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Traumatic Avascular Necrosis of the Femoral Head

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Osteonecrosis

Abstract

Avascular necrosis (AVN) of the femoral head is a rare but devastating complication following fractures of the proximal femur or hip dislocation. Traumatic AVN derives from the interruption of the blood flow to the femoral head, which is mainly supplied by the medial circumflex femoral artery (MCFA) in the adult hip [1, 2]. The incidence of AVN depends on the fracture pattern and the integrity of the deep branch of the MCFA. In addition to traumatic interruption of the femoral head blood supply, the MCFA can be injured iatrogenically. Symptoms and radiographic changes in hips with AVN of the femoral head usually occur late and often months after the trauma. There is no curative treatment and therefore prevention is most important. While total hip arthroplasty shows very good clinical results in elderly patients, it is not the treatment of choice in children and adolescents with AVN. For this age group, hip preserving alternatives include core decompression, femoral osteotomies, and various bone grafting techniques.

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References

  1. Gautier E, Ganz K, Krugel N, Gill T, Ganz R. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br. 2000;82(5):679–83.

    Article  CAS  PubMed  Google Scholar 

  2. Sevitt S, Thompson RG. The distribution and anastomoses of arteries supplying the head and neck of the femur. J Bone Joint Surg Br. 1965;47:560–73.

    CAS  PubMed  Google Scholar 

  3. Tannast M, Mack PW, Klaeser B, Siebenrock KA. Hip dislocation and femoral neck fracture: decision-making for head preservation. Injury. 2009;40(10):1118–24.

    Article  PubMed  Google Scholar 

  4. Kalhor M, Horowitz K, Gharehdaghi J, Beck M, Ganz R. Anatomic variations in femoral head circulation. Hip Int. 2012;22(3):307–12.

    Article  PubMed  Google Scholar 

  5. Brünner S, Christiansen J, Kristensen JK. Arteriographic prediction of femoral head viability in medial femoral neck fractures. Acta Chir Scand. 1967;133(6):449.

    PubMed  Google Scholar 

  6. Müssbichler H. Arteriographic studies in fractures of the femoral neck and trochanteric region type and incidence of findings in pre-and postoperative examina tions, relation to fracture dislocation and prognostic value. Angiology. 1970;21(6):385–402.

    Article  PubMed  Google Scholar 

  7. Gill TJ, Sledge JB, Ekkernkamp A, Ganz R. Intraoperative assessment of femoral head vascularity after femoral neck fracture. J Orthop Trauma. 1998;12(7):474–8.

    Article  CAS  PubMed  Google Scholar 

  8. Zlotorowicz M, Czubak J, Kozinski P, Boguslawska-Walecka R. Imaging the vascularisation of the femoral head by CT angiography. J Bone Joint Surg Br. 2012;94(9):1176–9.

    Article  CAS  PubMed  Google Scholar 

  9. Hirata T, Konishiike T, Kawai A, Sato T, Inoue H. Dynamic magnetic resonance imaging of femoral head perfusion in femoral neck fracture. Clin Orthop Relat Res. 2001;393:294–301.

    Article  PubMed  Google Scholar 

  10. Bauer G, Weber DA, Ceder L, Darte L, Egund N, Hansson LI, Strömqvist B. Dynamics of technetium-99m methylenediphosphonate imaging of the femoral head after hip fracture. Clin Orthop Relat Res. 1980;152:85–92.

    PubMed  Google Scholar 

  11. D’Ambrosia RD, Riggins RS, Stadalnik RC, Denardo GL. Vascularity of the femoral head: 99mTc diphosphonate scintigraphy validated with tetracycline labeling. Clin Orthop Relat Res. 1976;121:143–8.

    PubMed  Google Scholar 

  12. Cho M-R, Lee S-W, Shin D-K, Kim S-K, Kim S-Y, Ko S-B, Kwun K-W. A predictive method for subsequent avascular necrosis of the femoral head (AVNFH) by observation of bleeding from the cannulated screw used for fixation of intracapsular femoral neck fractures. J Orthop Trauma. 2007;21(3):158–64.

    Article  PubMed  Google Scholar 

  13. Sugamoto K, Ochi T, Takahashi Y, Tamura T, Matsuoka T. Hemodynamic measurement in the femoral head using laser Doppler. Clin Orthop Relat Res. 1998;353:138–47.

    Article  PubMed  Google Scholar 

  14. Watanabe Y, Terashima Y, Takenaka N, Kobayashi M, Matsushita T. Prediction of avascular necrosis of the femoral head by measuring intramedullary oxygen tension after femoral neck fracture. J Orthop Trauma. 2007;21(7):456–61.

    Article  PubMed  Google Scholar 

  15. Giannoudis PV, Kontakis G, Christoforakis Z, Akula M, Tosounidis T, Koutras C. Management, complications and clinical results of femoral head fractures. Injury. 2009;40(12):1245–51.

    Article  CAS  PubMed  Google Scholar 

  16. Guo JJ, Tang N, Yang HL, Qin L, Leung KS. Impact of surgical approach on postoperative heterotopic ossification and avascular necrosis in femoral head fractures: a systematic review. Int Orthop. 2010;34(3):319–22.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Moon ES, Mehlman CT. Risk factors for avascular necrosis after femoral neck fractures in children: 25 Cincinnati cases and meta-analysis of 360 cases. J Orthop Trauma. 2006;20(5):323–9.

    Article  PubMed  Google Scholar 

  18. Yeranosian M, Horneff JG, Baldwin K, Hosalkar HS. Factors affecting the outcome of fractures of the femoral neck in children and adolescents a systematic review. J Bone Joint Surg Am. 2013;95(1):135–42.

    Article  Google Scholar 

  19. Garden RS. Malreduction and avascular necrosis in subcapital fractures of the femur. J Bone Joint Surg Br. 1971;53(2):183–97.

    CAS  PubMed  Google Scholar 

  20. Holmberg S, Kalén R, Thorngren KG. Treatment and outcome of femoral neck fractures an analysis of 2418 patients admitted from their own homes. Clin Orthop Relat Res. 1987;218:42–52.

    PubMed  Google Scholar 

  21. Johnson JT, Crothers O. Nailing versus prosthesis for femoral-neck fractures. A critical review of long-term results in two hundred and thirty-nine consecutive private patients. J Bone Joint Surg Am. 1975;57(5):686–92.

    CAS  PubMed  Google Scholar 

  22. Strömqvist B, Hansson LI, Nilsson LT, Thorngren K-G. Hook-pin fixation in femoral neck fractures a two-year follow-up study of 300 cases. Clin Orthop Relat Res. 1987;218:58–62.

    PubMed  Google Scholar 

  23. Aguado-Maestro I, Escudero-Marcos R, Garcia-Garcia JM, Alonso-Garcia N, Perez-Bermejo DD, Aguado-Hernandez HJ, Nistal-Rodriguez J, Garcia-Alonso M. Results and complications of pertrochanteric hip fractures using an intramedullary nail with a helical blade (proximal femoral nail antirotation) in 200 patients. Rev Esp Cir Ortop Traumatol. 2013;57(3):201–7.

    CAS  PubMed  Google Scholar 

  24. Orler R, Hersche O, Helfet DL, Mayo KA, Ward T, Ganz R. Avascular necrosis of the femoral head as a serious complication following femoral nailing in children and adolescents. Unfallchirurg. 1998;101(6):495–9.

    Article  CAS  PubMed  Google Scholar 

  25. Brav EA. Traumatic dislocation of the hip: army experience and results over a 12 year period. J Bone Joint Surg Am. 1962;44:1115–34.

    Google Scholar 

  26. Epstein HC. Posterior fracture-dislocations of the hip; long-term follow-up. J Bone Joint Surg Am. 1974;56(6):1103–27.

    CAS  PubMed  Google Scholar 

  27. Hougaard K, Thomsen PB. Traumatic posterior dislocation of the hip—prognostic factors influencing the incidence of avascular necrosis of the femoral head. Arch Orthop Trauma Surg. 1986;106(1):32–5.

    Article  CAS  PubMed  Google Scholar 

  28. Delbet MP. Fractures du col de femur. Bull Mem Soc Chir. 1907;35:387–9.

    Google Scholar 

  29. Jain R, Koo M, Kreder HJ, Schemitsch EH, Davey JR, Mahomed NN. Comparison of early and delayed fixation of subcapital hip fractures in patients sixty years of age or less. J Bone Joint Surg Am. 2002;84(9):1605–12.

    PubMed  Google Scholar 

  30. Pillai A, Little K, Chappell A. Osteonecrosis of the femoral head following medullary nailing of the femur in an adult. Acta orthopaedica belgica. 2007;73(2):258.

    PubMed  Google Scholar 

  31. Wu C-C, Yu C-T, Hsieh C-P, Chen S-J, Chang L. Femoral head avascular necrosis after interlocking nail of a femoral shaft fracture in a male adult: a case report. Arch Orthop Trauma Surg. 2008;128(4):399–402.

    Article  PubMed  Google Scholar 

  32. Dora C, Leunig M, Beck M, Rothenfluh D, Ganz R. Entry point soft tissue damage in antegrade femoral nailing: a cadaver study. J Orthop Trauma. 2001;15(7):488–93.

    Article  CAS  PubMed  Google Scholar 

  33. Stannard JP, Harris HW, Volgas DA, Alonso JE. Functional outcome of patients with femoral head fractures associated with hip dislocations. Clin Orthop Relat Res. 2000;377:44–56.

    Article  PubMed  Google Scholar 

  34. Ganz R, Gill TJ, Gautier E, Ganz K, Krugel N, Berlemann U. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br. 2001;83(8):1119–24.

    Article  CAS  PubMed  Google Scholar 

  35. Shan-hong Q. Accuracy of closed reduction for displaced subcapital femoral neck fractures assisted by C-arm X-ray machine. CRTER. 2012;16(9):1643–6.

    Google Scholar 

  36. Mohan R, Karthikeyan R, Sonanis SV. Dynamic hip screw: does side make a difference? Effects of clockwise torque on right and left DHS. Injury. 2000;31(9):697–9.

    Article  CAS  PubMed  Google Scholar 

  37. Beck M, Siebenrock KA, Affolter B, Nötzli H, Parvizi J, Ganz R. Increased intraarticular pressure reduces blood flow to the femoral head. Clin Orthop Relat Res. 2004;424:149–52.

    Article  PubMed  Google Scholar 

  38. Bonnaire F, Schaefer DJ, Kuner EH. Hemarthrosis and hip joint pressure in femoral neck fractures. Clin Orthop Relat Res. 1998;353:148–55.

    Article  PubMed  Google Scholar 

  39. Crawfurd EJ, Emery RJ, Hansell DM, Phelan M, Andrews BG. Capsular distension and intracapsular pressure in subcapital fractures of the femur. J Bone Joint Surg Br. 1988;70(2):195–8.

    CAS  PubMed  Google Scholar 

  40. Woodhouse CF. Dynamic influences of vascular occlusion affecting the development of avascular necrosis of the femoral head. Clin Orthop Relat Res. 1964;32:119–29.

    CAS  PubMed  Google Scholar 

  41. Shih L-Y, Chen T-H, Lo W-H. Avascular necrosis of the femoral head-an unusual complication of an intertrochanteric fracture. J Orthop Trauma. 1992;6(3):382–5.

    Article  CAS  PubMed  Google Scholar 

  42. Kaweblum M, Lehman WB, Grant AD, Strongwater A. Avascular necrosis of the femoral head as sequela of fracture of the greater trochanter: a case report and review of the literature. Clin Orthop Relat Res. 1993;294:193–5.

    PubMed  Google Scholar 

  43. Linhart W, Stampfel O, Ritter G. Post-traumatic femur head necrosis following trochanter fracture. Z Orthop Ihre Grenzgeb. 1984;122(6):766.

    Article  CAS  PubMed  Google Scholar 

  44. Stougard J. Post-traumatic avascular necrosis of the femoral head in children. Report of two cases. J Bone Joint Surg Br. 1969;51(2):354–5.

    CAS  PubMed  Google Scholar 

  45. Trueta J. The normal vascular anatomy of the human femoral head during growth. J Bone Joint Surg Br. 1957;39(2):358–94.

    PubMed  Google Scholar 

  46. Tannast M, Pleus F, Bonel H, Galloway H, Siebenrock KA, Anderson SE. Magnetic resonance imaging in traumatic posterior hip dislocation. J Orthop Trauma. 2010;24(12):723–31.

    Article  PubMed  Google Scholar 

  47. Notzli HP, Siebenrock KA, Hempfing A, Ramseier LE, Ganz R. Perfusion of the femoral head during surgical dislocation of the hip. Monitoring by laser Doppler flowmetry. J Bone Joint Surg Br. 2002;84(2):300–4.

    Article  CAS  PubMed  Google Scholar 

  48. Tannast M, Siebenrock KA. Open therapy of femoroacetabular impingement. Oper Orthop Traumatol. 2010;22(1):3–16.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, 3010, Switzerland

    Simon Damian Steppacher, Pascal Cyrill Haefeli, Helen Anwander, Klaus Arno Siebenrock & Moritz Tannast

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  1. Simon Damian Steppacher
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  2. Pascal Cyrill Haefeli
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  3. Helen Anwander
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  4. Klaus Arno Siebenrock
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  5. Moritz Tannast
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Correspondence to Moritz Tannast .

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Editors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Kyonggi-do, Korea, Republic of (South Korea)

    Kyung-Hoi Koo

  2. Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland, USA

    Michael A. Mont

  3. Department of Orthopaedic Surgery, Department of Orthopaedic Surgery, Center for Metabolism and Obesity Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    Lynne C. Jones

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Steppacher, S.D., Haefeli, P.C., Anwander, H., Siebenrock, K.A., Tannast, M. (2014). Traumatic Avascular Necrosis of the Femoral Head. In: Koo, KH., Mont, M., Jones, L. (eds) Osteonecrosis. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-35767-1_14

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  • DOI: https://doi.org/10.1007/978-3-642-35767-1_14

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