Blood Flow Changes to the Femoral Head After Acetabular Fracture or Dislocation in the Acute Injury and Perioperative Periods
OBJECTIVESAcute blood flow to the femoral head has been postulated to be affected negatively by traumatic acetabular fracture or dislocation. To the best of our knowledge, a prospective study that has examined acute changes in blood flow to the femoral head with respect to the timing of reduction an...
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description | OBJECTIVESAcute blood flow to the femoral head has been postulated to be affected negatively by traumatic acetabular fracture or dislocation. To the best of our knowledge, a prospective study that has examined acute changes in blood flow to the femoral head with respect to the timing of reduction and the effect of open reduction and internal fixation after acetabular fracture or dislocations has not been performed.
DESIGN AND SETTINGFrom June 1994 to February 1996, fifty-four consecutive patients with hip dislocations with or without fractures of the acetabulum were entered into this investigation. The patients were categorized into three groupsisolated dislocations, fractures or dislocations requiring open reduction and internal fixation, and isolated acetabular fractures without dislocation but requiring open reduction and internal fixation. Single-photon emission computed tomography (SPECT) scans were obtained after relocations and preoperatively and postoperatively after open reduction and internal fixation of displaced acetabular fractures.
RESULTSThe median dislocation time for all patients flow was 4.00 hours (range 1 to 24 hours). SPECT scanning showed a low blood flow pattern in five (9.25 percent) patients. A low blood flow pattern was seen in patients with early and late relocation times. Open reduction and internal fixation was not statistically associated with an avascular pattern of blood flow. Forty-two (78 percent) of our patients were available for follow-up, with an average of 24.3 months and a minimum of one year. There was one false-positive, one false-negative, and thirty-eight true-negative scans.
CONCLUSIONSA global loss of scintillation in the femoral head as determined by SPECT scanning occurs in some patients with hip dislocations and fractures or dislocations of the acetabulum in the early injury period. Changes in blood flow occurred in patients with short (one hour) and long (twenty-four hours) dislocation times. However, the development of avascular necrosis could not be predicted by early SPECT scanning. Until further multicenter studies are performed, SPECT scanning cannot be recommended on an acute or routine basis to predict those patients who will develop avascular necrosis. Operative approaches for open reduction of the hip and internal fixation of acetabular fractures do not appear to affect blood flow to the femoral head. Although a golden time to relocation cannot be fully established from this study, early relocation |
doi_str_mv | 10.1097/00005131-200103000-00004 |
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DESIGN AND SETTINGFrom June 1994 to February 1996, fifty-four consecutive patients with hip dislocations with or without fractures of the acetabulum were entered into this investigation. The patients were categorized into three groupsisolated dislocations, fractures or dislocations requiring open reduction and internal fixation, and isolated acetabular fractures without dislocation but requiring open reduction and internal fixation. Single-photon emission computed tomography (SPECT) scans were obtained after relocations and preoperatively and postoperatively after open reduction and internal fixation of displaced acetabular fractures.
RESULTSThe median dislocation time for all patients flow was 4.00 hours (range 1 to 24 hours). SPECT scanning showed a low blood flow pattern in five (9.25 percent) patients. A low blood flow pattern was seen in patients with early and late relocation times. Open reduction and internal fixation was not statistically associated with an avascular pattern of blood flow. Forty-two (78 percent) of our patients were available for follow-up, with an average of 24.3 months and a minimum of one year. There was one false-positive, one false-negative, and thirty-eight true-negative scans.
CONCLUSIONSA global loss of scintillation in the femoral head as determined by SPECT scanning occurs in some patients with hip dislocations and fractures or dislocations of the acetabulum in the early injury period. Changes in blood flow occurred in patients with short (one hour) and long (twenty-four hours) dislocation times. However, the development of avascular necrosis could not be predicted by early SPECT scanning. Until further multicenter studies are performed, SPECT scanning cannot be recommended on an acute or routine basis to predict those patients who will develop avascular necrosis. Operative approaches for open reduction of the hip and internal fixation of acetabular fractures do not appear to affect blood flow to the femoral head. Although a golden time to relocation cannot be fully established from this study, early relocation is advised to decrease the potential risk of vascular spasm, scarring, and subsequent avascular necrosis.</description><identifier>ISSN: 0890-5339</identifier><identifier>EISSN: 1531-2291</identifier><identifier>DOI: 10.1097/00005131-200103000-00004</identifier><identifier>PMID: 11265006</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins, Inc</publisher><subject>Acetabulum - injuries ; Acute Disease ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Blood Flow Velocity ; Chi-Square Distribution ; Female ; Femur Head - blood supply ; Femur Head Necrosis - diagnostic imaging ; Femur Head Necrosis - etiology ; Femur Head Necrosis - physiopathology ; Follow-Up Studies ; Fracture Fixation, Internal - adverse effects ; Fracture Fixation, Internal - methods ; Fracture Healing - physiology ; Fractures, Bone - complications ; Fractures, Bone - diagnostic imaging ; Fractures, Bone - surgery ; Hip Joint - diagnostic imaging ; Hip Joint - physiopathology ; Humans ; Injuries of the limb. Injuries of the spine ; Injury Severity Score ; Joint Dislocations - complications ; Joint Dislocations - diagnostic imaging ; Joint Dislocations - surgery ; Male ; Medical sciences ; Middle Aged ; Postoperative Period ; Preoperative Care ; Prospective Studies ; Radiography ; Tomography, Emission-Computed, Single-Photon - methods ; Traumas. Diseases due to physical agents ; Treatment Outcome</subject><ispartof>Journal of orthopaedic trauma, 2001-03, Vol.15 (3), p.170-176</ispartof><rights>2001 Lippincott Williams & Wilkins, Inc.</rights><rights>2001 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4134-aa6c486185a4f1a8838f11bb8a0795ce3cb704a7efd2356e39b317a35ad09fc43</citedby><cites>FETCH-LOGICAL-c4134-aa6c486185a4f1a8838f11bb8a0795ce3cb704a7efd2356e39b317a35ad09fc43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=942193$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11265006$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yue, James J</creatorcontrib><creatorcontrib>Sontich, John K</creatorcontrib><creatorcontrib>Miron, Stefan D</creatorcontrib><creatorcontrib>Peljovich, Allan E</creatorcontrib><creatorcontrib>Wilber, John H</creatorcontrib><creatorcontrib>Yue, David N</creatorcontrib><creatorcontrib>Patterson, Brendan M</creatorcontrib><title>Blood Flow Changes to the Femoral Head After Acetabular Fracture or Dislocation in the Acute Injury and Perioperative Periods</title><title>Journal of orthopaedic trauma</title><addtitle>J Orthop Trauma</addtitle><description>OBJECTIVESAcute blood flow to the femoral head has been postulated to be affected negatively by traumatic acetabular fracture or dislocation. To the best of our knowledge, a prospective study that has examined acute changes in blood flow to the femoral head with respect to the timing of reduction and the effect of open reduction and internal fixation after acetabular fracture or dislocations has not been performed.
DESIGN AND SETTINGFrom June 1994 to February 1996, fifty-four consecutive patients with hip dislocations with or without fractures of the acetabulum were entered into this investigation. The patients were categorized into three groupsisolated dislocations, fractures or dislocations requiring open reduction and internal fixation, and isolated acetabular fractures without dislocation but requiring open reduction and internal fixation. Single-photon emission computed tomography (SPECT) scans were obtained after relocations and preoperatively and postoperatively after open reduction and internal fixation of displaced acetabular fractures.
RESULTSThe median dislocation time for all patients flow was 4.00 hours (range 1 to 24 hours). SPECT scanning showed a low blood flow pattern in five (9.25 percent) patients. A low blood flow pattern was seen in patients with early and late relocation times. Open reduction and internal fixation was not statistically associated with an avascular pattern of blood flow. Forty-two (78 percent) of our patients were available for follow-up, with an average of 24.3 months and a minimum of one year. There was one false-positive, one false-negative, and thirty-eight true-negative scans.
CONCLUSIONSA global loss of scintillation in the femoral head as determined by SPECT scanning occurs in some patients with hip dislocations and fractures or dislocations of the acetabulum in the early injury period. Changes in blood flow occurred in patients with short (one hour) and long (twenty-four hours) dislocation times. However, the development of avascular necrosis could not be predicted by early SPECT scanning. Until further multicenter studies are performed, SPECT scanning cannot be recommended on an acute or routine basis to predict those patients who will develop avascular necrosis. Operative approaches for open reduction of the hip and internal fixation of acetabular fractures do not appear to affect blood flow to the femoral head. Although a golden time to relocation cannot be fully established from this study, early relocation is advised to decrease the potential risk of vascular spasm, scarring, and subsequent avascular necrosis.</description><subject>Acetabulum - injuries</subject><subject>Acute Disease</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Blood Flow Velocity</subject><subject>Chi-Square Distribution</subject><subject>Female</subject><subject>Femur Head - blood supply</subject><subject>Femur Head Necrosis - diagnostic imaging</subject><subject>Femur Head Necrosis - etiology</subject><subject>Femur Head Necrosis - physiopathology</subject><subject>Follow-Up Studies</subject><subject>Fracture Fixation, Internal - adverse effects</subject><subject>Fracture Fixation, Internal - methods</subject><subject>Fracture Healing - physiology</subject><subject>Fractures, Bone - complications</subject><subject>Fractures, Bone - diagnostic imaging</subject><subject>Fractures, Bone - surgery</subject><subject>Hip Joint - diagnostic imaging</subject><subject>Hip Joint - physiopathology</subject><subject>Humans</subject><subject>Injuries of the limb. Injuries of the spine</subject><subject>Injury Severity Score</subject><subject>Joint Dislocations - complications</subject><subject>Joint Dislocations - diagnostic imaging</subject><subject>Joint Dislocations - surgery</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Postoperative Period</subject><subject>Preoperative Care</subject><subject>Prospective Studies</subject><subject>Radiography</subject><subject>Tomography, Emission-Computed, Single-Photon - methods</subject><subject>Traumas. Diseases due to physical agents</subject><subject>Treatment Outcome</subject><issn>0890-5339</issn><issn>1531-2291</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kcFu1DAQhi0EokvhFZAlJG4BT-wk9nFZWFqpEhzgbE2cCZvijRfb6aoH3p2ku5QTvljz6_s90mfGOIh3IEzzXsynAglFKQQIOU_FEqknbAXVEpcGnrKV0EYUlZTmgr1I6XYmtCjL5-wCoKwrIeoV-_3Bh9DxrQ9Hvtnh-IMSz4HnHfEt7UNEz68IO77uM0W-dpSxnTxGvo3o8hSJh8g_DskHh3kIIx_Gh_LaTZn49Xg7xXuOY8e_UhzCgeJM3dFp6tJL9qxHn-jV-b5k37efvm2uipsvn68365vCKZCqQKyd0jXoClUPqLXUPUDbahSNqRxJ1zZCYUN9V8qqJmlaCQ3KCjtheqfkJXt7evcQw6-JUrb7ITnyHkcKU7JNI2YxegH1CXQxpBSpt4c47DHeWxB2UW__qreP6h-ipfr6vGNq99T9K55dz8CbM4DJoe8jjm5Ij5xRJRg5U-pEHYOflaeffjpStDtCn3f2fx8v_wBbMpqr</recordid><startdate>200103</startdate><enddate>200103</enddate><creator>Yue, James J</creator><creator>Sontich, John K</creator><creator>Miron, Stefan D</creator><creator>Peljovich, Allan E</creator><creator>Wilber, John H</creator><creator>Yue, David N</creator><creator>Patterson, Brendan M</creator><general>Lippincott Williams & Wilkins, Inc</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200103</creationdate><title>Blood Flow Changes to the Femoral Head After Acetabular Fracture or Dislocation in the Acute Injury and Perioperative Periods</title><author>Yue, James J ; Sontich, John K ; Miron, Stefan D ; Peljovich, Allan E ; Wilber, John H ; Yue, David N ; Patterson, Brendan M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4134-aa6c486185a4f1a8838f11bb8a0795ce3cb704a7efd2356e39b317a35ad09fc43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Acetabulum - injuries</topic><topic>Acute Disease</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Blood Flow Velocity</topic><topic>Chi-Square Distribution</topic><topic>Female</topic><topic>Femur Head - blood supply</topic><topic>Femur Head Necrosis - diagnostic imaging</topic><topic>Femur Head Necrosis - etiology</topic><topic>Femur Head Necrosis - physiopathology</topic><topic>Follow-Up Studies</topic><topic>Fracture Fixation, Internal - adverse effects</topic><topic>Fracture Fixation, Internal - methods</topic><topic>Fracture Healing - physiology</topic><topic>Fractures, Bone - complications</topic><topic>Fractures, Bone - diagnostic imaging</topic><topic>Fractures, Bone - surgery</topic><topic>Hip Joint - diagnostic imaging</topic><topic>Hip Joint - physiopathology</topic><topic>Humans</topic><topic>Injuries of the limb. Injuries of the spine</topic><topic>Injury Severity Score</topic><topic>Joint Dislocations - complications</topic><topic>Joint Dislocations - diagnostic imaging</topic><topic>Joint Dislocations - surgery</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Postoperative Period</topic><topic>Preoperative Care</topic><topic>Prospective Studies</topic><topic>Radiography</topic><topic>Tomography, Emission-Computed, Single-Photon - methods</topic><topic>Traumas. Diseases due to physical agents</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yue, James J</creatorcontrib><creatorcontrib>Sontich, John K</creatorcontrib><creatorcontrib>Miron, Stefan D</creatorcontrib><creatorcontrib>Peljovich, Allan E</creatorcontrib><creatorcontrib>Wilber, John H</creatorcontrib><creatorcontrib>Yue, David N</creatorcontrib><creatorcontrib>Patterson, Brendan M</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of orthopaedic trauma</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yue, James J</au><au>Sontich, John K</au><au>Miron, Stefan D</au><au>Peljovich, Allan E</au><au>Wilber, John H</au><au>Yue, David N</au><au>Patterson, Brendan M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Blood Flow Changes to the Femoral Head After Acetabular Fracture or Dislocation in the Acute Injury and Perioperative Periods</atitle><jtitle>Journal of orthopaedic trauma</jtitle><addtitle>J Orthop Trauma</addtitle><date>2001-03</date><risdate>2001</risdate><volume>15</volume><issue>3</issue><spage>170</spage><epage>176</epage><pages>170-176</pages><issn>0890-5339</issn><eissn>1531-2291</eissn><abstract>OBJECTIVESAcute blood flow to the femoral head has been postulated to be affected negatively by traumatic acetabular fracture or dislocation. To the best of our knowledge, a prospective study that has examined acute changes in blood flow to the femoral head with respect to the timing of reduction and the effect of open reduction and internal fixation after acetabular fracture or dislocations has not been performed.
DESIGN AND SETTINGFrom June 1994 to February 1996, fifty-four consecutive patients with hip dislocations with or without fractures of the acetabulum were entered into this investigation. The patients were categorized into three groupsisolated dislocations, fractures or dislocations requiring open reduction and internal fixation, and isolated acetabular fractures without dislocation but requiring open reduction and internal fixation. Single-photon emission computed tomography (SPECT) scans were obtained after relocations and preoperatively and postoperatively after open reduction and internal fixation of displaced acetabular fractures.
RESULTSThe median dislocation time for all patients flow was 4.00 hours (range 1 to 24 hours). SPECT scanning showed a low blood flow pattern in five (9.25 percent) patients. A low blood flow pattern was seen in patients with early and late relocation times. Open reduction and internal fixation was not statistically associated with an avascular pattern of blood flow. Forty-two (78 percent) of our patients were available for follow-up, with an average of 24.3 months and a minimum of one year. There was one false-positive, one false-negative, and thirty-eight true-negative scans.
CONCLUSIONSA global loss of scintillation in the femoral head as determined by SPECT scanning occurs in some patients with hip dislocations and fractures or dislocations of the acetabulum in the early injury period. Changes in blood flow occurred in patients with short (one hour) and long (twenty-four hours) dislocation times. However, the development of avascular necrosis could not be predicted by early SPECT scanning. Until further multicenter studies are performed, SPECT scanning cannot be recommended on an acute or routine basis to predict those patients who will develop avascular necrosis. Operative approaches for open reduction of the hip and internal fixation of acetabular fractures do not appear to affect blood flow to the femoral head. Although a golden time to relocation cannot be fully established from this study, early relocation is advised to decrease the potential risk of vascular spasm, scarring, and subsequent avascular necrosis.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>11265006</pmid><doi>10.1097/00005131-200103000-00004</doi><tpages>7</tpages></addata></record> |
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subjects | Acetabulum - injuries Acute Disease Adolescent Adult Aged Aged, 80 and over Biological and medical sciences Blood Flow Velocity Chi-Square Distribution Female Femur Head - blood supply Femur Head Necrosis - diagnostic imaging Femur Head Necrosis - etiology Femur Head Necrosis - physiopathology Follow-Up Studies Fracture Fixation, Internal - adverse effects Fracture Fixation, Internal - methods Fracture Healing - physiology Fractures, Bone - complications Fractures, Bone - diagnostic imaging Fractures, Bone - surgery Hip Joint - diagnostic imaging Hip Joint - physiopathology Humans Injuries of the limb. Injuries of the spine Injury Severity Score Joint Dislocations - complications Joint Dislocations - diagnostic imaging Joint Dislocations - surgery Male Medical sciences Middle Aged Postoperative Period Preoperative Care Prospective Studies Radiography Tomography, Emission-Computed, Single-Photon - methods Traumas. Diseases due to physical agents Treatment Outcome |
title | Blood Flow Changes to the Femoral Head After Acetabular Fracture or Dislocation in the Acute Injury and Perioperative Periods |
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