Abstract
Background
Evaluating postoperative patients with hardware is challenging following surgical intervention for hip maladies such as femoral neck fractures and slipped capital femoral epiphysis (SCFE). These children are at increased risk of developing avascular necrosis, and imaging may be requested to confirm or exclude this diagnosis. Children with Legg-Calvé-Perthes disease can be monitored for restoration of blood flow to the capital femoral epiphysis to guide management and help with prognosis. Although MRI is sensitive for detecting early avascular necrosis, the presence of hardware degrades image quality.
Objective
This report examines the utility of bone scans for evaluating femoral head perfusion in children who have undergone surgery for femoral neck fractures, SCFE or Legg-Calvé-Perthes disease.
Materials and methods
A retrospective review of 20 patients (22 scans) after fixation for femoral neck fracture, SCFE or Legg-Calvé-Perthes disease from 2012 to 2015 was performed. The bone scan findings were correlated with the intraoperative findings or clinical follow-up.
Results
Twenty-one of the 22 (95%) bone scans in 19 of the 20 (95%) patients demonstrated findings consistent with clinical outcomes and/or the intraoperative appearance of the femoral head. Four of 20 patients (20%) had bone scan features of avascular necrosis, defined as “absent” or “moderately diminished” femoral head activity, which were confirmed intraoperatively and resulted in poor outcomes.
Conclusion
Radionuclide imaging of hips in the postoperative setting is a valuable modality for assessing the risk of avascular necrosis, a complication of femoral neck fractures and SCFE and for evaluating the restoration of flow to the capital femoral epiphyses of children with Legg-Calvé-Perthes disease.
Similar content being viewed by others
References
Canale ST, Bourland WL (1977) Fracture of the neck and intertrochanteric region of the femur in children. J Bone Joint Surg Am 59:431–443
Lam SF (1971) Fractures of the neck of the femur in children. J Bone Joint Surg Am 53:1165–1179
Hughes LO, Beaty JH (1994) Fractures of the head and neck of the femur in children. J Bone Joint Surg Am 76:283–292
Ratliff AH (1974) Fractures of the neck of the femur in children. Orthop Clin North Am 5:903–924
Napora JK, Gillmore A, Son-Hing J et al (2016) Early MRI detection and closed bone graft epiphysiodesis may alter the course of avascular necrosis following unstable slipped capital femoral epiphysis. J Pediatr Orthop https://doi.org/10.1097/BPO.0000000000000786
Perry DC, Machin DMG, Pope D et al (2012) Racial and geographic factors in the incidence of Legg-Calvé-Perthes’ disease: a systematic review. Am J Epidemiol 175:159–166
Lull RJ, Utz JA, Jackson JA et al (1983) Radionuclide evaluation of joint disease. In: Freeman LM, Weissman HS (eds) Nuclear medicine annual. Raven, New York, pp 281–328
Paul DJ, Gilday DL, Gurd A et al (1974) A better method for imaging of abnormal hips. Radiology 113:466–467
Conway JJ (1993) Scintigraphic classification of Legg-Calvé-Perthes disease. Semin Nucl Med 23:274–295
Danigelis JA (1976) Pinhole imaging in Legg-Perthes disease: further observations. Semin Nucl Med 6:69–82
Minikel J, Sty J, Simons G (1983) Sequential radionuclide bone imaging in avascular pediatric hip conditions. Clin Orthop Relat Res 175:202–208
Leshikar HB, Schoenecker J (2016) Legg-Calvé-Perthes disease. In: Martus JE (ed) Am Acad Orthop Surg, Rosemont, IL, pp 1–14
Fastings OJ, Bjerkreim I, Langeland N et al (1980) Scintigraphic evaluation of the severity of Perthes’ disease in the initial stage. Acta Orthop Scand 51:655
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
None
Rights and permissions
About this article
Cite this article
Parikh, A.K., Washington, E.R., Bobbey, A.J. et al. Evaluation of femoral head viability via bone scintigraphy in the postoperative pediatric patient. Pediatr Radiol 48, 350–358 (2018). https://doi.org/10.1007/s00247-017-4030-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-017-4030-7