Immediate changes in pulsed blood filling in the articular ends of the ilium and femur after their perforation in Perthes disease

Introduction In Perthes disease of stage 1 to 2, intraosseous pressure (IOP) of the tissue fluid in the head of the femur due to disorders of the venous outflow increases, the microvasculature is compressed and pulse blood supply is limited. To eliminate secondary circulatory insufficiency, the proximal femur and the supra-acetabular region of the ilium were perforated with wires, and differences in the pulse wave of blood filling in the femoral head associated with the order of perforation of the articular ends of the bones were revealed. Purpose To determine the dependence of the pulse wave of blood filling in the femoral head on the sequence of drilling of the supra-acetabular region of the ilium and the proximal femur in patients with Perthes disease. Material and methods A pulse wave of blood filling in the intraosseous tissues was recorded in 47 patients, aged 6-9 years, using rheovasography. In 6 patients, the supra-acetabular region of the ilium was perforated, then the proximal femur; in 41 patients the sequence was vice versa. Results In the hip joint, perforation of the articular end of one bone leads to post-traumatic angiospasm in the articular ends of both bones, and pulse blood supply decreases. However, by the initial perforation of the proximal end of the femur, the pulse blood supply to the tissues of the femoral head increases, and subsequent drilling of the supra-acetabular region of the ilium contributes to its additional increase. Taking into account the initially increased IOP in the femoral head, it was concluded that perforation leads to decompression of its microcirculatory bed, and pulse blood filling increases, and post-traumatic angiospasm does not develop. Conclusion In Perthes disease, the femoral head should be drilled first to decompress its microvasculature, then the supra-acetabular region of the ilium to redistribute blood circulation and further increase blood flow to the femoral head.