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Incidence and severity of femoral head avascularity after femoral neck or intertrochanteric fractures on preoperative bone single photon emission computed tomography/computed tomography

preliminary study

Han, Yeon-Heea; Jeong, Hwan-Jeonga; Sohn, Myung-Heea; Yoon, Sun-Jungb; Lim, Seok Taea

Nuclear Medicine Communications: March 2019 - Volume 40 - Issue 3 - p 199–205
doi: 10.1097/MNM.0000000000000963
ORIGINAL ARTICLES
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Objective The aim of the present study was to evaluate the incidence and degree of femoral head avascularity depending on the types of femoral neck or intertrochanteric fractures using preoperative bone single photon emission computed tomography (SPECT)/computed tomography (CT).

Patients and methods A total of 131 patients with femoral neck or intertrochanteric fractures who underwent preoperative bone SPECT/CT were enrolled. Femoral head avascularity was evaluated using bone SPECT/CT images. Visual scores ranged from 1 to 5 based on visually assessed diagnostic confidence: 1=definitely avascular femoral head, 2=likely avascular, 3=equivocal, 4=likely not avascular, and 5=definitely not avascular. In quantitative analysis, contralateral, ipsilateral, and size ratios were measured.

Results Among 131 patients, 39 of 54 (72.22%) with femoral neck fractures and 23 of 77 (29.87%) with intertrochanteric fractures showed avascular femoral heads. The incidence of femoral head avascularity was significantly higher in patients with femoral neck fracture than those with intertrochanteric fracture. While the incidence and severity of femoral head avascularity increased with higher Garden stage in femoral neck fracture, neither was related to AO/Orthopaedic Trauma Association classification of intertrochanteric fracture. In addition, the number of bony fragments around intertrochanteric fractures was not a significant predictor of femoral head avascularity.

Conclusion Although avascular femoral head on bone SPECT/CT does not directly indicate avascular necrosis, assessing the incidence and severity of femoral head avascularity using qualitative and quantitative parameters could give clinically useful information related to the classification. Additional studies with larger sample sizes would be a next step to expand the clinical role of bone SPECT/CT.

aDepartment of Nuclear Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Cyclotron Research Center, Molecular Imaging and Therapeutic Medicine Research Center, Chonbuk National University Medical School and Hospital

bDepartment of Orthopedic Surgery, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea

Correspondence to Seok Tae Lim, MD, PhD, Department of Nuclear Medicine, Chonbuk National University Medical School and Hospital, 20 Geonjiro, Duckjin-gu, Jeonju 561-712, Republic of Korea Tel: +82 632 501 371; fax: +82 632 551 172; e-mail: stlim@jbnu.ac.kr

Received July 24, 2018

Accepted November 14, 2018

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.