|
KMID : 0361619770120010023
|
|
Journal of the Korean Orthopaedic Association
1977 Volume.12 No. 1 p.23 ~ p.32
|
|
|
The clinical significance of Intra-Osseous Venography in the Hip injuries
|
|
문명상/Moon, Myung Sang
김인/김병기/박화현/Kim, In/Kim, Byoung Kee/Park, Wha Hyun
|
|
|
Abstract
|
|
|
We have many unsolved problems about the femoral neck fracture, especially non-union of the fracture znd avascular necrosis of the femoral head. It seems clear that underlying these are two basic problems; first, the mechanical ;difficulties in maintaining secure fixation; and second, biological factors interfering with union, paramount of which is damage to the blood supply of the femoral head.
Intra-capsular fracture of the femoral neck heals in the same way as other intra-articular fractures-only by endcsteal and nct by periosteal repair. If the femoral head has an intact blood supply, repair appears early on both sides of the fracture. But if the femoral head is not viable, this repair appears only on the neck side of the fracture. It can migrate into the head and heal the fracture only if there is close apposition and rigid fixation of well reduced fracture fragments. Clearly the femoral neck fracture heals not by periosteal callus but by callus arising from the marrow supporting structure. Yet there is still no reliable clinical method of ;determining ;early the union of the femoral neck fracture and the viability of the femoral head.
The femoral head intra-osseous venography, first described b~ Hulth (1953), to predict viability of the femoral head after fracture of the femoral neck has been carried by various previous authors (Hulth1953 1956 1958, Dahlgren 1959, Harrison 1962, Hulth and Johansson 1962, Nagai 1962). However, they did not mention healing process of fractures of the femoral neck in these studies.
To observe the fracture healing and to predict the viability of the femoral head, authors adopted a femoral trochanteric intra-osseous venographic technique. The precedure was carried out under the control of a T-V image intensifier.
Venous drainage of the femoral head parallels the arterial supply. There are several venous drainage routes in the hip region; the medial and lateral circumflex vein, gluteal vein, nutrient vein, femoral - vein, vein of the ligamentum teres and obturator vein.
With the aid of a T-V image intensifier, a bone marrow needle. is driven 1 inch below the femoral greater trochanter. When the tip of the needle is in the marrow cavity, abut 30~c, of 75% Urograffin is injected. Next X-rays are taken at intervals of 2 seconds, the last film at o minutes.
A positive venography is one in which venous drainage is seen, and opaque fluid is seen in mottled distribution throughout neck region and part of the head. A negative venography is one in which no venous drainage is seen, on the contrary, opaque fluid pools within the trochanteric region are evident and remain for at least 5 minutes. A positive venography indicates that the head has an intact circulation, thus it may be predicted that the fracture can unite and the head is alive. Negative venography suggests that fracture union is not and will not take place and that the head may be dead. This study prossided information about fractu~ a healing processes and vascularities of the femoral head and its surrounding tissues during and after fractures healing. We have found that trochanteric intra-osseous venography is a useful diagnostic tool in hip injuries.
|
|
|
KEYWORD
|
|
|
|
|
|
FullTexts / Linksout information
|
|
|
|
|
Listed journal information
|
|
  
|
|