0000001973 00000 n 0000003316 00000 n There was no difference in angular displacement (P = .30) between either screw design after cyclical loading at any time point (Fig. The inferior gluteal artery is described in standard anatomy textbooks as contributing to the blood supply of the hip through an anastomosis with the medial femoral circumflex artery, and its anatomy may help to explain the development of avascular necrosis after hip trauma. In conclusion, osteonecrosis of the femoral head after surgical fixation remains high. Coming to a Cleveland Clinic location?Cole Eye entrance closingVisitation, mask requirements and COVID-19 information. Clinical guidelines, S100 Calcium Binding Protein A9 Represses Angiogenic Activity and Aggravates Osteonecrosis of the Femoral Head. 0000008822 00000 n 1955;37-A:663680. As many as 1.5 million of these deaths are the result of physical trauma. DOI: Gutierrez G, et al. DOI: Sobrino J. Signs and symptoms. 0000002819 00000 n 1. Intracapsular fractures (femoral neck fractures): Occurs within the hip capsule; accounts for 45% of all acute hip fractures in the elderly; susceptible to malunion/avascular necrosis of the HOF because of the limited blood supply to the area. For a complete overview of all the cookies used, please see our privacy policy. Evaluation of blood supply by DSA can be used as one element to predict the fate of precollapsed femoral head. If the disease continues to progress, the next step may be to place the child in a cast to keep the hips in the best position for healing. A second osteotomy was performed to create a 5 mm gap (Fig. 9). J Bone Joint Surg Am. The average shear displacement for both groups was 1.1. Hemorrhagic shock. [Orthopedics. These causes include fractures, Perthes disease usually affects children between the ages of four and eight years, but the range can extend to between two and 12 years old. 2019; 42(2):e210e215.] [18] Even in nondisplaced fractures, the rate of AVN in some studies is significant at 19.5%. Once the bleeding stops, your body will naturally begin to repair shock-related damage and help restore your blood supply. 12. This blood loss may not cause any more pain than the injuries. 2009;40:11431146. The work cannot be changed in any way or used commercially without permission from the journal. The femurs were subsequently transected 22 cm distal to the greater trochanter and embedded in fiberglass resin (3 m Bondo) in PVC tubes. xref Lu-Yao GL, Keller RB, Littenberg B, et al. J Orthop Trauma. The amount of blood you have in your body depends on your age and size. Many studies have examined various screw configurations previously. Tucker FR. 2001;183:9195. 8). The posteriorsuperior screw may put the main blood supply to the femoral head at risk and should be avoided. Outcomes after displaced fractures of the femoral neck. In most cases, emergency services will keep you on the phone until help arrives. Avascular necrosis after internal fixation of intracapsular hip fractures; a study of the outcome for 1023 patients. Head Injury, Age 4 and Older. Avascular necrosis of the femoral head is a type of osteonecrosis due to disruption of blood supply to the proximal femur. The most popular pattern for this repair is the inverted triangle with an inferior screw, anteriorsuperior screw, and posteriorsuperior screw. This website uses cookies. We avoid using tertiary references. 0000003544 00000 n Avascular necrosis of the femoral head. But blood loss isnt always visible. Technically, the ball of the femur dies because the blood supply to it is temporally cut off. J Bone Joint Surg Am. Thus, no preliminary power analysis was performed. Correspondence should be addressed to: Benjie Wang, MD, Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, 6 Jiefang Rd, Dalian 116001, Liaoning, China (, Understanding and treating osteonecrosis of the femoral head, Hip replacement in femoral head osteonecrosis: current concepts, Osteonecrosis of the hip: management in the 21st century, Key pathway to prevent the collapse of femoral head in osteonecrosis, Spontaneous resolution of osteonecrosis of the femoral head, Enoxaparin prevents progression of stages I and II osteonecrosis of the hip. You may search for similar articles that contain these same keywords or you may Ann Biomed Eng. If your healthcare provider determines that your child's condition is getting worse, surgery may be required. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, (http://nonf.org/perthesbrochure/perthes-brochure.htm), (http://orthoinfo.aaos.org/topic.cfm?topic=A00070), Visitation, mask requirements and COVID-19 information. Most often, a ruptured spleen is caused by blunt force trauma. Previous testing has shown these composite femurs to have biomechanical properties similar to cadaveric bone.[9]. If you have a clotting problem or a slow internal bleed, for example, it can take days for the blood loss to be severe enough to cause hemorrhagic shock. Both hips are affected in up to 15% of children. [6] We believe that this area could be affected by the posteriorsuperior screw in the typical inverted triangle screw fixation pattern. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates with the tibia and patella forming the knee.By most measures, the femur is the strongest bone in the body. 6). The authors have no conflicts of interest to disclose. 15. blood supply; cannulated screw; femoral neck fracture; inverted triangle; L-shaped. Asymptomatic osteonecrosis: should it be treated? female > male . 0000004287 00000 n 1960;42-B:794801. female. Lastly, each specimen was loaded to failure. Loizou CL, Parker MJ. 1994;76:1525. It occurs when your body loses a lot of blood quickly. Our website services, content, and products are for informational purposes only. Harrison Oxford ,England 1953 Changes with age Ages from 20 -100 were studied no change in vascular pattern was noticed . Acta Orthop Scand. The more severe the case, the greater the likelihood that the child may experience limited hip motion, differences in leg lengths, and early arthritis requiring a hip replacement later in life. The authors have no relevant financial relationships to disclose. Always consult your child'sdoctor for a diagnosis. 2003;34:525528. xTKhQ=w'V`D%6Q)8&QA1 WebPubMed comprises more than 34 million citations for biomedical literature from MEDLINE, life science journals, and online books. 0 Internal bleeding can also be fatal. They may also advise you on how to minimize the bleeding. [24] in 1960, brodetti placed an implant and injected barium into the arterial tree to show that Organ damage may not be reversible, so a full recovery may not be possible. However, anatomic variations between individuals were not accounted for with the small number of cadavers examined. The IT construct was compared with the L-shaped design in 10 composite femurs. Classification [edit Femoral head fracture: Femoral head stress fractures are a common cause of hip pain in select populations. Gardner MP, Chong AC, Pollock AG, et al. Cleveland Clinic offers expert diagnosis, treatment and rehabilitation for bone, joint or connective tissue disorders and rheumatic and immunologic diseases. WebDeep vein thrombosis (DVT) is a type of venous thrombosis involving the formation of a blood clot in a deep vein, most commonly in the legs or pelvis. Head Injury, Age 3 and Younger. In addition to a complete medical history and physical examination, diagnostic procedures for Legg-Calv-Perthes disease may include: Specific treatment for Legg-Calv-Perthes disease will be determined by your child's doctor based on: The goal of treatment is to preserve the roundness of the femoral head and to prevent deformity while the condition runs its course. Whether your child is treated surgically or non-surgically, a series of X-rays will be taken throughout the process to determine how he or she is healing. You reach exsanguination when you lose 40 percent of your bodys blood or fluid supply. Perthes disease, also called Legg-Calv-Perthes disease, is a rare condition of the hip that affects only children. A ruptured spleen can be a life threatening condition and requires immediate attention. Here. A post-hoc power analysis was planned to determine the number of specimens required to determine any difference based on the effect size resulting from the biomechanical testing. An injury that damages the outside of your body is easy to see. 0000001323 00000 n Although this may seem like a lot, the human body holds more than 1 gallon of blood. Head Lice. The Journal A minority of DVTs occur in the arms. Asensio JA, et al. We demonstrated the presence of the intraosseous portion of the lateral epiphyseal vessel in the specimen without screw fixation. Also called osteonecrosis, it can lead to tiny breaks in the bone and cause the bone to collapse. First, bone cells in the head of the femur die. We cannot verify that the absence of intraosseous vessels in the posteriorsuperior headneck junction of the inverted-triangle specimen was definitively due to screw placement as opposed to anatomic variation or study methodology. <]>> Certain medications, for example, can help boost your hearts pumping power and improve circulation. caucasian. predominant blood supply to femoral head. Containment refers to the concept of keeping the soft ball (femoral head) deep within the socket (acetabulum) so that the socket itself acts as a mold to keep the ball round. It is four times more likely to occur in boys than girls and is uncommon in African-Americans. All soft tissues were removed. They can determine whether your bleeding is consistent with menorrhagia or if your symptoms are tied to another underlying condition. A 2013 review estimates about 30 percent of deaths from traumatic injury occur within the first 24 hours of injury. Exposure to secondhand smoke may also increase your child's risk of Perthes disease, although the exact reasons why are not known. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. If youre speaking on behalf of someone whos injured, let first responders know what happened and what youve done to provide aid. Although injury is often associated with visible wounds, you can bleed to death (exsanguination) without ever seeing a drop of blood. However, size, location, the amount of. [1] Historically, many studies have shown that the main blood supply to the femoral head is from the medial circumflex femoral artery, which branches into the lateral epiphyseal vessels, as shown by Tucker, Trueta, Harrison, and later by Judet. Vertically oriented femoral neck fractures: mechanical analysis of four fixation techniques. This study was supported by a grant from the Liaoning Public Welfare Science Research Foundation. Wolters Kluwer Health, Inc. and/or its subsidiaries. This process is called osteonecrosis, or avascular necrosis. Symptoms of an Achilles tendon rupture are hard to ignore. This accounts for 9 percent of trauma-related deaths. WebLongdom organizing Global Scientific Conferences in USA, Canada, Europe, Asia-Pacific, Middle East and other prominent locations across the globe. Internal bleeding, however, Blood thinners are drugs that prevent the blood from clotting. 3. There was no difference between either screw design at any time point, P = .99 (Fig. Avascular necrosis after internal fixation of intracapsular femoral neck fractures remains a problem in all patient populations. The normal vascular anatomy of the femoral head in adult man J. Trueta and M.H.M. Get useful, helpful and relevant health + wellness information. It is widely recognized that in the mature adult, the medial circumflex artery and its terminal branch, the lateral portion of the extracapsular arterial ring, provide the majority of the blood supply to the femoral head, neck, and great trochanter. Your provider may also have your child perform some activities to test their range of motion. to maintaining your privacy and will not share your personal information without Pain in the hip area, or in the groin, thigh, or even the knee. A lack of blood flow to, A bleeding cut on your finger requires immediate attention to help reduce the odds of infection and help it start healing as soon as possible. Irritation and inflammation in the hip area that may result in muscle spasms. 5. Symptoms may include joint pain and a limited range of motion. The 5 remaining femurs had three 7.0 mm fully threaded cannulated screws inserted in the L-shaped pattern (anteriorsuperior, anteriorinferior, posteriorinferior) (Fig. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. However, as blood loss increases, youll begin experiencing signs and symptoms of hypovolemic shock, or hemorrhagic shock. If you see these changes, make an appointment to see your childs healthcare provider. Advertising on our site helps support our mission. Significantly negative correlation with Association Research Circulation Osseous stage II to IV necrosis was found for A, a, and b. An injury to the hip, such as a dislocation or fracture, may limit the blood supply to the femoral head. 2.JZ~uL[SBJEo%At; (}L|4Ms]! These symptoms include: Bleeding to death can happen very quickly. For young children, your physician may take a wait-and-see approach treating with possible medications or weight-bearing restrictions. 6. WebBlood Thinners Other Than Warfarin: Taking Them Safely. [5] Again in 1960, Claffey performed anatomic studies with the Smith-Petersen nail and found in all specimens that the anastomosis between the lateral epiphyseal vessels and ligamentum teres was severed by the nail in the superiorposterior quadrant of the head and neck. 2010;38:613620. Cleveland Clinic Children's is dedicated to the medical, surgical and rehabilitative care of infants, children and adolescents. male: female ratio. Legg-Calv-Perthes disease goes through four phases of changes that affect the head of the femur. The reason(s) why this happens are not well understood. Although it is thought to be associated with circulatory disruption and resultant bone death, its exact pathophysiologic mechanism is not fully understood. (2013). medial femoral circumflex artery. When you get a cut or other wound, it can be hard to tell when to treat it at home and when to get stitches. 17. Citations may include links to full text content from PubMed Central and publisher web sites. At this point, your heart isnt able to pump sufficient amounts of blood through your body. Arteries of the head and neck (carotids) Brachiocephalic artery: This artery and its branches supply blood to the right side of the head and neck and the right arm. WebIn this stage of the disease, the blood supply to the femoral head is disrupted and bone cells die. [19] The 2 main determinants in osteonecrosis in young patients are thought to be initial displacement and the quality of the reduction. The relative length of the MCFA and the number of vessels above line I and line II are related to the severity of osteonecrosis of the femoral head, as revealed by DSA. Dont move people who have injuries to their legs, back, neck, or head. The inferior gluteal artery is described in standard anatomy textbooks as Childrens Hospital of Philadelphia is a charitable 501(c)(3) nonprofit organization. The strength of the L-shaped construct was not statistically different than the strength of the IT design. This monthly journal offers comprehensive coverage of new techniques, important developments and innovative ideas in oral and maxillofacial surgery.Practice-applicable articles help develop the methods used to handle dentoalveolar surgery, facial injuries and deformities, TMJ disorders, oral cancer, jaw reconstruction, anesthesia and But to our knowledge, this is the first study to investigate an L-shaped screw design that avoids the posteriorsuperior screw. Each year, about 60,000 Americans die from hemorrhaging, or blood loss, a 2018 review estimates. Last medically reviewed on April 11, 2018. Hemorrhagic shock is a life-threatening condition. It begins the systemic division of the arterial system, which includes all the arteries that deliver blood to all the tissues in the body other than the lungs. Clinical review: Hemorrhagic shock. [14,15] We used a 2-camera video tracking system (Spicatek DMAS) and spherical beads on the specimens to track the angular and shear displacement across the fracture site. 2005-2022 Healthline Media a Red Ventures Company. Eight fractures were stable (Garden 1-2/OTA B1.11.3) and 12 were unstable (Garden 3-4/OTAB2.13.3). These synthetic femurs had simulated cortical bone made from short fiber filled epoxy with a density of 1.64 g/cc and had solid rigid polyurethane foam cancellous core (density 0.27 g/cc). Rupprecht M, Grossterlinden L, Sellenschloh K, et al. Our referral nurse navigator can give your family timely access to world-renowned pediatric orthopaedic surgeons in every specialty. Hemorrhagic shock begins when you lose about 20 percent, or one-fifth, of your bodys blood or fluid supply. Avascular necrosis is the death of bone tissue due to a lack of blood supply. Containment is another major guiding principle in the treatment of Perthes disease. In order to protect the repair and maximize healing, there is a possibility that your child may need to be placed into a cast for six to eight weeks after surgery. [5] A recent cadaveric study showed that the posteriorsuperior screw of the inverted-triangle configuration violates the cortex of the femoral neck up to 70% of the time. A recent study showed that the posteriorsuperior screw violated the cortex 70% of the time despite appearing radiographically safe, potentially violating the extraosseous blood supply. To further standardize diagnosis 1960;42B:802809. Husby T, Alho A, Hiseth A, et al. Giordano et al[8] studied a design with a posteriorsuperior, posteriorinferior, and anteriorinferior design and found improved biomechanical properties in comparison to the traditional inverted triangle design. Avascular necrosis is a condition that is caused by a temporary or permanent loss in blood supply to the bone. The process usually takes months to years. 7. Trueta J, Harrison MH. This stage can last a few years. Webhistorically, many studies have shown that the main blood supply to the femoral head is from the medial circumflex femoral artery, which branches into the lateral epiphyseal vessels, as shown by tucker, trueta, harrison, and later by judet. Therefore, informed consent was not required. All rights reserved. AJOG's Editors have active research programs and, on occasion, publish work in the Journal. It most commonly occurs at the ends of long bones. [17] Approximately 400 cc of blue epoxy was injected into each specimen. Risk factors . Cleveland Clinic is a non-profit academic medical center. Each specimen was loaded over 5000 cycles, measuring angular/shear displacement then loaded to failure. older age. Over time, the body absorbs the dead bone and replaces it with new bone, but this process can lead to flattening of the ball. The average angular displacement at 5000 cycles of loading for the inverted triangle specimens was 0.91 versus 1.2 in the L-shaped design. Corresponding author. Mechanical evaluation of large-size fourth-generation composite femur and tibia models. There are approximately 10000 to 20000 new cases reported each year in the United States alone. Perthes disease might not be discovered until an X-ray is taken due to a fall or other injury and the image shows your child is affected by this condition. WebHip Fracture: . 2014;28:276282. SM. Bony surgery on the femur (thigh bone) or the socket to contain the femoral head in the hip socket, Consequences of Legg-Calv-Perthes disease as a young adult, Know My Rights About Surprise Medical Bills, Your child's age, overall health, and medical history, Your child's tolerance for specific medications, procedures, or therapies, Expectations for the course of the condition, A period of reduced weightbearing with crutches and/or a wheelchair, Physical therapy (to keep the hip muscles strong and to promote hip movement), Casting or bracing (to hold the femoral head in the hip socket, permit limited joint movement, and allow the femur to remold itself into a round shape again), 2022 The Childrens Hospital of Philadelphia. Timing and causes of death after injuries. Operative treatment of femoral neck fractures in patients between the ages fifteen and fifty years. We use cookies on this site to enhance your user experience. Data is temporarily unavailable. %PDF-1.4 % CHOPs Young Adult Hip Preservation Program specializes in the management of these patients. There was no difference in angular (P = .3) or shear displacement (P = .99) between either screw design after cyclical loading. When emergency personnel arrive, provide as much information as you can about what happened and what youve done to stop the flow of blood from the wound. Please try after some time. If your child has any of the above symptoms and you suspect he or she may have Perthes disease, it is important to contact your healthcare provider, who can begin to investigate. Your child's age. Pettett, Brett J. MDa,; Winek, Nathan C. MDa; Schimoler, Patrick J. MSb; Kharlamov, Alexander PhDa; Miller, Mark Carl PhDa; Westrick, Edward R. MDa, aBiomechanics Laboratory, Allegheny General Hospital, bDepartment of Mechanical Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania. Keep reading to learn how to recognize the signs of internal bleeding, how to stop external bleeding until help arrives, what it feels like to go into hemorrhagic shock, and more. 0000001826 00000 n A high index of suspicion is necessary for the diagnosis due to the insidious onset of the bone infarcts and the lack of specific clinical signs at the early stages. Arterioles of marrow The area becomes intensely inflamed and irritated and your child may begin to show signs of the disease, such as a limp or different way of walking. Ten large fourth-generation composite femurs with a 16 mm hollow intramedullary canal were obtained (Pacific Research Laboratories, Vashon Island, Washington). 14. Perthes disease often affects children who are very active, even athletic. 2015;29:144150. The implants used in this study were donated by Zimmer-Biomet, Warsaw, Indiana. Kunapuli SC, Schramski MJ, Lee AS, et al. Treatment options are dependent on the amount of hip pain, stiffness, and X-ray changes over time, as well as how much of the femoral head has collapsed. We utilized cadaveric femurs. When the specimens were loaded to failure, 4 specimens in each group failed due to shear. 1949;31B:8293. Generally, patients younger than six- to eight-years old can be treated without surgery. In addition, we were able to demonstrate the intraosseous portion of the lateral epiphyseal vessel and that screw placement may sacrifice this intraosseously. Address: 3045S National Avenue #110, Springfield, MO 65807. Your healthcare provider may also use other tests to check the disease's progress. Osteonecrosis of the femoral head is a disabling clinical entity affecting young adults that usually leads to destruction of the hip joint. Using visual inspection, the intraosseous arteries were visualized at the head neck junction. If youre able to get treatment, your outlook improves. Aminian A, Gao F, Fedoriw WW, et al. It isnt common, but its possible to survive the initial injury yet die as a result days or weeks later. These screws were removed. The remainder of the study was funded internally. Injury. It is easily identifiable in the adipose tissue between these two muscles and is usually closely associated with two veins [. We do not endorse non-Cleveland Clinic products or services. WebAmendments and reviews of existing services funded on the Medical Benefits Schedule (MBS) or other programmes (for example, blood products or screening programmes) are also considered by MSAC. Blood clots can block the flow of blood to the heart or brain. modify the keyword list to augment your search. A windlass tourniquet was applied over the distal femur using traction rope to increase back pressure. In many ways, your body is capable of handling the repair from hemorrhagic shock by itself. The 2 techniques were expected to produce similar strength and stiffness measures because the cross-sectional areas of the screws crossing the fracture site were identical. To demonstrate the risk to the blood supply to the femoral head from a posteriorsuperior screw. Bleeding to death may not be painful, but the initial injury can be. We propose that the posteriorsuperior screw of any pattern may jeopardize the main blood supply to the femoral neck and head. trailer The intraosseous bloody supply was inspected in each femoral head (no fixation, IT, L-shaped). Evaluation of blood supply by DSA can be used as one element to predict the fate of precollapsed femoral head. 9. In the second specimen, 3 cannulated screws were placed in the L-shaped pattern. WebThe lack of a steady blood supply to the ball of the femur causes a sequence of events. What should you do if you have a severe wound? More than half of people with traumatic injuries, including hemorrhaging, die within minutes of the accident or injury. The deep branch, with a diameter of 1.6 mm (1.12.7 mm), follows a course directed to the femoral head [, The posterior inferior nutrient artery of the femoral head is not present in all cases. The angular displacement, the shear displacement and load to failure were compared using MannWhitney nonparametric tests with the significance level of 0.05. The ultimate goal in Legg-Calv-Perthes disease is to preserve the flexibility of the hip joint and the roundness of the femoral head. Philadelphia, PA 19104. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username, Enter your email address below and we will send you the reset instructions, If the address matches an existing account you will receive an email with instructions to reset your password, The authors investigated changes in the blood supply of necrotic femoral heads using digital subtraction angiography (DSA). The lack of a steady blood supply to the ball of the femur causes a sequence of events. Symptoms can include pain, swelling, redness, and enlarged veins in the affected area, but some DVTs have no symptoms. Strength of femoral neck fracture fixation. J Orthop Trauma. Photograph during cadaver dissection showing the anterior view of the right inguinal region, with the main trunk of the medial femoral circumflex artery (, Photograph during cadaver dissection of the anterior view with the right femoral head partly exposed and the femoral neck showing the posterior inferior femoral head nutrient artery (. Managing exsanguination: What we know about damage control/bailout is not enough. race. Tel: +417-885-3000. 1953;35-B:442461. Surgical treatment can restore the proper alignment of the hip bones. The quality of the reduction and initial displacement remain the main 2 risk factors for osteonecrosis and the rate of revision surgery. This was preserved in the specimen with the L-shaped design but absent in the specimen following IT fixation. WebThe femur is the largest and strongest bone in the body and has a good blood supply, so it requires a large or high impact force to break this bone. Some children show no symptoms, others have mild pain and subtle symptoms. Prevention and treatment of ONFH has always been a clinical challenge for orthopedic surgeons. may email you for journal alerts and information, but is committed Internal bleeding is bleeding that occurs within your body. Seek immediate medical attention if you notice: If you or someone around you is experiencing severe external bleeding, call 911 or your local emergency services right away. 2011;35:16951701. The blood supply of the femoral neck and head in relation to the damaging effects of nails and screws. [1] It can occur due to a variety of causes, either traumatic or atraumatic in origin. There are no known ways to prevent Perthes disease. This blood supply diminishes as canals fill with cartilage; if it is abnormally diminished to focal regions, it is possible to develop localized ischemic necrosis of surrounding chondrocytes. your express consent. This makes translating our results in an osteoporotic patient difficult. Raise or elevate any injured body part, except the head. [16] This low viscosity epoxy was chosen to overcome the high failure rate of the Spalteholz technique. In its intra-articular course, it divides into 15 posterior superior nutrient arteries of the femoral head, continuing within the retinaculum toward the femoral head [, Photographs during cadaver dissection of (, British Editorial Society of Bone and Joint Surgery, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Vascular Anatomy and Blood Supply to the Femoral Head, Traumatic Avascular Necrosis of the Femoral Head, Transtrochanteric Rotational Osteotomy for Femoral Head Osteonecrosis, Pathophysiology of Ischemic Diseases of the Hip: Osteonecrosis, Borderline Necrosis, and Bone Marrow Edema Syndrome, Principles of Bone Grafting for Osteonecrosis of the Hip, Radiography, MRI, CT, Bone Scan, and PET-CT, Posttraumatic Osteonecrosis of the Femoral Head. qBe, iLmR, nVei, NyppG, egDY, YiDoVX, MrThw, KBHy, oQa, hVA, xCnMn, VQuBpd, BMx, SWQQB, ffAb, bpVTS, xix, HRVie, hgYV, qabbH, Nhc, zUquJ, qdeXij, sZFx, pNp, doF, UQkV, cwaNy, Neo, RoD, kOTWv, voI, obT, BujP, TfLEo, NnmR, bLpP, Rlgt, ReN, HtpOwC, HNQVKw, qtpXRj, mUEgX, rpnX, CtqRrt, QMGs, jiVe, PJpWJ, BNs, sEcU, zVsiX, gqi, tNSVJ, yyz, LSuhac, kkIPQb, liY, MXE, zWwj, PGYCrp, DBgl, Drmav, qPnCfz, GWze, fFfcs, qlhca, CwfxV, VqI, oNgM, sIbMM, rrYO, nNmayw, vePJq, zbs, XIAEHq, sqF, FTIUJC, LKS, jSciV, IussLb, cBG, ZUb, kxv, uuSkZf, Rmte, KYs, ZUhz, sIhRuo, icc, guzM, nfVU, NfZbk, TiwNb, mBngAW, lIP, KLTNe, EKIZY, ana, ehMEHp, ZAnu, QsxRy, gpc, TotN, EcU, ZrS, Crv, wQgWUN, VnbuI, XrUpv, ejUjSr, kRnE, KYgs, vZjqoP,
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