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Avascular necrosis of the femoral head
Volume I Number I
HUTZSCHENREUTER ET AL. : RIGIDITY OF INTERNAL FIXATION
MULLER, M. E., ALLGOWER, M., and WILLENEGGER, H. (1963), Technik der Operativen Frakturenbehandhmg. Berlin: Springer. PERREN, S. M., HUGGLER, A., RUSSENBERGER, M., ALLGOWER, M., MATHYS, R., SCHENK, R., WILLENEGGER, H., and MOLLER, M. E. (1969), ' The Reaction of Cortical Bone to Static Compression', Acta orthop, scand., in the press. RAHN, B., GALLINARO, P., HUNTER, W., SCHENK, R., and PERREN, S. M. (1969), ' P r i m a r y Healing of
81
Osteotomies in Rabbits using New Compression Plates ', Ibid., in the press. SCHENK, R., MOLLER, J., and WILLENEGGER,H. (1968), 'Experimentell-histologischer Beitrag zur Entstehung und Behandlung von Pseudarthrosen ', Hft. Unfallheilk., 94, 15. --and WILLENEGGER, H. (1963), ' Histologie der Prim~ren Knochenheilung ', Arch.klin. Chir., 19, 593. (1967), ' Morphological Findings in Primary Fracture Healing ', Syrup. Biol. hung., 7, 75.
Requests for reprhlts should be addressed to:--P. Hutzschenreuter, Laboratory for ExperimentalSurgery, CH 7270, Davos-Platz, Switzerland.
ABSTRACTS Dislocations of the Hip
Dislocations and associated fractures of the hipjoint can be very disabling. They are relatively common to car occupants; they amounted to 10 per cent of the authors' unselected series of hospital admissions. Fifty cases are analysed in 4 diagnostic groups; 26 of them were posterior dislocations or posterior fracture-dislocations--all due to accidents with frontal aspects. Dislocations without fracture appeared to be caused by impacts on the knee with the thigh more flexed than in the injuries complicated by fractures. In 6 cases the posterior wall and in 11 cases the roof of the acetabulum was fractured. Most of these injuries were from frontal impacts. The 7 cases of central fracture-dislocation are of particular interest in that most were caused by direct impacts from the side. In several of the cases reviewed seat-belts were being worn at the time. As has previously been shown, these only provide partial restraint of the lower limbs. It follows that improved design of fascia panels to absorb impact by the knee is still required, even if seatbelts are universally used. This article is well illustrated with radiographs of the injuries and photographs of the vehicles in which they occurred. The authors are on the staff of the Road Research Laboratory; this bridging of the gap between engineers studying the design of roads and vehicles, and clinicians having to deal with injuries produced in that environment is particularly appropriate. GRATTAN, E., and HOBBS, J. A. (1969), ' Injuries to Hip Joint in Car Occupants ', Br. rned. J., 1, 71. Dislocation of the Hip
Forty-nine of the 57 cases reviewed in this article sustained their injury as the result of a car or motorcycle accident. In 45 per cent of cases the dislocation occurred without fracture, and in 41 per cent was associated with a fracture of the lip of the acetabulum. In only 14 per cent of the cases was the dislocation associated with a fracture through the acetabulum or the femoral head. The injury was complicated by a sciatic nerve lesion in 6 cases, but in 5 cases the nerve lesion recovered within 5 days of reduction.
Peri-articular calcification was a late sequela in 5 cases, but in itself did not appear to be of any clinical significance. Only 1 patient showed signs of true avascular necrosis, but radiographic changes of some degree of degenerative arthritis were seen in 15 cases, the majority occurring in patients over the age of 50. The average period of follow-up was 7 years. The follow-up of dislocations without fracture supports the view that immobilization by simple traction should be confined to a period of about 3 weeks, allowing full weight-bearing after a further 3 weeks. The number of cases submitted to open reduction and fixation of the posterior fragment of the acetabulum was too small to permit any definiteconclusions, but does suggest that it should only be performed if closed reduction fails, or there is recurrent dislocation implying instability. The degree of functional disability frequently bore little relationship to the radiographic changes, and reconstructive surgery of the hip should be delayed until the patient becomes increasingly disabled. HUNTER, G. A. (1969), ' Posterior Dislocation and Fracture-dislocation of the Hip. A Review of 57 Patients ', J. Bone Jt Surg., 51B, 63. Avascular Necrosis of the Femoral Head
Experimental investigations of ischaemic changes in the femoral head in rabbits were conducted by transecting the ligament of the femoral head and applying a ligature around the femoral neck. Using various staining techniques, a comparison was made between osteocyte nuclei from the controlled epiphysis and the operated epiphysis of the same animal, using an integral microcytometer. Distinct histological signs of disintegration were present 6 hours after operation with a progressive loss in D N A content during the period of ischaemia. A study of the results led to the conclusion that in the femoral head of the rabbit the period of irreversible damage for osteocytes must have ended within 6 hours. They suggest that in dealing with a clinical condition involving impairment of blood-supply to the femoral head (for example, a fresh fracture of the neck of the femur), it should be treated immediately in order to prevent irreparable damage, although evidence of such damage might become apparent only after many months. ROSINGH, G. E., and JAMES, J. (1969), ' E a r l y Phases of Avascular Necrosis of the Femoral Head in Rabbits ', J. Bone Jt Surg., 51B, 165.
HUTZSCHENREUTER ET AL. : RIGIDITY OF INTERNAL FIXATION
MULLER, M. E., ALLGOWER, M., and WILLENEGGER, H. (1963), Technik der Operativen Frakturenbehandhmg. Berlin: Springer. PERREN, S. M., HUGGLER, A., RUSSENBERGER, M., ALLGOWER, M., MATHYS, R., SCHENK, R., WILLENEGGER, H., and MOLLER, M. E. (1969), ' The Reaction of Cortical Bone to Static Compression', Acta orthop, scand., in the press. RAHN, B., GALLINARO, P., HUNTER, W., SCHENK, R., and PERREN, S. M. (1969), ' P r i m a r y Healing of
81
Osteotomies in Rabbits using New Compression Plates ', Ibid., in the press. SCHENK, R., MOLLER, J., and WILLENEGGER,H. (1968), 'Experimentell-histologischer Beitrag zur Entstehung und Behandlung von Pseudarthrosen ', Hft. Unfallheilk., 94, 15. --and WILLENEGGER, H. (1963), ' Histologie der Prim~ren Knochenheilung ', Arch.klin. Chir., 19, 593. (1967), ' Morphological Findings in Primary Fracture Healing ', Syrup. Biol. hung., 7, 75.
Requests for reprhlts should be addressed to:--P. Hutzschenreuter, Laboratory for ExperimentalSurgery, CH 7270, Davos-Platz, Switzerland.
ABSTRACTS Dislocations of the Hip
Dislocations and associated fractures of the hipjoint can be very disabling. They are relatively common to car occupants; they amounted to 10 per cent of the authors' unselected series of hospital admissions. Fifty cases are analysed in 4 diagnostic groups; 26 of them were posterior dislocations or posterior fracture-dislocations--all due to accidents with frontal aspects. Dislocations without fracture appeared to be caused by impacts on the knee with the thigh more flexed than in the injuries complicated by fractures. In 6 cases the posterior wall and in 11 cases the roof of the acetabulum was fractured. Most of these injuries were from frontal impacts. The 7 cases of central fracture-dislocation are of particular interest in that most were caused by direct impacts from the side. In several of the cases reviewed seat-belts were being worn at the time. As has previously been shown, these only provide partial restraint of the lower limbs. It follows that improved design of fascia panels to absorb impact by the knee is still required, even if seatbelts are universally used. This article is well illustrated with radiographs of the injuries and photographs of the vehicles in which they occurred. The authors are on the staff of the Road Research Laboratory; this bridging of the gap between engineers studying the design of roads and vehicles, and clinicians having to deal with injuries produced in that environment is particularly appropriate. GRATTAN, E., and HOBBS, J. A. (1969), ' Injuries to Hip Joint in Car Occupants ', Br. rned. J., 1, 71. Dislocation of the Hip
Forty-nine of the 57 cases reviewed in this article sustained their injury as the result of a car or motorcycle accident. In 45 per cent of cases the dislocation occurred without fracture, and in 41 per cent was associated with a fracture of the lip of the acetabulum. In only 14 per cent of the cases was the dislocation associated with a fracture through the acetabulum or the femoral head. The injury was complicated by a sciatic nerve lesion in 6 cases, but in 5 cases the nerve lesion recovered within 5 days of reduction.
Peri-articular calcification was a late sequela in 5 cases, but in itself did not appear to be of any clinical significance. Only 1 patient showed signs of true avascular necrosis, but radiographic changes of some degree of degenerative arthritis were seen in 15 cases, the majority occurring in patients over the age of 50. The average period of follow-up was 7 years. The follow-up of dislocations without fracture supports the view that immobilization by simple traction should be confined to a period of about 3 weeks, allowing full weight-bearing after a further 3 weeks. The number of cases submitted to open reduction and fixation of the posterior fragment of the acetabulum was too small to permit any definiteconclusions, but does suggest that it should only be performed if closed reduction fails, or there is recurrent dislocation implying instability. The degree of functional disability frequently bore little relationship to the radiographic changes, and reconstructive surgery of the hip should be delayed until the patient becomes increasingly disabled. HUNTER, G. A. (1969), ' Posterior Dislocation and Fracture-dislocation of the Hip. A Review of 57 Patients ', J. Bone Jt Surg., 51B, 63. Avascular Necrosis of the Femoral Head
Experimental investigations of ischaemic changes in the femoral head in rabbits were conducted by transecting the ligament of the femoral head and applying a ligature around the femoral neck. Using various staining techniques, a comparison was made between osteocyte nuclei from the controlled epiphysis and the operated epiphysis of the same animal, using an integral microcytometer. Distinct histological signs of disintegration were present 6 hours after operation with a progressive loss in D N A content during the period of ischaemia. A study of the results led to the conclusion that in the femoral head of the rabbit the period of irreversible damage for osteocytes must have ended within 6 hours. They suggest that in dealing with a clinical condition involving impairment of blood-supply to the femoral head (for example, a fresh fracture of the neck of the femur), it should be treated immediately in order to prevent irreparable damage, although evidence of such damage might become apparent only after many months. ROSINGH, G. E., and JAMES, J. (1969), ' E a r l y Phases of Avascular Necrosis of the Femoral Head in Rabbits ', J. Bone Jt Surg., 51B, 165.