Twenty-nine patients with less than 1 year of follow-up after surgery were excluded from the analysis. Among a total of 112 patients, 91 underwent immediate postoperative bone SPECT/CT for assessment of the blood supply to the femoral head within 2 weeks of surgery. We retrospectively reviewed consecutive patients who underwent internal fixation for a femoral neck fracture between November 2007 and October 2014 in our institution. Therefore, this study was performed to investigate the relationship between radiotracer uptake patterns of the femoral head on postoperative bone SPECT/CT and subsequent occurrence of AVN of the femoral head and whether it is different according to the time point of imaging in patients who underwent internal fixation of a femoral neck fracture. We hypothesized that postoperative bone SPECT/CT might stratify the risk of AVN of the femoral head after internal fixation of femoral neck fractures and the time point of the scan might affect its risk assessment ability. Despite the improved diagnostic performance of SPECT/CT over planar scintigraphy, no studies have investigated the usefulness of bone SPECT/CT for AVN of the femoral head after femoral neck fracture. In addition to SPECT imaging, hybrid imaging of SPECT and computed tomography (CT) provides complex anatomical information on the hip and attenuation correction of SPECT images. Bone single-photon emission computed tomography (SPECT) has a better diagnostic ability for detecting cold defects of the femoral head than planar bone scintigraphy on which the cold femoral head may be obscured by other surrounding activities. Therefore, it remains unclear whether these inconsistent reports result from limited performance of bone scintigraphy for assessing the blood supply to the femoral head or the different time points of imaging. However, the time when bone scintigraphy was performed varies, and the predictive values were different for each study. There are several studies on the usefulness of planar bone scintigraphy for predicting AVN of the femoral head after internal fixation of femoral neck fractures. As absent radiotracer uptake on bone scintigraphy reflects disrupted blood supply to bone tissue, a cold defect in the femoral head is considered an early scintigraphic sign of osteonecrosis of the femoral head. Vascular damage induces bone cell ischemia and subsequent cell death, followed by structural changes. Hence, early prediction of developing AVN is critical for assessing the functional prognosis and planning further therapeutic approaches.ĭisruption of the blood supply to the femoral head at the time of injury is considered to underlying AVN of the femoral head following femoral neck fracture. Joint-preserving procedures, such as core decompression or vascularized fibular grafts, can be performed more successfully at an earlier stage of AVN to prevent progression in severity and joint destruction. Femoral head collapse is considered the most important functional prognostic factor in progression to secondary osteoarthritis. A significant proportion of those who develop AVN complain of disabling pain and require secondary arthroplasty because of secondary osteoarthritis. The overall incidence of AVN of the femoral head after internal fixation of a femoral neck fracture is 15–25 %. One of the main complications after internal fixation of a femoral neck fracture is avascular necrosis (AVN) of the femoral head. However, in older patients with displaced fractures, primary arthroplasty is commonly performed to restore mobility. Although the optimal choice for management remains controversial, internal fixation is generally preferred in young patients with undisplaced fractures in whom the therapeutic goal is to save the natural femoral head. Physiologic age and the degree of displacement of the fracture are the main factors for determining the method of operation. These fractures can be managed by internal fixation or primary arthroplasty. The increasing proportion of the older population has been accompanied by an increase in the incidence of femoral neck fractures. Femoral neck fractures are not only a life-threatening lesion in the elderly, with a mortality rate of 20–30 %, but also cause serious disability in the young.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |