title: Managing AVN following internal fixation: treatment options and clinical results.
abstract: Avascular necrosis (AVN) after internal fixation of intracapsular hip fractures is a progressive multifactorial disease that ultimately results in local ischemia with ensuing osteocyte necrosis and structural compromise. This disease can cause significant clinical morbidity and affects patients of any age, including young and active patients. Effective treatment of this condition among young adults is challenging due to their high functional demands. The aim of managing AVN is to relieve pain, preserve range of movement and improve function. Treatment methods vary depending on the stage of the disease and can be broadly categorised into two options, hip preserving surgery and hip arthroplasty. Although, hip preserving techniques are attractive in the young adult, they may alter the morphology of the proximal femur and make subsequent arthroplasty more challenging. Conversely, arthroplasty in the young adult may require repeat revision procedures throughout the patient's life. Current evidence suggests that modifications of prevailing treatments, in addition to new technologies, have led to the development of management strategies that may be able to alter the course of femoral head osteonecrosis. This review aims to summarise the options available for treatment of AVN in the young adult and review the clinical results.
authors.affiliation: Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Canada M5C 1R6.
authors.forename: Simon
authors.initials: S
authors.lastname: Hoskinson
authors.affiliation: Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Canada M5C 1R6.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Morison
authors.affiliation: Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Canada M5C 1R6.
authors.forename: Shahram
authors.initials: S
authors.lastname: Shahrokhi
authors.affiliation: Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Canada M5C 1R6. Electronic address: schemitsche@smh.ca.
authors.forename: Emil H
authors.initials: EH
authors.lastname: Schemitsch
mesh_terms: D019299:Decompression, Surgical / Q000379:methods*; D042241:Early Diagnosis; D019317:Evidence-Based Medicine; D005265:Femoral Neck Fractures / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D005270:Femur Head / Q000098:blood supply / Q000503:physiopathology / Q000601:surgery*; D005271:Femur Head Necrosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D006801:Humans; D016059:Range of Motion, Articular; D012039:Regional Blood Flow; D016896:Treatment Outcome
keywords: Arthroplasty; Avascular necrosis; Femoral neck fractures; Operative management