Abstract
Introduction
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.
Results
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.
Conclusion
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.
Keywords
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Article info
Publication history
Accepted:
May 23,
2012
Identification
Copyright
© 2012 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
