Avascular necrosis of the femoral head following pertrochanteric fracture

Murphy, Andrew J.; Ricketts, David; Thomas, W.

doi:10.1016/0020-1383(95)00023-3

Cited by 4 publications

(2 citation statements)

References 5 publications

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“…On the other side, this small volume is enough to biomechanically enhance stability significantly [4,19,23,33,34,40]. A possible limitation to the statement about bone necrosis is that previous authors reported an onset after 3 years [3,22,27].…”

Section: Discussionmentioning

confidence: 95%

Long-term results of the augmented PFNA: a prospective multicenter trial

Kammerlander

Doshi

Gebhard

et al. 2013

Arch Orthop Trauma Surg

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MethodsIn 5 european clinics, 62 patients (79 % female, mean age 85.3 years) suffering from an osteoporotic pertrochanteric fracture (AO 31) were treated with the augmented PFNA ® . The primary objectives were assessment of activities of daily living, pain and mobility. Furthermore, the X-rays were analyzed for the cortical thickness index, changes of the trabecular structure around the cement and the hip joint space. Results The mean follow-up time was 15.3 months. We observed callus healing in all cases. The surgical complication rate was 3.2 % with no complication related to the cement augmentation. A mean volume of 3.8 ml of cement was injected and no complication was reported due to this procedure. 59.9 % reached their prefracture mobility level until follow-up. The mean hip joint space did not change significantly until follow-up and there were no signs of osteonecrosis in the follow-up X-rays. Furthermore, no blade migration was assessed. Conclusion This study makes us believe that the standardized augmentation of the PFNA with a perforated blade is a safe method to treat pertrochanteric femoral fractures. It leads to good functional results and is not associated with cartilage or bone necrosis.

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Section: Discussionmentioning

confidence: 95%

Long-term results of the augmented PFNA: a prospective multicenter trial

Kammerlander

Doshi

Gebhard

et al. 2013

Arch Orthop Trauma Surg

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“…Avascular necrosis incidence after intertrochanteric fracture is very rare with 0.3% to 0.8%, 13 -15 but there has been reports that actual AVN incidence would be higher because patients are old, have many underlying diseases, and are difficult to follow-up. 16,17 In our study, AVN was not observed in 53 patients with intertrochanteric fracture who had osteosynthesis.…”

Section: Discussionmentioning

confidence: 99%

Prediction Value of SPECT/CT in Avascular Necrosis of Femoral Head After Femur Neck Fracture

Park

Moon

et al. 2019

Geriatr Orthop Surg Rehabil

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Introduction: The aim of this study was to determine the diagnostic value of single-photon emission computed tomography/computed tomography (SPECT/CT) in prediction of avascular necrosis (AVN) after femoral neck fracture and to evaluate whether photon defect in femoral head as seen in SPECT/CT can be an index for choice of surgical method. Methods: This study was based on 97 patients who took SPECT/CT after femoral neck fracture from November 2012 to November 2017, with 64 patients with femoral intertrochanteric fracture in which chances of AVN is rare as a comparison group. Among 97 patients with femoral neck fracture, osteosynthesis was conducted in 7 patients with less than 15% of photon defect in damaged femoral head and 7 patients who wanted osteosynthesis, despite photon defect more than 15%, and 83 patients with photon defect more than 25% had arthroplasty. Patient with osteosynthesis was followed up with AVN by conducting magnetic resonance imaging (MRI) in 1 year after the surgery. Results: Quantitative analysis of SPECT/CT in 14 patients who had femoral neck osteosynthesis showed that 7 patients with femoral neck fracture showed photon defect of 15% or more, but less than 25% and 3 patients in these were diagnosed with AVN after 1-year follow-up by MRI. Sensitivity and specificity of SPECT/CT in predicting AVN was 100% and 63.6%, respectively, with prediction accuracy of 71.4%. Among 14 patients with femoral neck fracture who had osteosynthesis, photon defect in 3 patients diagnosed with AVN was 19.6% ± 5.2%, but photon defect in 11 patients who was not diagnosed with AVN was 10.7% ± 5.2%, showing statistically significant difference between 2 groups ( P = .001). Conclusion: Single-photon emission computed tomography/CT in patients with femoral neck fracture is considered to have diagnostic value in predicting occurrence of AVN, and percentage of photon defect is considered to be an useful index in determining the operative method.

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