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Diagnosed with avascular necrosis of the elbow, articular capitellum and trochlea, had swelling. Suggest?

Dec 2012
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Answered by

General & Family Physician
Practicing since : 2012
Answered : 1694 Questions
My son was recently diagnosed with AVN of the elbow after traumatic injury to his elbow - articular capitellum and trochlea. I was wondering if the delay in surgical resection increases the risk of of AVN? He didn't have surgery until 9 days post injury due to swelling.
Posted Sat, 14 Sep 2013 in Bones, Muscles and Joints
Answered by Dr. Nsah Bernard 45 minutes later
Brief Answer:
Early surgical resection has an "upper hand"

Detailed Answer:

Thanks for posting on XXXXXXX

I will like to start by providing you with some additional info regarding AVN (avascular necrosis or osteonecrosis). Avascular necrosis is the death of bone tissue due to a lack of blood supply. Also called osteonecrosis, avascular necrosis can lead to tiny breaks in the bone and the bone's eventual collapse. The blood flow to a section of bone can be interrupted if the bone is fractured or the joint becomes dislocated. Avascular necrosis of bone is also associated with long-term use of high-dose steroid medications and excessive alcohol intake.
AVN is usually caused by:
- Joint or bone injury: A traumatic injury, such as a dislocated joint, may reduce the blood supply to a section of bone, leading to bone death.
- Pressure inside the bone: Some medical conditions, such as sickle cell anemia or Gaucher's disease, can increase the pressure inside the bone making it more difficult for fresh blood to enter.
Delay in surgical resection is not directly correlated to increased risk of AVN but could be responsible for aggravation. If after injury, he was diagnosed shortly after, chances of it getting worst might have been prevented.

Hope this helps and wish you both the best.
Dr. Nsah

Above answer was peer-reviewed by
Follow-up: Diagnosed with avascular necrosis of the elbow, articular capitellum and trochlea, had swelling. Suggest? 1 hour later
Not sure what this means "If after injury, he was diagnosed shortly after, chances of it getting worst might have been prevented."

If AVN is blood loss to the bone and the bone fragments are displaced, then how would it get blood? I read that bone cells start to die about 5 hours after displacement so if the fragments are not reconnected, then wouldn't it make sense that the risk increases?

Everything I have read about AVN, it isn't typical with children so I'm wondering how this happened?
Answered by Dr. Nsah Bernard 13 minutes later
Brief Answer:
by prevented I meant severity of the AVN

Detailed Answer:

Thanks for updating,

Sorry for not being clear in my previous posting. What I meant was that after an injury or fracture there is evolution which will depend on how the fracture occurred and in your son's case was a traumatic injury of his elbow which could have lead to small crushing or mild injury to the bone. As you might already know, bone structure is a living tissue which is normally supplied by blood vessels (nutrients, minerals, oxygen etc) which help the bone grow (live) and if this blood supply is stopped to any part of the bone, then it can result to bone cell death which can then result to osteonecrosis. In your son's case, his elbow injury might have resulted to one part of his elbow bone to be injured or crushed, thereby preventing blood supply to that area hence bone cell death.
Well in medicine, there is nothing as 100% certain, one thing might be right for the majority of cases, but in odd cases, it might have another presentation. If what you have read about AVN does not seem similar to other cases you must have come across, then your son must be having an untypical presenation of AVN or osteonecrosis. .
I take from your word that bone cells start dying after about 5hours (which is correct) and this will continue with attend of other bone cells if the problem is not resolved early enough. 9 days after an injury is quite a long while and the situation might get worst if surgical resection (if indicated) was not done in time. I do believe that your son is in good hands with the doctors and what ever the situation, his injury/AVN would be resolved and he can go on with his daily activities.

Hope I was explicit enough this time around and please do feel free to write back in in any doubt.
Dr. Nsah
Above answer was peer-reviewed by
Follow-up: Diagnosed with avascular necrosis of the elbow, articular capitellum and trochlea, had swelling. Suggest? 11 minutes later
There are always risks with ortho surgery, such as comparmentalism and AVN, but these risks must increase with delays in resection, otherwise why would displaced fractures need to be completed within 48 hours? Why is early treatment favorable and minimizes risks?

My son is not ok actually, he is on his 3rd surgery and still has a serious contracture. The next surgery will involve grafting from his knee. I know so many families with kids that had similar injuries without incident and I'm curious as to what variables in his situation may have facilitated the complications.
Answered by Dr. Nsah Bernard 14 minutes later
Brief Answer:
Early treatment minimizes so many complications

Detailed Answer:

It is apparent you are worried about your son and I totally understand and I do condole with you.
Early treatment for all diseases conditions is always favorable as with most and almost diseases conditions, they always get complicated ones not treated early enough. There is no case difference with your son. But bringing up the fact that he had already had multiple surgeries raises my curiosity as to the reasons/indications of the surgery. If your son has been investigated for chronic diseases conditions such as sickle cell anemia or another form of blood diseases that could be a serious risk factor for pathologic fractures (which should not entirely be ruled out).
I believe your son developing AVN after an injury, having 2 previous surgeries and still to have another surgery (with grafting involved) tells me that your son might be suffering from another diseases condition (forgive me if I am wrong) that needs to be investigated by his doctors. If he is not having them, then I must say he is rather unfortunate to develop such bone complications at his young age.
Normally children's bones heal well and so I do not understand why he should be having such complications.

Please do feel free to write back with more updates so I can make a synthesis.

Dr. Nsah
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