In spite of recent development in fixation technique we still have lots of complication including avascular necrosis of femoral head. For many years, orthopaedic surgeon have been searching for a simple, safe, accurate and reliable clinical test to asses the vascular status of the femoral head. In early detection of viability of the femoral head, nothing is more certain than bone scan at the moment. Bone scan can detect or predict the viability of the femoral head. Subramanian and McAfee introduced 99mTc-Sn-polyphosphate as a bone seeking agents. We applied serial bone scan in 19 cases of femur neck fractures from 1982 to 1985 at the department of orthopaedic surgery, National Medical Center. The results were as follows; 1. The uptake ratio of displaced and undisplaced group based on preoperative radiography was 1.ZO, 1.46, 1.52, 1.55, and 0.63, 1.23, 1.81, 1.58 in average in postoperative bone scan interval 1–2 wks, 3 months, 6 months, 12 months. The bone scan uptake ratio was lower in the former than the latter, but after 3 months, there was no remarkable difference between them. 2. At the time of 1 to 2 weeks, 3 months, 6 months and 12 months, uneventful group was 0.74, 1.27, 1.72, 1.62 and avascular necrosis group 0.13, 0.18, 0.30, 0.67 in the uptake ratio. In 2 cases of avascular necrosis, the uptake ratio was markedly decreased. 3. There was no difference between the group operated within 48 hour after injury and the group delayed later.
Equidae ; Femoral Neck Fractures ; Femur Neck ; Femur ; Head ; Necrosis ; Radiography

PURPOSE: To investigate the causes of nonunion and its appropriate modality of treatment by a retrospective review of our cases. MATERIALS AND METHODS: Four cases of established nonunion of the femur neck referred from other hospitals were included and the initial fracture was Delbet type 2 in all cases. Three cases were mobile with marked bony resorption at the nonunion site. RESULTS: The causes of nonunion include insufficient fixation which did not cross physis in the state of inaccurate reduction, and also insufficient duration of cast immobilization, and early weight bearing. All cases of nonunion were successfully treated by adequate amount of autogenous cancellous bone graft with minimal pin fixation across physeal plate, and followed by sufficient cast immobilization for more than 12 weeks, reinforced by instituting long-term protective weight bearing for at least 6 months until evidence of union on plain roentgenography is shown. CONCLUSIONS: Based on our experience, we propose the followings instead of subtrochanteric valgus osteotomy in the treatment of mobile, osteopenic nonunion of the femur neck in children. The most important considerations are adequate amount of autogenous cancellous bone graft, and prolonged protective weight bearing until bony union is assured as well as less bulky internal fixation crossing the physis.
Child* ; Femoral Neck Fractures* ; Femur Neck* ; Femur* ; Humans ; Immobilization ; Osteotomy ; Radiography ; Retrospective Studies ; Transplants ; Weight-Bearing

PURPOSE: In order to assess the incidence and radiologic findings of herniation pit of the femur neck in Korean. IVlaterials and Methods:In 152 macerated femurs of 88 cadavers, and randomly selected 115 hips of 70 patients, the presence of herniation pit was determi ned by using fluoroscopy and radiography. It was then examined by CT for inspection of overlying surface and its opening was confirmed by inserting thin steal wire under the fluoroscopic guidance. RESULTS: Seventeen herniation pits in 15 macerated femurs of 13 cadavers were noted. (14.8%, 13/88). Two of 13 individuals showed bilaterality. All lesions were found only in males. Six herniation pit in 6 femurs of 6 patients (8.6%, 6/70) were also noted. All lesions were on anterosuperior aspect of. femur neck. Plain radiographs of macerated femurs revealed well marginated and thin sclerosis in 15 lesions. Of all 23 lesions, CTshowed cortical breakdown in 3, and overlying cortical thickening in 8. In 15 macerated femurs, roughed area of cortex was found in anterosuperior aspect of femur in all cases, and tiny openings(diameter less than 1 mm) related to cystic lesions were confirmed in 9 lesions. CONCLUSION: The incidence of herniation pits was 14.8% in 88 cadaver, and 8.6% in 70 patients. All were males.
Cadaver ; Femur Neck* ; Femur* ; Fluoroscopy ; Hip ; Humans ; Incidence* ; Male ; Radiography ; Sclerosis

PURPOSE: The aim of this study was to examine the validity of using cannulated screws as a method for predicting avascular necrosis of the femoral head after a fixation of fractures in patients with femoral neck fractures. MATERIALS AND METHODS: Between March 1999 and January 2001, 44 patients with a femoral neck fracture that had been fixed with cannulated screws were enrolled in this study. The follow up period was more than 25 months and the mean age of the patients was 51 years (range, 18 to 76 year). Blood drainage in the holes of the screw head was checked. There were 38 cases in the bleeding group, and 6 cases in the non-bleeding group. The development of head necrosis was evaluated using plain radiography. The validity of the relationship between the two groups and head necrosis was evaluated by the sensitivity, specificity, the positive predictive value, and the negative predictive value. RESULTS: An avascular necrosis of the femoral head developed in 7 cases (16%). Only one of the 38 patients in the bleeding group developed head necrosis (2.6%). However, all those in the non-bleeding group developed head necrosis (100%). The sensitivity was 86%, the specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 97%. CONCLUSION: Bleeding from holes in the cannulated screws is a simple and accurate perfusion assessment for predicting the development of an avascular necrosis of the femoral head after a femoral neck fracture.
Drainage ; Femoral Neck Fractures* ; Femur ; Femur Neck* ; Follow-Up Studies ; Head* ; Hemorrhage* ; Humans ; Necrosis* ; Perfusion ; Radiography ; Sensitivity and Specificity

Secondary ischemic necrosis of femoral head due to loss of blood supply following to femoral neck fracture is well known. The regional distribution of bone.seeking radiopharmaceuricals in the skeleton can depend on a number of facto rs, but bone blood flow is a major physiological determinant of regional skeletal uptake of Tc-99m polyphosphate and bone imaging may thus be used for the evaluation of vascularity of the femoral head. The authors made a comparative study of scintigraphic findings and operative findings of 28 cases of femoral neck fracture treated at Kyung Hee University Hospital from April ′80 to May ′84. The results were as follows: 1. In 16 cases of proven avscular necrosis of femoral head, scintigraphy showed absent or decreased activity in 14 cases (87.5%), while radiography showed increased density in 10 cases (62.5%). 2. In 12 cases of proven vital femoral head, scintigraphy showed increased activity in 9 cases (75%) and radiography showed decreased density in 9 cases (75%). 3. 99mTc-MDP scintigraphy was an excellent and useful method for assessing bone vitality of femoral head.
Femoral Neck Fractures ; Femur Head Necrosis ; Femur Neck ; Head ; Methods ; Necrosis ; Radiography ; Radionuclide Imaging ; Skeleton ; Technetium Tc 99m Medronate

BACKGROUND: Reports on the relationship between osteoporosis and osteoarthritis (OA) have tended to disagree, especially in non-weight bearing joints such as the hand joints. We aimed to investigate the relationship between bone mineral density (BMD) and hand and knee OA in a general Korean elderly population. METHODS: We evaluated femur neck BMD and the hand and knee radiographs of 143 men and 123 women over 65 years of age who participated in a population-based cohort study. The Kellgren-Lawrence criteria for grading OA were implemented, and grade 2 or higher were categorized as radiographic OA. BMD was compared according to the existence of radiographic OA in the hand and knee using analysis of covariance, and correlation analyses were performed to explore the relationship between BMD and radiographic OA grade. RESULTS: After controlling for age and body mass index, there was no significant difference in BMD between participants with and without hand OA (p = 0.717 in male and p = 0.862 in female), between those with and without knee OA (p = 0.974 in male and p = 0.563 in female), and between those with only hand OA and those with only knee OA (p = 0.920 in male and p = 0.961 in female). Furthermore, there was no significant correlation between BMD and the radiographic OA grade of the hands (p = 0.182 in male and p = 0.897 in female) and knees (p = 0.245 in male and p = 0.098 in female). CONCLUSIONS: In our cohort of the general Korean elderly population, no association was found between osteoporosis and OA, regardless of the weight bearing status of the joints.
Aged ; *Bone Density ; Female ; Femur Neck/*radiography ; Hand/*radiography ; Humans ; Male ; Osteoarthritis, Knee/complications/*radiography ; Osteoporosis/complications/*radiography ; Republic of Korea ; Sex Factors

A 21-year-old male had have a one-year history of persistent left hip pain that was aggrevated at night. The diagnosis was osteoid osteoma that was based on clinical examination, simple radiography, and computed tomography. Under spinal anesthesia, the tumor was localized using an image intensifier and its nidus was excised successfully using the burr down technique. We report upon a single case of arthroscopic excision of an osteoid osteoma using the burr down technique and the good result obtained at the 2 year follow-up.
Anesthesia, Spinal ; Diagnosis ; Femur Neck* ; Follow-Up Studies ; Hip ; Humans ; Male ; Osteoma, Osteoid* ; Radiography ; Young Adult

PURPOSE: Presence of a cephalomedullary nail (CMN) in the medullary canal has been thought as advantageous in the control of femoral neck shortening (FNS) and lag screw sliding in trochanteric fracture compared to extramedullary fixation system. However, researches on the factors that influence the degree of FNS after cephalomedullary nailing are lacking. MATERIALS AND METHODS: We observed 95 patients (mean age, 75+/-2.8 years) with trochanteric fractures who were treated with a CMN, and evaluated the relationship between FNS and patient factors including age, gender, fracture type (AO/OTA), bone mineral density, medullary canal diameter, canal occupancy ratio (COR=nail size/canal diameter), and tip-apex distance using initial, immediate postoperative, and follow-up radiography. RESULTS: Univariate regression analyses revealed that the degree of FNS was significantly correlated with fracture type (A1 versus A3, p<0.001), medullary canal diameter (p<0.001), and COR (p<0.001). Multiple regression analyses revealed that FNS was strongly correlated with fracture type (p<0.001) and COR (p<0.001). CONCLUSION: Presence of a CMN in the medullary canal could not effectively prevent FNS in patients with low COR and in A3 type fracture.
Aged ; *Bone Nails ; Female ; Femur Neck/*radiography ; Hip Fractures/radiography/*surgery ; Humans ; Male ; Orthopedic Procedures/*methods ; Regression Analysis

Diagnostic Errors ; Female ; Femoral Neck Fractures ; diagnosis ; diagnostic imaging ; Femur Neck ; diagnostic imaging ; injuries ; Humans ; Radiography ; Young Adult

PURPOSE: A basicervical femoral fracture is defined as a fracture of base of neck of femur that occurs medially from intertrochanteric line above lesser trochanter. In this study, we intended to evaluate radiological and clinical results of basicervical femoral fractures treated by intramedullary nailing. MATERIALS AND METHODS: Fifteen patients, who underwent intramedullary nailing among 50 patients, out of 50 who were diagnosed with basicervical femoral fractures from July 2012 to May 2015 were studied. All of 15 patients' fracture were two-part basicervical fractures. Using radiography, we characterized the: i) state of reduction, ii) location of the lag screw, iii) tip apex distance (TAD), and iv) sliding distance of lag screw and bone union. Additionally, we performed clinical assessment before injury and at final follow-up. RESULTS: In radiological assessment, we achieved acceptable reduction state in all patients. All lag screws were fixated on appropriate locations. Mean TAD was 17.3 mm (11.0–21.1 mm), which showed insertion point of < 25 mm in all cases. The mean sliding distance of the lag screw was 5.1 mm (0.1–16.0 mm) at the final follow-up. The mean bone union period was 4.8 months (3–10 months) with achieving in all cases. In clinical assessment, Harris hip score, visual analogue scale score and Western Ontario and McMaster Universities Arthritis Index score, all of them significantly improved postoperatively compared with preoperative scores (P < 0.05). CONCLUSION: In elderly patients with basicervical femoral fractures, treatment with intramedullary nailing showed satisfactory results, considered to be a useful method if performed with skilled technique.
Aged ; Arthritis ; Femoral Fractures ; Femur ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Hip ; Humans ; Methods ; Neck ; Ontario ; Radiography