limbs are affected. Necrosis can also affect the internal organs, but in this case other symptoms appear: poisoning, acute abdominal pain, tachycardia, putrid sputum. In most cases, gangrene manifests itself in the legs, and patients can pay attention to the symptoms in time to see a doctor in time for treatment.

What are the signs of gangrene

Symptoms vary depending on the extent of the lesion, the type of gangrene (dry or wet), sensitivity (moderate or no pain in nerves).

Species:

• Dry (mummification). It proceeds without a pronounced inflammatory process, affects only various parts of the limbs and skin.
• Wet. Occurs with the addition of infection. Gangrene of the internal organs is always wet. A dangerous condition is gas gangrene, complicated by the addition of anaerobic microflora.

Cause of symptoms of gangrene

Necrosis is tissue death accompanied by self-amputation (dry gangrene) or putrefaction (wet gangrene).

Causes:

• External damage, including minor: burns, frostbite, compression, electrical discharge.
• Internal causes: hypoxia of a limb or organ, allergies, trophic disorders, nerve damage in diabetes, atherosclerosis, blockage of veins, impaired blood flow due to smoking, inflammation of the arteries, oncology, endocrine diseases, decreased immune defenses.

Smokers and patients with cardiovascular disease are at risk, but especially those with diabetes. Patients with diabetes show signs of diabetic foot, any damage during the disease is dangerous, each wound must be carefully treated to avoid infection. The problem is that diabetic patients face nerve damage and loss of sensation, signs of incipient gangrene may simply not be noticed, which can ultimately lead to serious complications.

First signs of gangrene

Symptoms of the onset of gangrene may resemble other pathologies: in the case of limbs, varicose veins; if the internal organs are affected, then either symptoms of poisoning appear (intestines, gallbladder), or signs of appendicitis (vermiform appendix), or pneumonia with sputum and the smell of decay.

It is a mistake to think that the initial signs of gangrene are blackening of the extremities. Initially, pallor of the skin is observed, there is aches, over time, the pain syndrome increases. But with gas gangrene, most often associated with injuries, the course can be so rapid that 1 signs of gangrene already require cardinal treatment.

Dry gangrene

Symptoms:

• Changes in the skin: pallor, bleeding, bluish tint.
• Shrinkage of skin and muscles, wrinkling, mummification process.
• Detachment of the top layer of the skin.
• Decreased local temperature.
• Numbness, loss of sensation.
• Slight odor of decay.
• Pain worse even with slight exertion.
• Itching.
• Impaired mobility, paralysis.
• Non-healing wounds, sores.
• Different nature of pain: aching, shooting, chronic, severe.
• Darkening of the limb as symptoms progress.
• Restriction of healthy areas from living tissues: spontaneous amputation of foci of necrosis, for example, fingers.

It must be understood that the more pronounced the pain, the more living cells survived. As tissues and nerves die, the pain subsides, which should not please, but alert.

Dry gangrene can last for a long time. If the blood flow is disturbed, the damaged areas can be reanimated: it is even possible to do without amputation. The skin (superficial degree), muscles (deep) and all tissues up to the bone can be involved in the process. When foci of necrosis appear, dead tissues can no longer be replaced, they must be removed. The danger of dry gangrene is also that when an infection enters, a more dangerous wet form develops.

Wet gangrene

This form proceeds with the predominance of decomposition processes. The first sign of gangrene is the same as in the dry form. Under adverse conditions, one form flows into another – more dangerous, more difficult to treat. To identify the disease, it is necessary to pay attention to the symptoms of intermittent claudication, which has 5 stages. At the fifth stage, pain is disturbing even at rest, serious external changes appear. The main difference from the dry form is the inflammation of all layers from the skin to the bones.

Symptoms:

• Congestion, swelling, swelling of the limb.
• Pale, changing to blue, green, purple, and then black.
• Discharge of fluid from wounds.
• Deep injuries of tendons and bone tissue.
• Signs of intoxication.
• Fever, decreased blood pressure.

The difference between these two conditions is in the rate of blockage of blood vessels: with dry gangrene it is slow, with wet gangrene it is fast.

General symptoms of gas gangrene

Symptoms of gas gangrene are difficult to ignore: the pain becomes unbearable, when the affected area is squeezed, a crackling sound is heard. If signs of gas gangrene are observed, then we are no longer talking about saving the limb: it is more important to save the patient’s life.