OTA 1997 Posters - Hip Fractures

Ossovenography as a Reliable Method to Diagnose Postoperative Necrosis of the Femoral Head in the Presence of Internal Fixation Devices

Marc Wick, MD, Axel Ekkernkamp, MD, PhD, Dirk Richter, MD, Peter A. W. Ostermann, MD, PhD, Gert Muhr, MD, PhD

Bochum, Germany

Despite advances in the field of orthopedic surgery, necrosis of the femoral head still remains a serious problem. Under normal conditions Magnetic Resonance Tomography (MRT) is the gold standard in early diagnosis. Because of magnetic interference, this technique is not applicable in the diagnosis of a posttraumatic necrosis with internal fixation. This seems to be an ideal indication for ossovenography: contrast medium is injected into the femoral head under x-ray control and the venous flow is documented. Furthermore it is possible to get histological samples from suspicious areas.

Ossovenography was performed in twelve patients and the results were compared with histological samples. In every patient, where "necrosis of the femoral head" was diagnosed by ossovenography (91.6%), we also found a necrosis on histological examination. In one patient, where physiological flow was found, there was a corresponding absence of necrosis on the histological sample. We did not find any complications during the ossovenography. The results suggest that ossovenography is a promising and reliable method in the early diagnosis of a necrosis of the femoral head in the presence of internal fixation devices.