Risk Stratification for Avascular Necrosis of the Femoral Head After Internal Fixation of Femoral Neck Fractures by Post-Operative Bone SPECT/CT
10.1007/s13139-016-0443-8
- Author:
Sangwon HAN
1
;
Minyoung OH
;
Seokho YOON
;
Jinsoo KIM
;
Ji Wan KIM
;
Jae Suk CHANG
;
Jin Sook RYU
Author Information
1. Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. jsryu2@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Bone SPECT/CT;
Avascular necrosis;
Femoral neck fracture;
Internal fixation
- MeSH:
Femoral Neck Fractures;
Femur Neck;
Follow-Up Studies;
Head;
Hip;
Humans;
Necrosis;
Orthopedics;
Prognosis;
Retrospective Studies;
Surgeons
- From:Nuclear Medicine and Molecular Imaging
2017;51(1):49-57
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Avascular necrosis (AVN) of the femoral head is a major complication after internal fixation of a femoral neck fracture and determines the functional prognosis. We investigated postoperative bone single-photon emission computed tomography/computed tomography (SPECT/CT) for assessing the risk of femoral head AVN.METHODS: We retrospectively reviewed 53 consecutive patients who underwent bone SPECT/CT within 2 weeks of internal fixation of a femoral neck fracture and follow-up serial hip radiographs over at least 12 months.RESULTS: Nine patients developed femoral head AVN. In 15 patients who showed normal uptake on immediate postoperative SPECT/CT, no AVN occurred, whereas 9 of 38 patients who showed cold defects of the femoral head later developed AVN. The negative predictive value of immediate postoperative SPECT/CT for AVN was 100 %, whereas the positive predictive value was 24 %. Among 38 patients with cold defects, 1 developed AVN 3 months postoperatively. A follow-up bone SPECT/CT was performed in the other 37 patients at 2??0 months postoperatively. The follow-up bone SPECT/CT revealed completely normalized femoral head uptake in 27, partially normalized uptake in 8, and persistent cold defects in 2 patients. AVN developed in 3.7 % (1/27), 62.5 % (5/8), and 100 % (2/2) of each group, respectively.CONCLUSION: According to the time point of imaging, radiotracer uptake patterns of the femoral head on postoperative bone SPECT/CT indicate the risk of AVN after internal fixation of femoral neck fractures differently. Postoperative bone SPECT/CT may help orthopedic surgeons determine the appropriate follow-up of these patients.
