Search Menu Abstract Objectives. Dysbaric osteonecrosis DON is a complication of ineffective decompression following exposure to high-pressure environments. This study was designed to determine risk factors for the occurrence of DON in divers. Fifty-six male divers received skeletal examinations by radiography to assess the occurrence of DON. A questionnaire was used to obtain clinical and diving information, including diving experience and maximum diving depth. Blood samples were collected to analyse the levels of plasminogen activator inhibitor PAI -1, cholesterol, triglyceride, low-density lipoprotein, very low-density lipoprotein, high-density lipoprotein, apolipoprotein A1 and apolipoprotein B.
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Presentation[ edit ] The lesion begins as a localised area of infarction , usually without symptoms. Early identification of lesions by radiography is not possible, but over time areas of radiographic opacity develop in association with the damaged bone.
Symptomatic lesions usually involve joint surfaces, and fracture where attempted healing occurs. This process takes place over months to years and eventually causes disabling arthritis , particularly of the femoral head hip. The initial damage is attributed to the formation of bubbles, and one episode can be sufficient, however incidence is sporadic and generally associated with relatively long periods of hyperbaric exposure and aetiology is uncertain.
In juxta-articular lesions without symptoms , there is dead bone and marrow separated from living bone by a line of dense collagen.
Microscopic cysts form, fill with necrotic material and there is massive necrosis with replacement by cancellous bone with collapse of the lesions. Worsening of the condition from continued decompression in an asymptomatic x-ray finding may occur.
By using the most conservative decompression schedule reasonably practicable, and by minimizing the number of major decompression exposures, the risk of DON may be reduced. Diving should be restricted to shallow depths.
Tyler C. White1; Jeffrey S. Introduction Dysbaric osteonecrosis is a type of avascular necrosis of the bone most commonly found in undersea divers and workers breathing compressed air or gas. This condition can lead to increased risk of fracture depending on the location and size of the bony defect. The rate of receiving total joint arthroplasty is increased in this patient population as well. The most commonly involved region is the hip joint, specifically the proximal femur, with bilateral involvement not being uncommon. During decompression, gas dissolved in the arterial blood comes out of solution and can form arterial gas emboli.