An Introspection on Vascularized Bone Transfers for Avascular Necrosis of Bones of Femoral Head and Scaphoid

Sep 29, 2026

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Avascular necrosis of bone is a frequent skeletal pathology with causes ranging from trauma and chemo-radiation to hematological disorders and corticosteroid use. Treatment targets pain, stiffness, and movement limitations, using vascularized or non-vascularized bone grafting and arthroplasty in advanced stages. In a two-year series of five patients treated with pedicled or free vascularized bone, postoperative Technetium 99m scans assessed graft viability, while pain outcomes were tracked by VAS before and after surgery.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

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Introduction

Materials and Methods

Results

Conclusion

Keywords

Original Article Journal of Orthopaedic Case Reports 2025 December:15( 12) :Page 413-420 An Introspection on Vascularized bone transfers forAvascular Necrosis of Bones of Femoral Head and Scaphoid Sunil Kumar Rout¹Ǹ², Mainak Mallik²Ǹ³, Sujit Kumar Tripathy⁴ Learning Point of the Article: Considering the morbidity experienced by the patients ofavascular necrosis of bones, vascularized bone transfer should primarily be considered for the younger patients with AVN, with an option of definitive arthroplasty, kept in reserve later in their lives, if required. Abstract Introduction: Avascular necrosis of bone, due to various etiologies, is not an uncommon skeletal pathology seen in clinical practice. Treatment of these conditions includes treating the resultant pain, stiffness, and limitations ofmovement surgically with bone grafts both vascularized and non-vascularized andarthroplasty inmost advanced stages. Materials and Methods: In a duration of 2 years, five patients were treated for such pathologies using vascularized bones (pedicled or free). All of them were subjected to radioisotope (Technetium 99m) scan postoperatively to evaluate the viability of the transferred bones. The post-operative pain was assessed using visual analog scale (VAS) to assessthe outcome of treatment by comparing the scorebefore and after surgery. Results: All patients improved symptomatically as per the outcome assessment with VAS score with viability of the transferred bones as evidenced by radioisotope scan. Conclusion: Vascularized bone transfer is indispensable in the treatment of avascular necrosis of bone and the complications thereof, and should always be offered primarily to younger patients especially. Keywords: Avascularnecrosis of bone, vascularized bone graft, osteonecrosis of femoral head, scaphoidfracture non-union. Introduction Avascular necrosis (AVN) of bone, affecting various components of human skeletal system, is not uncommon in clinical practice. Commonly involved regions include theepiphyses of long bones at the weight-bearing site. Head of the femur is most commonly involved, followed by knee, talus, and small bones ofwrist, such as lunate and scaphoid. AVN results from a myriad ofcauses, ofwhich, common onesinclude trauma, chemo-radiation, and hematological disorders such as coagulopathies and sickle cell disease. Corticosteroid intake is also one of the common causes of this pathology. Treatment modality of this condition, by and large, is governed by the stage of the disease. Itvaries from conservative management with nonsteroidal anti-inflammatory drugs to advanced form of surgical management, like arthroplasties. In younger patients with advanced stage of AVN affecting major joints, arthroplasty isnot considered ideal, as the procedure most often needs to be repeated after about two decades. Hence, for these groups of patients, debridement of necrotic bone and replacing it with vascularized bone graft is considered tobe the most appropriate treatment to alleviate the symptoms of pain, stiffness, and limitations ofmovement and also prevent further complications. This is a short retrospective single-center series ofcases of AVN |
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DOI:
[https://doi.org/10.13107/jocr.2025.v15.i12.6576](https://doi.org/10.13107/jocr.2025.v15.i12.6576) | Author’s Photo Gallery | | | | --- | --- | --- | --- | | | | |
Dr. Sujit Kumar Tripathy | | |
1Department of Plastic and Reconstructive Surgery, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India,²Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India,³Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Kalyani, West Bengal, India,⁴Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Address of Correspondence:
Dr Mainak

FAQs

Why is vascularized bone transfer emphasized for younger patients with AVN?

The article highlights that arthroplasty often needs repetition after about two decades, so debridement of necrotic bone with vascularized bone grafting is considered more appropriate for younger patients to relieve symptoms and prevent further complications.

How were transferred bone grafts assessed after surgery?

Transferred bone viability was evaluated using a postoperative radioisotope scan with Technetium 99m.

What outcome measures were used to judge treatment effectiveness?

Post-operative pain was assessed with a visual analog scale (VAS), comparing scores before and after surgery, alongside scan evidence of graft viability.

Sep 29, 2026

Uploaded by acoobca