Assessment of Femoral Head and Head-Neck Junction Perfusion Following Surgical Hip Dislocation Using Gadolinium-Enhanced Magnetic Resonance Imaging: A.

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Presentation transcript:

Assessment of Femoral Head and Head-Neck Junction Perfusion Following Surgical Hip Dislocation Using Gadolinium-Enhanced Magnetic Resonance Imaging: A Cadaveric Study by Lionel E. Lazaro, Peter K. Sculco, Nadine C. Pardee, Craig E. Klinger, Jonathan P. Dyke, David L. Helfet, Edwin P. Su, and Dean G. Lorich J Bone Joint Surg Am Volume 95(23):e182 December 4, 2013 ©2013 by The Journal of Bone and Joint Surgery, Inc.

An illustration of the vascular danger zone (highlighted in blue), which represents the exposed deep medial femoral circumflex artery as it courses posterior to the obturator externus tendon. An illustration of the vascular danger zone (highlighted in blue), which represents the exposed deep medial femoral circumflex artery as it courses posterior to the obturator externus tendon. Also part of the danger zone, the ascending medial femoral circumflex artery runs between the obturator externus and the quadratus femoris muscles. Lionel E. Lazaro et al. J Bone Joint Surg Am 2013;95:e182 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Gross dissection further delineates the location of the exposed deep medial femoral circumflex artery. Gross dissection further delineates the location of the exposed deep medial femoral circumflex artery. Lionel E. Lazaro et al. J Bone Joint Surg Am 2013;95:e182 ©2013 by The Journal of Bone and Joint Surgery, Inc.

The quadratus femoris is reflected to demonstrate the relationship of the ascending medial femoral circumflex artery and the quadratus femoris and obturator externus muscles and the posterior structures in a representative specimen. The quadratus femoris is reflected to demonstrate the relationship of the ascending medial femoral circumflex artery and the quadratus femoris and obturator externus muscles and the posterior structures in a representative specimen. Lionel E. Lazaro et al. J Bone Joint Surg Am 2013;95:e182 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Graph demonstrating the average quantitative MRI results of the perfusion to the femoral head and head-neck junction following the three surgical approaches: the trochanteric flip osteotomy (TFO), the standard posterior approach (SPA), and the modified post... Graph demonstrating the average quantitative MRI results of the perfusion to the femoral head and head-neck junction following the three surgical approaches: the trochanteric flip osteotomy (TFO), the standard posterior approach (SPA), and the modified posterior approach (MPA). IRA = inferior retinacular artery, and MFCA = medial femoral circumflex artery. Lionel E. Lazaro et al. J Bone Joint Surg Am 2013;95:e182 ©2013 by The Journal of Bone and Joint Surgery, Inc.

An example of the standard posterior approach. An example of the standard posterior approach. The top image shows MRI scans acquired before (left) and after (right) administration of gadolinium on the experimental side. The bottom image shows the gross dissection of the experimental side, demonstrating disruption of both the ascending branch of the medial femoral circumflex artery (MFCA; compromising the superior retinacular arterial system) and inferior retinacular arterial system. Lionel E. Lazaro et al. J Bone Joint Surg Am 2013;95:e182 ©2013 by The Journal of Bone and Joint Surgery, Inc.

An example of the modified standard posterior approach. An example of the modified standard posterior approach. The top image shows MRI scans before (left) and after (right) administration of gadolinium on the experimental side. The bottom image shows the gross dissection of the experimental side, demonstrating disruption of the ascending branch of the medial femoral circumflex artery (MFCA; compromising the superior retinacular arterial system) and preservation of the inferior retinacular arterial system. Lionel E. Lazaro et al. J Bone Joint Surg Am 2013;95:e182 ©2013 by The Journal of Bone and Joint Surgery, Inc.

An example of the anterior surgical dislocation of the hip through a trochanteric flip osteotomy. An example of the anterior surgical dislocation of the hip through a trochanteric flip osteotomy. The top image shows MRI scans before (left) and after (right) administration of gadolinium on the experimental side. The bottom image shows the gross dissection of the experimental side, demonstrating preservation of both the superior and inferior retinacular arterial systems. MFCA = medial femoral circumflex artery. Lionel E. Lazaro et al. J Bone Joint Surg Am 2013;95:e182 ©2013 by The Journal of Bone and Joint Surgery, Inc.