Multifocal Avascular Necrosis Complicating Delivery: A Report of Two Cases

Avascular necrosis (AVN) is characterized by bone death. It affects bones with precarious blood supply. Trauma with disruption of blood supply is a common cause. The aim of this case report is to highlight the difficulty in managing patients with AVN. We present the cases of two young mothers who presented with pains in the shoulder and hip joints. The first is a 22year Para 1+ 0 housewife referred to our centre with pains in both shoulders and hips of 14 months duration, six months following her last confinement. The Pain was severe, non-radiating, aggravated by movements and relieved with intake of analgesics. She was said to have been in labour for over 24 hours following which she was delivered of a baby boy through spontaneous vertex delivery (SVD). She however had a retained placenta that was removed piecemeal after several attempts at removal failed. The second patient is a 25year old Para 1+0, none alive woman presented with 8years Complaint of pains in both hips with limitation of movements following a difficult delivery 10 months earlier. Both patients were from a low socioeconomic economic background. They were managed with analgesics and physiotherapy and counselled for total joint replacement. Avascular necrosis and osteoarthritis of major joints poses a major challenge in management in a poor resource setting without health financing and insurance.