HEMARTHROSIS AND HIP-JOINT PRESSURE IN FEMORAL-NECK FRACTURES

In a prospective clinical study the intraarticular pressure of 55 pati ents with intracapsular femoral neck fractures,Fas measured intraopera tively with the hip in different positions. Intraarticular hemarthrosi s was quantified by a preoperative sonography examination, In 75% of t he patients, increased intraarticular pressure caused by the hemarthro sis was found. The spontaneous median pressure increased significantly from 22 mm Hg with extension (28 mm Hg) and internal rotation of the hip joint (56 mm Hg). The lowest pressure was found in 70 degrees flex ion (15 mm Hg), The median pressures increased within the first 24 hou rs after injury from 26 mm Hg in the first 6 hours to 46 mm Hg from 7 to 24 hours. Even in the first and second weeks after trauma, increase d median pressures were detected (8.5 mm Hg and 13 mm Hg, respectively ). No significant difference was found between undisplaced and displac ed fracture types. Because increased joint pressure in other studies c orrelates with reduced perfusion of the femoral head, it can be deduce d that reduction maneuvers without capsulotomy can compromise the circ ulation of the femoral head. Capsulotomy and osteosynthesis of the fem oral neck at the earliest time possible is the best prophylaxis of tam ponade, If the osteosynthesis is delayed, a preoperative sonography af ter admission and a control sonogram after 6 hours is recommended, In the event of relevant hemarthrosis, immediate therapeutic drainage is suggested for patients who will receive joint conserving osteosynthesi s.