Osteoscopy for assessment of blood supply to the femoral head: a preliminary study

The aim of our study was to develop a minimally invasive endoscopic procedure (osteoscopy), which is capable of visualizing blood supply and quantitatively assessing circulation to the femoral head at the time of definitive surgery.

The new diagnostic technique was developed in animal experiments (four piglets) and was subsequently tested in nine consecutive patients requiring surgery for a femoral neck fracture. The direct visualization of the femoral head circulation was performed in the mortise prepared for the implant. The osteoscope optic fiber was placed at the orifice of the cavity created by the custom-made drill bit. The "mortise-sleeve-optic" system was connected to a manometer and a saline reservoir. The bleeding from the wall of bony cavity was observed, meanwhile the inner pressure of the "mortise-sleeve-optic" system was changed gradually. The pressure measurement at the first appearance of bleeding and the intraosseal pressure was recorded.

The animal investigations demonstrated that the osteoscopy readily distinguished among diffuse bleeding, pulsatile bleeding, and the absence of bleeding in the femoral head. The human experiments proved that a different quality of the femoral head circulation can be observed during osteoscopy.

Preliminary findings indicate that clinical osteoscopy may be a useful tool in the assessment of blood circulation to the femoral head.