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Pediatric Radiology

Published in:

01-09-2010 | Original Article

Biphasic threat to femoral head perfusion in abduction: arterial hypoperfusion and venous congestion

Authors: David K. Yousefzadeh, Diego Jaramillo, Neil Johnson, Kirk Doerger, Christopher Sullivan

Published in: Pediatric Radiology | Issue 9/2010

Abstract

Background

Hip abduction can cause avascular necrosis (AVN) of the femoral head in infants.

Objective

To compare the US perfusion pattern of femoral head cartilage in neutral position with that in different degrees and duration of abduction, testing the venous congestion theory of post-abduction ischemia.

Materials and methods

In 20 neonates, the Doppler flow characteristics of the posterosuperior (PS) branch of the femoral head cartilage feeding vessels were evaluated in neutral and at 30°, 45°, and 60° abduction. In three neonates the leg was held in 45-degree abduction and flow was assessed at 5, 10, and 15 min.

Results

Male/female ratio was 11/9 with a mean age of 1.86 ± 0.7 weeks. The peak systolic velocities (PSV) declined in all three degrees of abduction. After 15 min of 45-degree abduction, the mean PSV declined and showed an absent or reversed diastolic component and undetectable venous return. No perfusion was detected at 60-degree abduction.

Conclusion

Abduction-induced femoral head ischemia is biphasic and degree- and duration-dependent. In phase I there is arterial hypoperfusion and in phase II there is venous congestion. A new pathogeneses for femoral head ischemia is offered.

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Title: Biphasic threat to femoral head perfusion in abduction: arterial hypoperfusion and venous congestion
Authors: David K. Yousefzadeh
Diego Jaramillo
Neil Johnson
Kirk Doerger
Christopher Sullivan
Publication date: 01-09-2010
Publisher: Springer-Verlag
Published in: Pediatric Radiology / Issue 9/2010
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-010-1602-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Biphasic threat to femoral head perfusion in abduction: arterial hypoperfusion and venous congestion

Abstract

Background

Objective

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Materials and methods

Results

Conclusion

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