OBJECTIVE.Evaluation of the perfusion and viability of the femoral head after fracture of the femoral neck is important because the outcome of conservative treatment or joint-preserving surgery is adversely affected by the development of capital osteonecrosis.We evaluated the use of MR imaging, before and after IV RESULTS. Digital subtraction angiography showed impaired blood supply to the femoral head in five patients. On contrast-enhanced MR images of these patients, the femoral head did not enhance and was lower in signal intensity than were the enhancing femoral shaft and neck distal to the fracture and the enhancing femoral head on the unaffected side. In the patients with persistent perfusion, contrastenhanced MR images showed a uniform increase in signal intensity in the femoral shaft and neck as well as the femoral head; the femoral head on the fractured side showed contrast enhancement similar to that on the healthy side. CONCLUSION.These preliminary results indicate that contrast-enhanced MR imaging may be useful for noninvasive evaluation of femoral head perfusion after fracture of the femoral neck. MR findings also may aid the clinician in deciding between joint-preserving therapy and hip arthroplasty.AJR 1993;160:335-341
Early comments on the anterior cruciate ligament were found in ancient literature, and the first scientific reports were published in the nineteenth century. The first surgical treatment of a ruptured anterior cruciate ligament was carried out in 1895 by Robson performing a primary suture of the torn ligament. In 1903 F. Lange suggested a complete replacement of the injured ligament using silk ligaments and in 1914 Grekow was probably the first who recommended autogenous transplants by using a fascia lata strip. In 1917 Hey-Groves presented his surgical technique that was the fundament for reconstruction surgery in the following years. Today, the autogenous transplant is accepted to be the golden standard for replacement of the injured anterior cruciate ligament. The bone-tendon-bone transplant of the patellar ligament and the semitendinosus or gracilis tendon are recommended by most surgeons. In the history of anterior cruciate ligament surgery, the surgical technique of the operative procedures has also changed. The evolution started with open arthrotomy followed by mini-arthrotomy and led to arthroscopically assisted replacement of the anterior cruciate ligament.
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