title: The Use of Superselective Arteriography in the Evaluation of the Influence of Intracapsular Hip Joint Pressure on the Blood Flow of the Femoral Head.
abstract: OBJECTIVE
  We aimed to analyze the intracapsular pressure of the hip joint following femoral neck fracture and its relationship to the position of the hip or to traction and (using superselective arteriography) to evaluate the blood supply to the femoral head and the influence of traction and hip position on the blood supply.
  
  
  METHODS
  Twenty-six cases of fresh Garden type I-III femoral neck fractures were enrolled. After being placed in the neutral position, in internal rotation or with traction of 3 and 5 kg, respectively, intracapsular manometric changes were measured. Eight cases underwent superselective arteriography of the medial circumflex femoral artery and its branches under the manometric changes of the hip joint capsule.
  
  
  RESULTS
  Twenty-four to 48 h after the injury, the intracapsular pressure was significantly higher on the fractured side than on the normal side. The mean pressure was 28.41 ± 9.339 mm Hg in fully extended hips in the neutral position, 79.92 ± 12.80 mm Hg in internally rotated hips, 51.39 ± 15.41 mm Hg in hips with 3 kg of traction and 64.81 ± 13.56 mm Hg in hips with 5 kg of traction. The arteriographic findings revealed that traction and internal rotation reduced the perfusion of the femoral head at the medial circumflex femoral artery and its branches, and also negatively influenced venous reflux.
  
  
  CONCLUSIONS
  Traction and internal rotation both caused the intracapsular pressure of the hip joint to rise considerably, which reduced the femoral head perfusion and impeded venous reflux. This could lead to avascular necrosis of the femoral head.
authors.affiliation: Department of Orthopedics Trauma, Shanghai Emergency Trauma Center, the First People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Wu
authors.forename: Jianhua
authors.initials: J
authors.lastname: Huang
authors.forename: Qiugen
authors.initials: Q
authors.lastname: Wang
mesh_terms: D000792:Angiography / Q000379:methods; D015901:Angiography, Digital Subtraction; D001783:Blood Flow Velocity; D005260:Female; D005265:Femoral Neck Fractures / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005270:Femur Head / Q000098:blood supply*; D006621:Hip Joint / Q000098:blood supply* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D011312:Pressure