The role of electrical stimulation in the management of avascular necrosis of the femoral head in adults: a systematic review.

BACKGROUND: Avascular necrosis of the femoral head causes significant morbidity and occurs in up to 20,000 people per year. A variety of nonoperative and operative measures have been trialled however a definitive treatment algorithm is yet to be established. Young adults in many cases have undergone multiple surgical procedures in their lifetime with increasing risks of complications. Less invasive techniques may help reduce the number of operations required and positively influence the natural history of the disease process. Our aim was to navigate the literature and examine the results of electrical stimulation of the femoral head in avascular necrosis. METHODS: The following defined search strategy was used to perform a systematic review using MEDLINE and Google Scholar databases: ((avascular necrosis) OR (osteonecrosis)) AND (femoral head) AND ((electrical stimulation) OR (capacitive coupling) OR (pulsed electromagnetic fields)). Articles were reviewed and data compiled into tables for analysis. RESULTS: Fourty six articles were identified with a total of 10 articles meeting the inclusion criteria. 8 articles were prospective studies and 2 were retrospective. Early Ficat stages showed the best responses to treatment via pulsed electromagnetic fields with improvements in both clinical and radiographic parameters. Direct current and capacitative coupling have had a more ambiguous outcome. CONCLUSIONS: Pulsed electromagnetic fields may have a role in the management of early avascular necrosis. The paucity of clinical studies into this technique indicates a need for further studies.

Primary extraskeletal osteosarcoma of small bowel mesentery presenting with acute bowel obstruction.

Extraskeletal osteosarcoma of the small bowel mesentery is an exceedingly rare condition. It is an aggressive malignant neoplasm of mesenchymal origin characterized by osteoid formation. Final diagnosis is often made by histopathological analysis. However, we believe that prospective radiological diagnosis may be possible through careful analysis of densities (ossification) within the mesenteric mass. To the best of our knowledge, there is no current literature describing the radiological approach to making a prospective diagnosis of this condition. We present the 12th case of extraskeletal osteosarcoma worldwide and describe a radiological approach that is potentially useful in making a prospective diagnosis.