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Repair of Bone in the Presence of Aseptic Necrosis Resulting from Fractures, Transplantations, and Vascular Obstruction
D.B. Phemister, MD
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Appeared in JBJS Vol. 12, pp. 769-787, October 1930 (available at jbjs.org as Supplementary Material to this JBJS Classic)

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Mar 01;87(3):672-672
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Aseptic necrosis of bone may result from a number of causes—as vascular disturbances, injuries, the action of chemicals, and the application of radium in the treatment of malignant disease. The process of repair of the damaged area differs with the causative agent and with the amount of functional stimulation to which the part is subjected during the reparative period. It also differs from that seen in cases of necrosis produced by infection. Necrosis en masse produced by severe infection is nearly always followed by a fibroblastic and fixed tissue phagocytic reaction which usually results in complete absorption of the dead bone, if the area is small, or in sequestration, if it is large. However, mild inflammatory reactions, particularly when associated with embolic or thrombotic processes and due to low grade micro-organisms, may sometimes result in necrosis which is followed by simultaneous absorption of dead bone and incomplete, irregular replacement by new bone (creeping substitution).

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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