Management of a complex case of avascular necrosis of femoral head encased by extensive venous malformation

Abstract

We report a case of a 26-year-old female patient who suffered from avascular necrosis of femoral head of the left hip encased by extensive venous malformations (VMs) causing severe movement impairment and uncontrolled pain, and complicated with consumptive coagulopathy. Following unsuccessful non-surgical management, a Girdlestone procedure was planned and performed, after a session of sclerotherapy, by a specialist multi-disciplinary team for vascular anomalies. The consumptive coagulopathy was managed with tight monitoring of her coagulation profile, optimization of anti-coagulation, adequate platelet, fibrinogen and clotting factor replacement, and tranexamic acid to reduce the risk of bleeding. The Girdlestone procedure led to marked improvement in her symptoms postoperatively. This case highlights the importance of specialist multi-disciplinary management of surgical problems involving patients with complex vascular anomalies to achieve optimal outcomes.

Keywords

• Venous malformations
• Girdlestone operation
• Localized intravascular coagulopathy
• Avascular necrosis of femoral head