TITLE

ARTERIOGRAPHIC STUDIES IN FRACTURES OF THE FEMORAL NECK AND TROCHANTERIC REGION

AUTHOR(S)
Müssbichler, Herbert
PUB. DATE
June 1970
SOURCE
Angiology;Jun1970, Vol. 21 Issue 6, p385
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Arteriography was performed in 49 patients with fractures of the proximal end of the femur, in which 37 involved the medial part of the neck and 12 the trochanteric region. Of 37 recent fractures examined before osteosynthesis, 25 of them were reexamined after osteosynthesis while 12 were studied postoperatively only. In 17 cases, the contralateral unaffected hip was also examined for comparison with the fractured hip. Arteriography was made by injection of 20 ml of Dijodon, 50 per cent, through a blunt cannula or of 16 ml of Urografin, 76 per cent through a polyethylene catheter inserted into the external iliac artery. The results of the investigation comprise the following findings: (1) Out of 37 recent fractures, the circulation in the posterior collum branch was not disturbed. e.g., normal, in 19 cases. It was arrested in 12 medial neck fractures, and 3 pertrochanteric fractures and delayed only in 3 medial neck fractures. (2) Disturbed circulation occurred only in fractures which were in malrotation position. (3) After reduction of malrotation position by forced manual inward rotation of the leg, arrested circulation in the posterior collum branch improved immediately. (4) After final reduction and osteosynthesis, arrested circulation normalized or improved to '"delayed." (5) The filling of the superior retinacular artery was dependent on normal circulation in the posterior collum branch. (6) Outward rotation of the leg may affect the circulation in the posterior collum branch won after complete reduction and ostoosyntbesis as demonstrated in two pertrochanteric fractures. (7) From angiographic findings in recent unreduced neck fractures, a close relation was found between arrested circulation in the posterior collum branch and the incidence of necrosis of the femoral head as well as between normal circulation and nondevelopment of necrosis. In operated fractures, however, a correlation between delayed and normal circulation and the fate of the femoral head could not be ascertained. (8) In those 7 cases with medial neck fractures in which the superior retinaeular artery was filled, necrosis was not observed. (9) In none of the 7 pertrochanteric fractures followed-up was necrosis noted. In one of the cases the circulation in the posterior collum branch in the recent unreduced fracture had been arrested.
ACCESSION #
16371211

 

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