Nontraumatic Osteonecrosis of the Femoral Head

Unsuccessful vascularized fibular periosteal graft for treatment of femoral head osteonecrosis

“…Despite the theoretical enhanced osteogenic properties of vascularized periosteum tissue transfers over the classic FVFG technique [4,5], VFPG failed to adequately forestall femoral head from collapse in our patient. The negative outcomes we experienced at short-term followup with the use of VFPG highlight the importance of FVFG as a mechanical support element in the treatment of ONFH [2].…”

“…Recently, vascularized periosteal graft (VPG) has received considerable attention for the repair of bone disorders due to its excellent osteogenic and angiogenic potential in children [4,5]. Compared to the standard FVFG, the surgical technique behind VPG leads to an increased exposed area of periosteal cambium layer, rich in stem cells with angiogenic and osteogenic potential.…”

“…At that moment, the femoral head was classified as Ficat stage III with minimal collapse. All surgical steps largely followed Urbaniak's technique, but we utilized a modified VFPG to revascularize the femoral head [4]. The vascularized flap consisted of a periosteal flap with a preserved longitudinal stick fibular bone that avoided periosteal retraction and facilitated its introduction in the femoral tunnel (Fig.…”

Core decompression combined with implantation of a demineralised bone matrix for non-traumatic osteonecrosis of the femoral head

“…The radiographic evaluation was done by a radiologist and a surgeon, according to the Ficat [21] and ARCO classiWcation [8,22]. Preoperatively, the Ficat scores were distrib- uted as follows: no patient showed a Ficat stage III or IV, while one patient showed Ficat stage I, n = 6 hips a Ficat stage IIA, and n = 7 hips a Ficat stage IIB.…”

Osteonecrosis of the femoral head and glaucoma caused by topical corticosteroid application

“…There were no other risk factors for ONFH, such as smoking, coagulation disorder, hyperlipidemia, HIV infection, or pancreatitis [3]. However, in 1982 he had been diagnosed with atopic dermatitis, and for the following 24 years he had been treated continuously with various corticosteroid ointments, used on his face, neck, chest, and arms.…”