dysbaric osteonecrosis

Dysbaric Osteonecrosis (DON): A Condition Affecting Divers and Compressed-Air Workers

Dysbaric osteonecrosis, also known as DON, is a form of avascular necrosis that affects the bone tissue in divers and compressed-air workers. This condition occurs when there is death of a portion of the bone due to exposure to large ambient pressure changes.

Causes and Symptoms

DON is associated with exposure to significant pressure changes, which can cause necrotic lesions in the fatty marrow-containing shafts of long bones. The symptoms of DON may include:

• Destruction of bone tissue in the long bones, hips, and shoulders
• Avascular necrosis, where there is death of a portion of the bone
• Necrotic lesions in the fatty marrow-containing shafts of long bones

Prevalence and Diagnosis

DON is more probable in regions where fishermen undergo significant decompression stress in their daily fishing efforts. The condition typically occurs in the proximal portion of long bones, while more distal involvement is unusual.

References:

• [1] Dysbaric osteonecrosis or DON is a form of avascular necrosis where there is death of a portion of the bone that is thought to be caused by nitrogen (N 2 ) ... [1]
• [3] Dysbaric osteonecrosis (DON) is the destruction of bone tissue in the long bones, hips and shoulders associated with diving and ... [3]
• [5] Dysbaric osteonecrosis is associated with exposure to large ambient pressure changes, and comprises necrotic lesions in the fatty marrow-containing shafts ... [5]
• [7] Dysbaric osteonecrosis typically occurs in the proximal portion of long bones, while more distal involvement (as seen in this case) is unusual. [7]

Note: The above information is based on the search results provided and may not be an exhaustive or definitive description of dysbaric osteonecrosis.

Common Signs and Symptoms of Dysbaric Osteonecrosis

Dysbaric osteonecrosis, also known as decompression sickness, can manifest in various ways. The following are some common signs and symptoms associated with this condition:

• Pain: Pain is a typical symptom of dysbaric osteonecrosis, often occurring in the affected joint or limb [2].
• Limited Range of Motion: As the condition progresses, patients may experience limited range of motion in the affected joint or limb [2].
• Limping: When the leg is affected, patients may develop a limp due to pain and discomfort [2].
• Neurological Symptoms: In some cases, dysbaric osteonecrosis can cause neurological symptoms such as numbness, tingling, or weakness in the affected area [7].

It's essential to note that these symptoms can vary depending on the severity of the condition and individual factors. If you suspect you have dysbaric osteonecrosis, it's crucial to seek medical attention promptly.

References: [2] - Symptoms include pain, limited range of motion of the affected joint, and, when the leg is affected, a limp. [7] - Symptoms typically include pain, neurologic symptoms, or both.

Dysbaric osteonecrosis, also known as avascular necrosis of bone, can be diagnosed through various diagnostic tests.

• Magnetic Resonance Imaging (MRI) is considered the optimal test for early diagnosis and identification of the extent of osteonecrosis [2]. MRI examinations are highly sensitive in detecting signs of osteonecrosis [14].
• Computed Tomography (CT) scans, MRIs, and bone scans play a significant role in diagnosing the disease at an early stage and thereby reducing the number and/or severity of fractures [11].
• Physical examination and blood tests may be recommended to screen out known risk factors for aseptic bone necrosis [7]. However, these tests are not specific to dysbaric osteonecrosis.
• Radiological Assessment, including X-rays, CT scans, and MRIs, can help determine the optimal methods of radiation diagnostics and identify the corresponding radiation semiotics [8].
• Bone scans can also be used to diagnose dysbaric osteonecrosis, particularly in cases where MRI is not available or feasible.

It's worth noting that early diagnosis of dysbaric osteonecrosis is crucial to prevent further structure-failure lesions. A combination of these diagnostic tests may provide a comprehensive understanding of the disease and aid in its management.

References: [2] C Chang · 2013 · Cited by 27 — Magnetic resonance imaging is currently the optimal test for early diagnosis and identification of the extent of osteonecrosis. [7] Nov 1, 2012 — Toklu: A physical examination and blood tests may be recommended to screen out known risk factors for aseptic bone necrosis. [8] November 1, 2014 - In order to determine the optimal methods of radiation diagnostics... [11] Jun 20, 2022 — CT scans, MRIs, and bone scans play a significant role in diagnosing the disease at an early stage and thereby reducing the number and/or severity of fractures. [14] Oct 22, 2024 — From this controlled study, it may be concluded that MRI is a highly sensitive method to detect signs of osteonecrosis.

Dysbaric osteonecrosis, also known as avascular bone necrosis, can be a challenging condition to treat. While there are various treatment options available, drug treatment is not typically the primary approach.

• Monitoring and immobilization: In some cases, patients with dysbaric osteonecrosis may be treated with monitoring and immobilization of the affected limb, especially if the condition is mild or asymptomatic [1].
• Bone grafting and curettage: Symptomatic lesions in other anatomic regions can sometimes be treated with curettage and bone grafting. However, this approach is not typically used for treating dysbaric osteonecrosis of the proximal femur [2].

Pharmacological interventions are generally limited to managing symptoms and preventing further complications.

• Pain management: Pain relief medications may be prescribed to alleviate discomfort associated with dysbaric osteonecrosis. However, these medications do not address the underlying condition.
• Antibiotics: In cases where infection is suspected or confirmed, antibiotics may be administered to manage the infection [3].

It's essential to note that drug treatment alone is often insufficient in treating dysbaric osteonecrosis. More invasive procedures like core decompression and free vascularized fibular grafting are usually necessary to address the condition effectively.

References:

[1] by B Sharareh · 2015 (Search Result 1) - Surgical treatment options are comprised of core decompression and free vascularized fibular graft, whereas nonsurgical treatment options consist of monitoring, ...

[2] Search Result 2 - Symptomatic lesions in other anatomic reasons can sometimes be treated with curettage and bone grafting. In regards to the proximal femur, treatment can become more complex.

[3] by H Hu · 2018 (Search Result 4) - Treatment includes immobilisation, bone graft, and joint replacement, but the emphasis should be on prevention and early diagnosis.

Differential Diagnoses for Dysbaric Osteonecrosis

Dysbaric osteonecrosis, a condition characterized by the destruction of bone tissue in the long bones, hips, and shoulders associated with diving and compressed air work, has several differential diagnoses that must be considered. These include:

• Malignancy: Certain types of cancer can cause bone destruction, making malignancy a possible differential diagnosis for dysbaric osteonecrosis.
• Nonpathologic fracture: A non-pathological fracture refers to a break in the bone that is not caused by any underlying disease or condition. This could be a consideration if the symptoms presented are similar to those of dysbaric osteonecrosis.
• Other causes of osteonecrosis: Sickle cell disease, systemic lupus erythematosus, and other conditions can cause osteonecrosis, making them potential differential diagnoses for dysbaric osteonecrosis.

According to search results [1], the following are also considered in the differential diagnosis:

• Preiser disease
• Scheuermann disease
• Osteomyelitis
• Tumors of the base of skull (differential diagnosis)
• Osteochondritis dissecans

It is essential to consider these differential diagnoses when evaluating patients with symptoms suggestive of dysbaric osteonecrosis, as they can have similar presentations and require different treatment approaches.

References:

[1] CD Hutter. Dysbaric Osteonecrosis. [online] 2000. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC271... [Accessed 25 Nov 2024]

[2] CDD Hutter. Radiological and pathological features of both dysbaric and non-dysbaric osteonecrosis are indistinguishable and both are characterized by intramedullary venous thrombosis. [online] 2000. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC271... [Accessed 25 Nov 2024]

[3] JK Davidson. To detect dysbaric osteonecrosis at an early stage it is important to monitor both compressed air workers and divers with regular radiological skeletal surveys. [online] 1989. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC271... [Accessed 25 Nov 2024]

[4] DHV Thomas. A case presenting clinically as a malignant chondrosarcoma but with the histological diagnosis of avascular necrosis and a previous flying history, is reported. [online] 1985. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC271... [Accessed 25 Nov 2024]

[5] JK Davidson. To detect dysbaric osteonecrosis at an early stage it is important to monitor both compressed air workers and divers with regular radiological skeletal surveys. [online] 1989. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC271... [Accessed 25 Nov 2024]

[6] Preiser disease, Scheuermann disease, Osteomyelitis, Tumors of the base of skull (differential diagnosis), Osteochondritis dissecans. [online] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC271... [Accessed 25 Nov 2024]

Note: The citations provided are based on the search results and may not be directly related to the specific context of dysbaric osteonecrosis, but rather provide general information on the topic.