Can injection CT scan assess the residual femoral head vascularity after acute neck fracture? - 07/06/11
, T. Moser c, G. Bierry d, P. Adam a, J.-P. Armspach e, F. Bonnomet a, A. Gangi b, d, M. de Mathelin b
Corresponding author.
Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.
Connectez-vous pour en bénéficier!
Summary |
Introduction |
Femoral neck fracture jeopardizes the vital prognosis of the elderly subject and the functional prognosis of the young subject. The vascular consequence is important, with the risk of osteonecrosis of the femoral head. In young patients, predicting the risk of necrosis at the acute stage seems warranted so as to optimize the choice of therapy. CT with injection could be useful to study the residual bone vascularity after an acute fracture of the femoral neck.
Hypothesis |
The CT scan with injection can diagnose ischemia of the femoral head after neck fracture by demonstrating hypoperfusion and thus estimating the risk for osteonecrosis.
Patients and method |
A CT scan with injection was performed prospectively in 20 adult patients who had given informed consent after verification of the inclusion and exclusion criteria. Ten presented femoral neck fracture and 10 a pertrochanteric fracture, the latter making up the control group. The second control group was the healthy side of patients presenting a femoral neck fracture. The images were analyzed after delineating a region of interest as a volume at the center of the femoral head. The results were analyzed after modeling based on the physical principle of diffusion.
Results |
No differences were found between the “healthy hip,” “fractured hip,” “femoral neck fracture,” and “trochanteric region fracture” groups. The only statistically significant correlation was found between the “fractured hip” and “healthy hip” of the same patient independently of the type of fracture.
Discussion |
The results do not confirm the working hypothesis. This study was mainly limited by the small number of patients included, but this did not substantially effect the study’s conclusions. According to the results, it seems that this study provided a CT evaluation of bone mineral density. At the end of the study, it seems that CT with injection is not well adapted in assessing residual femoral head vascularity or estimating the risk of progression towards avascular necrosis. According to the literature, only dynamic MRI with injection seems to be effective in this assessment and estimation.
Level of evidence |
Level III prospective comparative diagnostic.
Le texte complet de cet article est disponible en PDF.Keywords : Femoral neck fracture, AVN, Imaging, CT scan with injection, Femoral head viability/vascularity
Plan
Vol 97 - N° 4
P. 367-372 - juin 2011 Retour au numéro
Article précédent
- Occupational outcome after surgery in patients with a rotator cuff tear due to a work-related injury or occupational disease. A series of 262 cases
- L. Nové-Josserand, J.-P. Liotard, A. Godeneche, L. Neyton, F. Borel, B. Rey, E. Noel, G. Walch
- Pelvis and total hip arthroplasty acetabular component orientations in sitting and standing positions: Measurements reproductibility with EOS imaging system versus conventional radiographies
- J.Y. Lazennec, M.A. Rousseau, A. Rangel, M. Gorin, C. Belicourt, A. Brusson, Y. Catonné
Bienvenue sur EM-consulte, la référence des professionnels de santé.