The purpose of this study was to assess the natural history of bone bruise and bone mineral density (BMD) after traumatic hip dislocations and conservatively treated acetabular fractures. Our hypothesis was that poor bone quality can influence degree of bone bruise and, in time, cause degenerative changes.
Materials and methods
Eight consecutive patients with traumatic hip dislocations and five patients with conservatively treated fractures in the femoral head and/or acetabulum were included. Magnetic resonance imaging (MRI) was obtained after 1, 17, 42, 82 and 97 weeks. Dual-emission X-ray absorptiometry (DXA) measurements were made after 10 days and 2 years. Sizes of bone bruise lesions were measured and classified. At the 2-year follow-up, Harris hip score (HHS) was calculated and signs of radiological osteoarthritis (OA) registered.
The bone bruise changes were small and all changes resolved within 42 weeks in all, except for three patients; one with a small Pipkin fracture had segmental avascular necrosis (AVN) of the femoral head, one had persisting1–3 mm small spots of bone bruises in the femoral head and the third had <1 cm lesions in both the femoral head and the acetabulum. The lesions were bigger in the femoral head in the hip dislocations and more pronounced in the acetabulum in the fractured acetabuli. We found no significant changes in BMD in four regions of interest (ROIs) after 2 years. No patients developed OA, and all had excellent HHS except for the one patient with AVN.
The post-traumatic bone bruise changes in the dislocated hips and the fractured acetabuli were small and transient compared to findings of other authors examining traumatised knees. The patients had excellent function and no OA after 2 years if they did not develop AVN. In our small sample of relatively young patients with normal age-adjusted BMD, no post-traumatic osteopenia was observed. This might differ in the elderly with poorer bone quality; further studies are needed to assess that.
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- Occult intraosseous fracture: detection with MR imaging.Radiology. 1988; 167: 749-751
- Occult osseous lesions documented by magnetic resonance imaging associated with anterior cruciate ligament ruptures.Arthroscopy. 1991; 7: 45-51
- Occult posttraumatic osteochondral lesions of the knee: prevalence, classification, and short-term sequelae evaluated with MR imaging.Radiology. 1991; 178: 271-276
- Osteochondral lesions and cruciate ligament injuries. MRI in 18 knees.Acta Orthopaedica Scandinavica. 1993; 64: 434-436
- Bone bruise of the knee: histology and cryosections in 5 cases.Acta Orthopaedica Scandinavica. 1998; 69: 291-294
- “Bone bruises” on magnetic resonance imaging evaluation of anterior cruciate ligament injuries.American Journal of Sports Medicine. 1993; 21: 220-223
- Bone bruises detected by magnetic resonance imaging following lateral ankle sprains.Knee Surgery, Sports Traumatology, Arthroscopy. 1997; 5: 113-117
- Magnetic resonance imaging of the wrist: occult osseous lesions.Journal of Manipulative and Physiological Therapeutics. 1992; 15: 599-603
- Incidence and clinical significance of bone bruises after supination injury of the ankle. A double-blind, prospective study.Journal of Bone and Joint Surgery: British Volume. 1998; 80: 513-515
- Occult osteochondral lesions after anterior cruciate ligament rupture. Six-year magnetic resonance imaging follow-up study.American Journal of Sports Medicine. 1999; 27: 489-494
- Occult osseous lesions associated with anterior cruciate ligament tears.Clinical Orthopaedics and Related Research. 1995; : 187-193
- Follow-up of occult bone lesions detected at MR imaging: systematic review.Radiology. 2006; 238: 853-862
- Occult cartilage and bone injuries of the knee: detection, classification, and assessment with MR imaging.Radiology. 1989; 170: 823-829
- Imaging of acute injuries of the articular surfaces (chondral, osteochondral and subchondral fractures).Skeletal Radiology. 1999; 28: 545-560
- Magnetic resonance imaging follow-up study of bone bruises associated with anterior cruciate ligament ruptures.Arthroscopy. 2001; 17: 445-449
- Comparison of distribution, agreement and correlation between the original and modified Merle d’Aubigne-Postel Score and the Harris hip score after acetabular fracture treatment: moderate agreement, high ceiling effect and excellent correlation in 450 patients.Acta Orthopaedica. 2005; 76: 796-802
- Articular cartilage degeneration after acute subchondral bone damage: an experimental study in dogs with histopathological grading.Acta Orthopaedica Scandinavica. 2004; 75: 762-767
- The natural history of bone bruises. A prospective study of magnetic resonance imaging-detected trabecular microfractures in patients with isolated medial collateral ligament injuries.American Journal of Sports Medicine. 1998; 26: 15-19
- Osseous injury associated with acute tears of the anterior cruciate ligament.American Journal of Sports Medicine. 1992; 20: 382-389
- Traumatic posterior dislocation of the hip – prognostic factors influencing the incidence of avascular necrosis of the femoral head.Archives of Orthopaedic and Trauma Surgery. 1986; 106: 32-35
- Traumatic dislocation of the hip.Journal of Trauma. 1980; 20: 603-606
- Traumatic dislocation of the hip.Clinical Orthopaedics and Related Research. 1991; : 218-227
- Traumatic dislocation and fracture dislocation of the hip. A long-term follow-up study.Clinical Orthopaedics and Related Research. 1987; : 249-263
- Posterior fracture dislocation of the hip with fractures of the femoral head.Clinical Orthopaedics and Related Research. 1985; : 9-17
- Posterior fracture-dislocations of the hip; long-term follow-up.Journal of Bone and Joint Surgery. 1974; 56: 1103-1127
- Isolated traumatic dislocation of the hip. Long-term results in 50 patients.Journal of Bone and Joint Surgery: British Volume. 1994; 76: 6-12
- Dislocation and fracture-dislocation of the hip.Journal of Bone and Joint Surgery: British Volume. 1991; 73: 465-469
- Coxarthrosis following traumatic posterior dislocation of the hip.Journal of Bone and Joint Surgery. 1987; 69: 679-683
- An analysis of the late effects of traumatic posterior dislocation of the hip without fractures.Journal of Bone and Joint Surgery: British Volume. 1983; 65: 150-152
WHO. WHO scientific group on the assessment of osteoporosis at primary health care level. Brussels, Belgium. www.who.int/entity/chp/topics/Osteoporosis.pdf; 05.05.04.
- Bone and muscle mass after femoral neck fracture. A controlled quantitative computed tomography study of osteosynthesis versus primary total hip arthroplasty.Archives of Orthopaedic and Trauma Surgery. 1997; 116: 470-474
- Changes of bone mineral mass and soft tissue composition after hip fracture.Bone. 1996; 18: 19-22
- Osteopenia after plated and nailed femoral shaft fractures.Journal of Orthopaedic Trauma. 1988; 2: 13-17
- Osteopenia after ankle fractures. The influence of early weight bearing and muscle activity.Clinical Orthopaedics and Related Research. 1989; : 261-268
Accepted: May 23, 2012
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