title: Dysbaric osteonecrosis: a literature review of pathophysiology, clinical presentation, and management.
abstract: OBJECTIVE
  To perform a general literature review of dysbaric osteonecrosis (DON) to describe its pathophysiology, prevalence in scuba divers, prognosis, and treatment options.
  
  
  METHODS
  A literature search on PubMed was performed using the term "dysbaric osteonecrosis" yielding 67 results. There was no exclusion based on dates. Articles that mainly dealt with decompression sickness secondary to tunnel work, mining, or airplane travel were not selected. An additional search on PubMed using the terms "(osteonecrosis diving) NOT dysbaric" was performed to identify other publications not picked up in the initial search.
  
  
  RESULTS
  Dysbaric osteonecrosis is associated with prolonged hyperbaric exposure and rapid decompression that cause nitrogen bubbles to enter the fatty marrow-containing shafts of long bones leading to reduction in blood flow and subsequent osteonecrosis. Patients may present asymptomatically, and typical radiographic findings of DON include: decalcification of bone, cystic lesions, osteosclerotic patterns, nontraumatic fractures, bone islands, and a subchondral crescent sign. Surgical treatment options are comprised of core decompression and free vascularized fibular graft, whereas nonsurgical treatment options consist of monitoring, physical therapy, and bisphosphonate therapy.
  
  
  CONCLUSIONS
  Although the incidence of DON has decreased significantly over the past 2 decades, the lack of timely diagnosis and optimal management keeps DON relevant in the orthopedic and sport medicine community.
authors.affiliation: Orthopaedic Department, University of California Irvine Medical Center, Orange, California.
authors.forename: Behnam
authors.initials: B
authors.lastname: Sharareh
authors.forename: Ran
authors.initials: R
authors.lastname: Schwarzkopf
mesh_terms: D000337:Aerospace Medicine; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D003665:Decompression Sickness / Q000150:complications / Q000628:therapy*; D004164:Diphosphonates / Q000627:therapeutic use*; D004242:Diving / Q000293:injuries*; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods*; D019637:Orthopedic Procedures; D010020:Osteonecrosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates