scholarly journals Ordinary Cannulated Compression Screws or Headless Cannulated Compression Screws? A Synthetic Bone Biomechanical Research in the Internal Fixation of Vertical Femoral Neck Fracture

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Baokun Zhang ◽  
Jingwen Liu ◽  
Wei Zhang
Keyword(s):  
Compressive Strength ◽  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Maximum Load ◽  
Biomechanical Stability ◽  
Compression Screw ◽  
Significant Difference ◽  
Load To Failure ◽  
Neck Fracture ◽  
3D Printed

Purpose. The purpose of this study is to verify whether the headless cannulated compression screw (HCCS) has higher biomechanical stability than the ordinary cannulated compression screw (OCCS) in the treatment of vertical femoral neck fractures. Materials and Methods. 30 synthetic femur models were equally divided into 2 groups, with 50°, 60°, and 70° Pauwels angle of femoral neck fracture, under 3D printed guiding plates and C-arm fluoroscopic guidance. The femur molds were fixed with three parallel OCCSs as OCCS group and three parallel HCCSs as HCCS group. All specimens were tested for compressive strength and maximum load to failure with a loading rate of 2 mm/min. Results. The result showed that there was no significant difference with the compressive strength in the Pauwels angle of 50° and 60°. However, we observed that the maximum load to failure with the Pauwels angle of 50°, 60°, and 70° and the compressive strength with 70° of HCCS group showed better performance than the OCCS group. Conclusion. HCCS performs with better biomechanical stability than OCCS in the treatment of vertical femoral neck fracture, especially with the Pauwels angle of 70°.

scholarly journals Re-Recognition of Garden Index as a Criterion for Evaluating the Quality of Femoral Neck Fracture Reduction: An Imaging Study Based on Cadaver Specimens

2021 ◽  
Author(s):  
Leyi Cai ◽  
Wenjie Li ◽  
Wenhao Zheng ◽  
Jianshun Wang ◽  
Xiaoshan Guo ◽  
...  
Keyword(s):  
Femoral Head ◽  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Kirschner Wire ◽  
Imaging Study ◽  
Lateral View ◽  
Healthy Human ◽  
Rotational Displacement ◽  
Significant Difference ◽  
Neck Fracture

Abstract ObjectiveTo investigate whether the Garden index can determine the rotational displacement of femoral neck fracture. MethodsTen healthy human femoral specimens were obtained. A 2.0 mm diameter Kirschner-wire was placed in the center of the femoral head. The osteotomy was perpendicular in the middle of the femoral neck. The distal osteotomy surface was indicated the angle of rotation (pronation and supination to 90°, every 10° was an interval). The X-ray of anterior-posterior and lateral view was taken at different angles according to the mark. The Garden index and other relevant data were analyzed with the PCAS system. Meanwhile, the change of the area of the femoral head fovea at different rotation angles was observed. ResultsThere was no significant difference in the Garden index in 0~30° at pronation and supination position (P>0.05). In range of 40°~90°, there was a statistical difference in the Garden index (P<0.05). With the increase of the pronation angle, the area of the femoral head fovea is gradually reduced; as the angle of the supination increases, the area of the femoral head fovea is gradually increased. ConclusionThe Garden Index cannot accurately determine the rotational displacement of the femoral neck fracture during the pronation or supination range of 0~30°. Changes in the area of the femoral head fovea can help determine the rotational displacement of the femoral neck fracture.Level of EvidenceLevel V.

scholarly journals Comparison of Ordinary Cannulated Compression Screw and Double-Head Cannulated Compression Screw Fixation in Vertical Femoral Neck Fractures

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Yuelei Zhang ◽  
Chao Yan ◽  
Lecheng Zhang ◽  
Wei Zhang ◽  
Gang Wang
Keyword(s):  
Femoral Neck ◽  
Maximum Load ◽  
Femoral Neck Fractures ◽  
Axial Stiffness ◽  
Screw Loosening ◽  
Compression Screw ◽  
Fixation Failure ◽  
Fracture Displacement ◽  
Load To Failure ◽  
Double Head

Background. The treatment of vertical femoral neck fractures in young patients remains a challenge. This study is aimed at comparing ordinary cannulated compression screw (OCCS) and double-head cannulated compression screw (DhCCS) fixation in vertical femoral neck fractures both clinically and biomechanically. Materials and Methods. Clinically, the radiographs of 81 patients with Pauwel’s III femoral neck fractures, including 54 fractures fixed with three parallel OCCSs and 27 fractures fixed with three parallel DhCCSs, were reviewed retrospectively. Complications consisting of fixation failure (screw loosening, obvious fracture displacement, varus deformity, or femoral neck shortening), bony nonunion, and avascular necrosis (AVN) were determined. Biomechanically, twenty synthetic femur models of vertical femoral fractures with an 80° Pauwel’s angle were divided into two groups and subsequently fixed with three parallel OCCSs or DhCCSs. All specimens were tested for axial stiffness, load to 5 mm displacement, and a maximum load to failure with a loading rate of 2 mm/min. Results. Clinically, 22 fractures in the OCCS group experienced fixation failure, including 19 screw loosening, 18 femoral neck shortening, 14 varus deformities, and 8 obvious fracture displacements, whereas only 4 fractures experienced fixation failure in the DhCCS group, including 3 screw loosening, 3 femoral neck shortening, 3 varus deformities, and 1 obvious fracture displacement. Additionally, 11 fractures in the OCCS group exhibited nonunion, whereas only 3 in the DhCCS group exhibited nonunion. Nine fractures with AVN were noted in the OCCS group, whereas only 1 was observed in the DhCCS group. Biomechanically, the axial stiffness of the DhCCS group was greater than that of the OCCS group ( 154.9 ± 6.81 vs. 128.1 ± 7.41  N/mm), and the load to 5 mm displacement was also significantly greater in the DhCCS group ( 646.1 ± 25.87 vs. 475.8 ± 21.46  N). Moreover, the maximum load to failure in the DhCCS group exhibited significant advantages compared with that of the OCCS group ( 1148 ± 39.47 vs. 795.9 ± 51.39  N). Conclusion. Our results suggested that using three DhCCSs improved the outcome of vertical femoral neck fractures compared to three OCCSs, offering a new choice for the treatment of femoral neck fracture.

Comparative Analysis of Preoperative and Postoperative Muscle Around Hip Joint by Computed Tomography Between Intertrochanteric Fracture and Femur Neck Fracture

2020 ◽  
Author(s):  
Sung Yoon Jung ◽  
Hyeon Jun Kim ◽  
Kyu Taek Oh
Keyword(s):  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Intertrochanteric Fracture ◽  
Femoral Neck Fractures ◽  
Final Visit ◽  
Cross Sectional ◽  
Fracture Group ◽  
Significant Difference ◽  
Neck Fracture

Abstract Background:This study assessed the changes in hip muscles by comparing the preoperative and postoperative CT scan results between patients with intertrochanteric versus femoral neck fractures. Methods:48 patients who received surgical treatment for intertrochanteric or femoral neck fractures from February 2013 to February 2019 and underwent pelvic computed tomography(CT) preoperative and postoperatively aged 65 and older with a minimum follow-up of 1 year were included. The subjects were divided into two groups: 26 patients with intertrochanteric fracture and 22 patients with femoral neck fracture. We measured the cross-sectional area(CSA) and attenuation of the gluteus medius(G.med), gluteus minimus(G.min), iliopsoas(IP), and rectus femoris(RF) on the contralateral side. Patient basic data were collected from medial records including sex, age, height, weight, BMI, BMD, Harris hip score (HHS), and length of follow-up until the final visit. Results: There was no significant difference in sex, age, height, weight, BMI, BMD, HHS, and length of follow-up until the final visit between two groups. The femoral neck fracture group had significantly larger CSA and cross-sectional area per weight(CSA/Wt) of the G.med and G.min(G.med CSA, CSA/wt preoperative 1995.29 vs 1713.64, 38.87 vs 32.74; postoperative 2144.98 vs 1815.56, 37.48 vs 32.78/G.min preoperative 745.22 vs 566.59, 14.32 vs 10.96; postoperative 764.39 vs 619.17, 14.78 vs 11.25). On the contrary, the intertrochanteric fracture group had significantly greater CSA and CSA/Wt of the IP and RF(IP preoperative 810.86 vs 661.88, 17.73 vs 9.42; postoperative 681.98 vs 571.32, 12.68 vs 9.88/RF preoperative 503.66 vs 386.72, 9.42 vs 7.23; postoperative 426.24 vs 349.31, 7.17 vs 5.23). HHS related with function had no significant correlation with postoperative CSA and CSA/Wt. There was no significant difference in attenuation between two groups. All subjects had a significant decrease of muscle attenuation postoperatively.Conclusions: The CSA of the hip abductor(G.med and G.min) was significantly larger in the femoral neck fracture group, while the CSA of the hip flexor(IP and RF) was significantly higher in the intertrochanteric fracture group. Based on these findings, choosing the rehabilitation program suitable for the fracture site is expected to be beneficial in hip fracture rehabilitation.

scholarly journals Az ellenoldali csípőtáji törésig eltelt időt befolyásoló prognosztikai tényezők vizsgálata

2018 ◽  
Vol 159 (38) ◽  
pp. 1543-1547
Author(s):  
Krisztina Juhász ◽  
Imre Boncz ◽  
Péter Kanizsai ◽  
Andor Sebestyén
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Hip Fracture ◽  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Hip Fractures ◽  
Age Groups ◽  
Significant Difference ◽  
Neck Fracture ◽  
The Impact

Abstract: Introduction: Although several national studies reported on the risk factors for contralateral hip fracture, there are no data about the prognostic factors of the time until contralateral hip fractures. Aim: The aim of the study was to analyse the impact of different prognostic factors on the time until the development of contralateral fracture and to determine the incidence of contralateral hip fractures after femoral neck fractures. Method: Patients aged 60 years and over with contralateral hip fracture between 01 Jan 2000 and 31 Dec 2008 were identified among those who suffered their femoral neck fracture in Hungary in 2000. Risk factors as age, sex, comorbidities, type of fracture and surgery, place of living and hospitals providing treatment for primary fracture were analysed by one way ANOVA focusing on the time until the development of contralateral hip fracture. Results: 312 patients met the inclusion criteria. The incidence of contralateral hip fracture after femoral neck fracture ranged between 1.5% and 2.1%, the cumulative incidence was 8.24%. The mean time until the development of contralateral hip fracture was 1159.8 days. The incidence of contralateral hip fracture showed no significant deviation. Significantly shorter time (p = 0.010) was detected until the contralateral hip fracture in older patients with femoral neck fracture. Conclusions: The yearly incidence of contralateral hip fracture showed no significant difference by patients with femoral neck fracture over 60 years. The shorter time until the contralateral hip fracture by the older age groups highlights the need of elaboration of prevention strategies. Orv Hetil. 2018; 159(38): 1543–1547.

scholarly journals Clinical Observation and Finite Element Analysis of Cannulated Screw Internal Fixation in the Treatment of Femoral Neck Fracture Based on Different Reduction Quality

2021 ◽  
Author(s):  
Gan Zhao ◽  
Ming Liu ◽  
bin Li ◽  
haizhong Sun ◽  
Biaofang Wei
Keyword(s):  
Finite Element ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Cannulated Screw ◽  
Anatomical Reduction ◽  
Significant Difference ◽  
Reduction Group ◽  
Neck Fracture ◽  
Time From Injury

Abstract Objective: Femoral neck fracture is one of the most common bone types. The effect of reduction quality on hip joint function and complications after screw internal fixation is not fully understood. To investigate the clinical efficacy and mechanical mechanism of positive buttress, anatomical reduction and negative buttress in the treatment of femoral neck fracture after cannulated screw fixation.Methods: Retrospective analysis of patients with femoral neck fracture treated with three cannulated screws internal fixation in our hospital from January 2013 to December 2018.According to the quality of fracture reduction, the patients were divided into positive buttress group, anatomical reduction group and negative buttress group. Basic information such as injury mechanism, time from injury to surgery, Garden classification and Pauwels classification was collected, Harris scores were performed at 3 months, 6 months and 12 months after surgery, and postoperative complications (femoral head necrosis, femoral neck shortening and femoral neck nonunion) were collected. At the same time, three groups of finite element models with different reduction quality were established for stress analysis, their stress clouds were observed and the average displacement and stress of the three groups of models were compared. P < 0.05 was used to represent a statistically significant difference.Results: A total of 225 cases of unilateral femoral neck fractures were included and followed up for an average of 4.12 ± 0.69 years. There was no significant difference in age, gender, side, injury mechanism, time from injury to surgery, BMI, Garden classification, Pauwels classification and follow-up time among the three groups (P > 0.05).However, there was significant difference in harris score at 6 and 12 months after operation among the three groups (P < 0.05), which was higher in the positive buttress group and anatomical reduction group than in the negative buttress group. In addition, the incidence of osteonecrosis of the femoral head in the negative buttress group (32.2%) was greater than that in the anatomical reduction group (13.4%) and the positive buttress group (5.4%) (P < 0.05). In addition, the incidence of femoral neck nonunion and femoral neck shortening in the negative buttress group was also higher than that in the anatomical reduction positive buttress group (P < 0.05). The finite element results showed that the stress and fracture end displacement in the negative buttress group were greater than those in the positive buttress group (P < 0.05).Conclusion: Both positive buttress and anatomical reduction in the treatment of femoral neck fracture with cannulated screw internal fixation can obtain better clinical effect and lower postoperative complications. Positive brace support and anatomic reduction can limit the restoration of femoral stress conduction. Therefore, it is not necessary to pursue anatomical reduction too deliberately during surgery, while negative buttress reduction should be avoided.

scholarly journals The Diagnostic Value of SPECT/CT in Predicting the Occurrence of Osteonecrosis following Femoral Neck Fracture : a prospective cohort study

2020 ◽  
Author(s):  
Jae Youn Yoon ◽  
Soong Joon Lee ◽  
Kang Sup Yoon ◽  
Pil Whan Yoon
Keyword(s):  
Computed Tomography ◽  
Femoral Head ◽  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Diagnostic Value ◽  
Emission Computed Tomography ◽  
Uptake Ratio ◽  
Significant Difference ◽  
Neck Fracture ◽  
The Mean

Abstract Backgrounds One of the most significant complications after a femoral neck fracture is osteonecrosis of the femoral head (ONFH). The concomitant use of single-photon emission computed tomography (SPECT) with computed tomography (CT) increases the sensitivity for detecting the anatomic location and severity of ONFH. In this study, we evaluated the diagnostic value of SPECT/CT for the occurrence of ONFH by quantifying the perfusion status of the femoral head. Methods A total of 30 patients who had multiple pinnings for femur neck fractures were included in this study. We classified the perfusion status into three groups: normal perfusion, decreased perfusion, and avascular groups, and compared the occurrence of femoral head necrosis between them. For quantitative analysis, we evaluated the uptake ratio of both femur heads (head-to-head uptake ratio). If the patient’s contralateral hip was incomparable, we measured the uptake ratio from the superior dome of the ipsilateral acetabulum (head-to-acetabulum uptake ratio). Results Twenty-four patients out of 30 achieved bone union, whereas the others developed ONFH. When the population was divided into intact and defective perfusion groups on scintigraphy, the sensitivity, specificity, and accuracy of the test were 83.3%, 75.0%, and 76.7%, respectively. The mean head-to-head uptake ratio value with a 95% confidence interval (CI) was 1.10 (95% CI: 0.85 – 1.36). In the osteonecrosis group, the mean value of the head-to-head uptake ratio was 0.33 (95% CI: 0.28 – 0.38). In contrast, the ratio was 1.30 (95% CI: 1.03 – 1.57) in the non-osteonecrosis group, demonstrating a significant difference in the uptake ratio ( P < 0.001). When the cutoff value of the uptake ratio was set to 0.5, both the sensitivity and specificity were 100%. There was also a significant difference in the head-to-acetabulum uptake ratio between the two groups ( P < 0.001). Conclusions SPECT/CT was useful in evaluating the perfusion status of the femoral head, showing high accuracy in predicting the occurrence of avascular necrosis. To demonstrate the reliability and validity of SPECT/CT, further prospective studies on a larger scale are warranted.

scholarly journals The Diagnostic Value of SPECT/CT in Predicting the Occurrence of Osteonecrosis Following Femoral Neck Fracture: a Prospective Cohort Study

2020 ◽  
Author(s):  
Jae Youn Yoon ◽  
Soong Joon Lee ◽  
Kang Sup Yoon ◽  
Pil Whan Yoon
Keyword(s):  
Computed Tomography ◽  
Femoral Head ◽  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Diagnostic Value ◽  
Emission Computed Tomography ◽  
Uptake Ratio ◽  
Significant Difference ◽  
Neck Fracture ◽  
The Mean

Abstract BackgroundsOne of the most significant complications after a femoral neck fracture is osteonecrosis of the femoral head (ONFH). The concomitant use of single-photon emission computed tomography (SPECT) with computed tomography (CT) increases the sensitivity for detecting the anatomic location and severity of ONFH. In this study, we evaluated the diagnostic value of SPECT/CT for the occurrence of ONFH by quantifying the perfusion status of the femoral head.MethodsA total of 30 patients who had multiple pinnings for femur neck fractures were included in this study. We classified the perfusion status into three groups: normal perfusion, decreased perfusion, and avascular groups, and compared the occurrence of femoral head necrosis between them. For quantitative analysis, we evaluated the uptake ratio of both femur heads (head-to-head uptake ratio). If the patient’s contralateral hip was incomparable, we measured the uptake ratio from the superior dome of the ipsilateral acetabulum (head-to-acetabulum uptake ratio).ResultsTwenty-four patients out of 30 achieved bone union, whereas the others developed ONFH. When the population was divided into intact and defective perfusion groups on scintigraphy, the sensitivity, specificity, and accuracy of the test were 83.3%, 75.0%, and 76.7%, respectively. The mean head-to-head uptake ratio value with a 95% confidence interval (CI) was 1.10 (95% CI: 0.85–1.36). In the osteonecrosis group, the mean value of the head-to-head uptake ratio was 0.33 (95% CI: 0.28–0.38). In contrast, the ratio was 1.30 (95% CI: 1.03–1.57) in the non-osteonecrosis group, demonstrating a significant difference in the uptake ratio (P < 0.001). When the cutoff value of the uptake ratio was set to 0.5, both the sensitivity and specificity were 100%. There was also a significant difference in the head-to-acetabulum uptake ratio between the two groups (P < 0.001).ConclusionsSPECT/CT was useful in evaluating the perfusion status of the femoral head, showing high accuracy in predicting the occurrence of avascular necrosis. To demonstrate the reliability and validity of SPECT/CT, further prospective studies on a larger scale are warranted.

scholarly journals Association between Hemiarthroplasty vs. Total Hip Arthroplasty and Major Surgical Complications among Patients with Femoral Neck Fracture

2020 ◽  
Vol 9 (10) ◽  
pp. 3203
Author(s):  
Takahisa Ogawa ◽  
Toshitaka Yoshii ◽  
Mutsuko Moriwaki ◽  
Shingo Morishita ◽  
Yoto Oh ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Propensity Score ◽  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Hip Arthroplasty ◽  
Perioperative Complications ◽  
Hip Dislocation ◽  
Total Hip ◽  
Significant Difference ◽  
Neck Fracture

Previous studies have shown better clinical outcomes after total hip arthroplasty (THA) compared to hemiarthroplasty (HA) for displaced femoral neck fracture. However, few studies have focused on the surgical risks of the two procedures. Therefore, we investigated the perioperative complications of HA and THA in femoral neck fracture, using a large nationwide inpatient database. A total of 286,269 patients (281,140 patients with HA and 5129 with THA) with a mean age of 81.7 were enrolled and HA and THA patients were matched by a propensity score to adjust for patient and hospital characteristics. Patients in a matched cohort were analyzed to compare complications and mortality. The systemic complication rate was not significantly different after a propensity score matching of 4967 pairs of patients. However, the incidence of both hip dislocation and revision surgery was more frequent in the THA group (Risk difference (RD), 2.74; 95% Confidence interval (CI), 2.21–3.27; p < 0.001; RD, 2.82; 95% CI, 2.27–3.37; p < 0.001, respectively). There was no significant difference in 30 day in-hospital mortality among the two groups. The risk of dislocation and reoperation was higher for THA than for HA in elderly patients with a femoral neck fracture in this retrospective study using a nationwide database.

scholarly journals Assessing the effect of gotfried reduction with positive buttress pattern in the young femoral neck fracture

2020 ◽  
Author(s):  
Kai Huang ◽  
Xiaohui Fang ◽  
Guijun Li ◽  
Jiajun Yue
Keyword(s):  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Clinical Results ◽  
Anatomic Reduction ◽  
Significant Difference ◽  
Reduction Group ◽  
Neck Fracture ◽  
Group A ◽  
Group B

Abstract Background: Although many available surgical procedures for displaced femoral neck fractures in young patients, there are still many challenges to achieve satisfactory results. The incidence of avascular necrosis and nonunion rates remain relatively high despite the progress in our understanding and surgical technique. The purpose of this study was to evaluate the clinical efficacy of gotfried reduction and cannulated screw fixation in the treatment of femoral neck fracture for young adults. Methods: A retrospective analysis was made on 67 cases from May 2013 to March 2019. They were divided into three groups according to the first postoperative anteroposterior view of hip X-ray: Anatomic reduction (group A), Gotfried positive buttress reduction (group B), and Gotfried negative buttress reduction (group C). The incidence of avascular osteonecrosis of the femoral head ( AVN ) and the Harris scores of hip joints were compared in three groups at the last follow-up. Results: The mean follow-up period after surgery was 22.5 ± 11.3 (range, 11–34) months. There were 21 cases (mean age,49.7 ± 11.6) in group A, 24 cases (mean age, 48.6 ± 11.3) in group B, 22 cases (mean age,48.3 ± 12.4) in group C. No significant difference in general preoperative demographics (P>0．05). The incidence of avascular necrosis of femoral head in Group A, B, and C was 19.05%,20.83%, and 22.73 %, respectively, showing no significant difference between groups(P=0．156). The mean Harris hip scores at the final follow-up for groups A (85．6±6．7)and B (84．5±6．2) were significantly higher than group C (74．3±8.3), and the difference was statistically significant(P=0．043). The incidence of femoral neck shortening in group A and group B was significantly lower than that in group C in postoperative one year, and the difference was statistically significant (P<0.05). Conclusions: Gotfried positive buttress reduction and fixation for femoral neck fracture may lead to similar clinical results with anatomic reduction, but much better than Gotfried negative buttress reduction. For the patients of femoral neck fracture with severe displacement and difficulty reduction, it is not necessary to pursue anatomical reduction。 Achieving positive valgus reduction can also obtain satisfactory clinical results, and should try to avoid negative buttress.

scholarly journals The Diagnostic Value of SPECT/CT in Predicting the Occurrence of Osteonecrosis following Femoral Neck Fracture : a prospective cohort study

2020 ◽  
Author(s):  
Jae Youn Yoon ◽  
Soong Joon Lee ◽  
Kang Sup Yoon ◽  
Pil Whan Yoon
Keyword(s):  
Computed Tomography ◽  
Femoral Head ◽  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Diagnostic Value ◽  
Emission Computed Tomography ◽  
Uptake Ratio ◽  
Significant Difference ◽  
Neck Fracture ◽  
The Mean

Abstract Backgrounds One of the most significant complications after a femoral neck fracture is osteonecrosis of the femoral head (ONFH). The concomitant use of single-photon emission computed tomography (SPECT) with computed tomography (CT) increases the sensitivity for detecting the anatomic location and severity of ONFH. In this study, we evaluated the diagnostic value of SPECT/CT for the occurrence of ONFH by quantifying the perfusion status of the femoral head.Methods A total of 30 patients who had multiple pinnings for femur neck fractures were included in this study. We classified the perfusion status into three groups: normal perfusion, decreased perfusion, and avascular groups, and compared the occurrence of femoral head necrosis between them. For quantitative analysis, we evaluated the uptake ratio of both femur heads (head-to-head uptake ratio). If the patient’s contralateral hip was incomparable, we measured the uptake ratio from the superior dome of the ipsilateral acetabulum (head-to-acetabulum uptake ratio).Results Twenty-four patients out of 30 achieved bone union, whereas the others developed ONFH. When the population was divided into intact and defective perfusion groups on scintigraphy, the sensitivity, specificity, and accuracy of the test were 83.3%, 75.0%, and 76.7%, respectively. The mean head-to-head uptake ratio value with a 95% confidence interval (CI) was 1.10 (95% CI: 0.85 – 1.36). In the osteonecrosis group, the mean value of the head-to-head uptake ratio was 0.33 (95% CI: 0.28 – 0.38). In contrast, the ratio was 1.30 (95% CI: 1.03 – 1.57) in the non-osteonecrosis group, demonstrating a significant difference in the uptake ratio (P < 0.001). When the cutoff value of the uptake ratio was set to 0.5, both the sensitivity and specificity were 100%. There was also a significant difference in the head-to-acetabulum uptake ratio between the two groups (P < 0.001).Conclusions SPECT/CT was useful in evaluating the perfusion status of the femoral head, showing high accuracy in predicting the occurrence of avascular necrosis. To demonstrate the reliability and validity of SPECT/CT, further prospective studies on a larger scale are warranted.

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